Brain Stem Stroke: Recovery & Rehabilitation

Instructor: Nancy Kilmer

Nancy is a registered nurse with a bachelor of science in nursing degree.

Recovery from a brain stem stroke initially focuses on supporting life functions. The rehabilitation period focuses on therapies that assist in restoring and improving functions that have been compromised by the stroke. Read on to learn more.

Recovery

A stroke (also known as CVA, cerebrovascular accident) is an interruption in blood flow to an area of the brain. Treatment and recovery options depend on the specific nature of the stroke. Let's look at recovery in more detail.

Beginning Recovery in the Hospital

A brain stem stroke can happen to anyone, but the story of Martha is one example. Martha was 61 years old, moderately overweight, and sedentary. She also had Type 2 diabetes and had a 25-year history of smoking. One evening her husband noticed as she walked across the room that she was staggering severely. He spoke to her, but she did not answer. She then fell to the floor unconscious and was barely breathing. Martha had suffered a brain stem stroke.

Initial treatment for brain stem stroke is based on whether there is a ruptured blood vessel or a blocked blood vessel. If there is a rupture, often surgery is required to stop the bleeding and repair the vessel. If there is a blockage, there are medications that can be given that will dissolve a clot and open the blood vessel. In some cases of blockage, surgery may be required.

In Martha's case a clot had blocked blood flow. As soon as she arrived in the emergency department, she was given IV medication called tissue plasminogen activator (tPA). This is one of several medications that are called thrombolytics, drugs that can quickly dissolve or reduce the size of a clot to allow restoration of blood flow. If this is done within three hours of symptoms developing, it can often reduce damage to the tissues and reverse symptoms.

Hospital recovery for Martha was aimed at maintaining basic life functions. She was placed on a ventilator to support normal breathing, and she regained consciousness. She was able to understand what was said to her, but she was unable to speak intelligibly. She also was unable to move the left side of her body. After a few days, she was able to breathe on her own without the ventilator. However, she was still having difficulty speaking clearly, and she could not swallow.

She had to be fed with TPN (total parenteral nutrition), an IV solution supplying her nutritional needs. Within a few more days she began to have some return of movement to her left side, but she was still unable to swallow. Therefore, a PEG (percutaneous endoscopic gastrostomy) tube was placed through her abdomen directly into her stomach to feed her. She was then ready to begin rehabilitation.

Rehabilitation

After a brain stem stroke, there can be multiple paths to rehabilitation. Let's look at these in more detail now.

Determining Rehabilitation Therapy Needs

The brain stem is located at the base of the skull just above the spinal cord. It is made up of the pons, midbrain, and medulla oblongata.

Structures of the brain stem
Diagram of brain showing brain stem

Though small in size, the brain stem is responsible for controlling vital functions necessary for life. These include controlling heartbeat, respirations, swallowing, hearing, muscle movement, digestion, eye movement, sleep, and consciousness. Rehabilitation is determined by the extent to which each of these functions is impaired. Depending upon the severity of symptoms, the patient may be transferred to an inpatient rehabilitation facility and receive several hours of therapy each day. After a few days to a few weeks, the patient could go home to continue therapy 2-3 times per week while continuing daily exercises.

Types of Therapy

If the ability to swallow or speak has been impaired, speech therapy will be required and usually in the hospital. In Martha's case the therapist gave her exercises to strengthen chewing and sucking. She tested Martha periodically to watch for improvements in her ability to swallow safely without choking. Then she gradually increased the texture and types of food until Martha was able to return to normal eating.

Muscle movement impairment is a focus for physical therapy after a stroke. Types of treatment include passive exercises to maintain muscle function (the therapist moves the joints for the patient), active exercises in which the patient does exercises on his or her own with increasing levels of strength and motion, and massage or water therapy. Each of these is designed to stimulate return of muscle strength and function. Martha required passive exercises due to the paralysis of the left side. She was able to advance to active exercises.

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