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Health Tips 25 Nov 2014

How to treat, manage brain stroke related disability

Brain stroke, one of the leading factors of death and disability, is caused due to post stroke spasticity. It is estimated that as many as 5 million persons are left permanently disabled because of stroke each year.

Among the common complications associated with brain stroke are redual paralysis and post stroke spasticity. Due to lack of awareness above disability management, thousands of people lead difficult lives, with each day a struggle.

Caused by the interruption of blood supply to the brain; either by blockage of blood vessels or due to rupture of blood vessels leading to brain hemorrhage. This cuts off the supply of oxygen and nutrients causing damage to the brain tissue. The effect of a stroke depends on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death. In other cases, a stroke may cause severe disability by paralysing a part of the body.

A number of people are left paralysed on one side after being hit by a brain stroke. Yet, fortunate others are able to emerge unscathed by the incident, mostly because they get timely medical intervention. Others have to undergo months of physiotherapy and other medical treatment options.

One important treatable complication of stroke is post-stroke spasticity. This can be effectively treated by injections of Onabotulinum toxin type A, popularly known as Botox, to manage the effects of loss of muscle function.

Our brain, an intricate network of nerves and cells which drives our bodies, is the single largest consumer of oxygen in our bodies. The brain cells need oxygen laden blood supply all the time to survive. What happens if this crucial oxygen supply is disrupted due to some reason? The brain cells deprived of oxygen will begin to die very fast, damaging that part of the brain. This is what happens in a brain stroke.

According to estimates by the World Health Organization (WHO), 80 per cent of the stroke cases in the world would occur in low and middle income countries like India by 2050.

Despite being a relatively younger country, India is witnessing a rise in incidents of brain stroke. But, not many people are equipped to sight the symptoms of a stroke; nor are they aware that it is possible to reverse its impact if the victim gets medical help or rushed to the hospital within 4 hours, by drug popularised as Clot Burster. Due to this lack of awareness, a lot of stroke victims who cannot be treated timely and die, or are left paralyzed for life. At the same time, a large number of those affected lead extremely difficult lives with even simple tasks of activity of life becoming a major struggle.


The most common symptom of a brain stroke is sudden weakness or numbness of the face, arm or sometime leg. The affected person might feel unable to move one side of his or her body. The victim may also experience difficultly in speaking coherently or seeing clearly. Loss of balance or coordination is also felt by some people; others may faint or feel dizzy. A severe headache may also occur in some cases.

Fast is easy to remember eponym which suggests:  Face paralysis, Arm drop, Speech abnormality and Time is brain (so act fast).


If the patient is lucky enough to reach hospital immediately after suffering a stroke, the affects can be reversed. Clot-busting drugs or Clot Buster like tPA can be used to reverse a stroke.

For patients to reach within the first 4 ½ hour from onset of paralysis, for the use of tPA therapy, it is very important that awareness about recognising a brain stroke is high among the masses. This unfortunately is not the case in India where most people reach a doctor much after the damage.

Once the affects of the stroke have pressed in, it becomes very difficult to treat them completely. In most cases, such patients are left partially paralysed and would need physiotherapy for month and accompanying treatments to improve their condition.

How much the patient recovers varies from person to person. The younger the patient, the better are the chances of recovery. Physiotherapy is primarily concerned with promotion of mobility, functional ability, quality of life and movement potential and is very useful for patients who are dealing with post stroke spasticity.

Post Stroke Treatment: Botulinum toxin (Botox)   

Spasticity or stiffness of limbs is a disturbing medical condition that afflicts some stroke survivors. Spasticity happens when the affected muscles fail to receive a message from the brain telling them to relax.  This loss or damage disrupts important signals between the nervous system and muscles, creating an imbalance that increases muscle activity or spasms.

The treatment for this condition involves medication, the use of Botox, a neuromuscular blocker, as a way to relax the strained muscles and physiotherapy. Injections of Onabotulinum toxin type A, popularly known as Botox, can help manage this condition.

The impact of one injection remains for approximately 4 to 6 months, and comes as a great relief to the suffering person. Depending upon the severity of the spasticity, a doctor will advise multiple treatment options to the patient including physical exercise and stretching; braces to hold a muscle in a normal position to keep it from contracting; oral medication; Intrathecal baclofen therapy (ITB) to reduce the side effects that often accompany oral medications; and Botox injections.


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