Mechanical thrombectomy in acute ischaemic stroke (AIS)
Stroke remains a major worldwide threat to health despite substantial improvements in both prevention and treatment in recent years. In Western countries, ischaemic stroke due to large vessel occlusion (LVO) predominates as a cause of disability, institutionalisation, and costs to healthcare and society.
Advanced therapies in neuro rehabilitation
Neurorehabilitation made its first appearance in 1960 as a treatment for patients with stroke, post traumatic brain injury and spinal cord lesions with severe motor and sensory complications. The central nervous system has the capacity to recovery spontaneous through neuroplasticity. The neuro rehabilitation field has gone through a big change in the last decade due to incorporation of electronic computerised technology with a goal to stimulate neuroplasticity. To mention a few of new technologies includes robotic assisted training for upper and lower limbs, virtual reality, functional electrostimulation, non-invasive brain stimulation and brain computer interface system that has created a lot of controversies in the literature. The goal of using technology in neurorehabilitation is to use the preserved neuromuscular function to compensate for, or to analyse and learn the functions of the damaged areas to improve sensory-motor function. The purpose of this article is to mention some of the clinical applications and advantages of these technologies that can be offered to patients with neuronal lesions.
An update on stroke imaging
In the mid 90s, a number of Randomised Controlled Trials (RCTs) were published showing the effectiveness of IV tPA in the treatment of acute ishaemic stroke. Subsequently IV tPA became the cornerstone of hyper-acute stroke treatment, albeit with a very limited time window of 4.5hrs. In 2015, following the publishing of a number of positive RCTs which showed the effectiveness of Mechanical Thrombectomy (MT) in the treatment acute stroke caused by large vessel occlusions (LVO), MT was adopted into the treatment guidelines. The initial time window for MT was defined as 6hrs, however, subsequent RCTs proved effectiveness of the treatment (in selected patients) in the 6 to 24hr time window.
The balancing act of stroke rehabilitation: A physiotherapy perspective
Physiotherapists, and other rehabilitation therapists, are truly fortunate in that, whether we intend it or not, we are drawn into the lives of our stroke patients, their families, and carers. Their future goals, their triumphs and their setbacks (both medical and personal) come together to form the rehabilitation journey we embark on together. It is an immense responsibility to take on a patient’s future after they have suffered a stroke. It requires empathy and patience whilst still maintaining your professionalism and objectivity.
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