Introduction
Cerebrovascular disease or the term stroke is used to describe the effects of an interruption
of the blood supply to a localised area of the brain. It is characterized by rapid focal or
global impairment of cerebral function lasting more than 24 hours or leading to death
(Hatano, 1976). As such it is a clinically defined syndrome and should not be regarded as a
single disease. Stroke affects 174-216 people per 10,000 population in the UK per year and
accounts for 11% of all deaths in England and Wales (Mant et al, 2004). The risk of
recurrent stroke within 5 years is between 30-43%. One problem is that the incidence of
stroke rises steeply with age and the number of elderly people in the UK is on the increase.
To date people who experience a stroke occupy around 20 per cent of all acute hospital
beds and 25 per cent of long term beds (Stroke Association, 2004). The British
Government now identifies stroke as a major economic burden on the National Health
Service (DoH, 2002).
Fifty percent of stroke survivors will experience some residual impairment (physical and
cognitive), which is devastating to the individual and their families (Rudd et al, 2002). It is
therefore vital for patients and resources that maximum functional recovery is achieved as
fast as possible. The physiotherapist has a key role to play in the management of stroke
patients, through assessment, prevention strategies, acute management and recovery. This
essay aims to critically discuss physiotherapeutic management and examine how it has and
may be influenced by a number of factors (e.g. type of organized system for the delivery of
post stroke care, setting of therapy, evidence based practice from which National
Guidelines are produced etc). The first stage is to outline stroke pathology, of which forms
the basis of appropriate management.
Pathology
There are two major stroke sub groups, those resulting from infarction (ischemic stroke)
and those resulting from haemorrhage (intracerebral and subarachnoid). Each of the types
can produce clinical symptoms that fulfil the definition of stroke. The types often differ
with respect to survival and long-term disability, from recovery in a day to incomplete
recovery, severe disability and death (Warlow et al, 2001).
Ischemic stroke is the most common type of stroke, which accounts for approximately
85% of all cases (Rudd et al, 2002). It affects 35 people per 100,000 of the population per
year (Coull et al, 2004). Ischemic stroke can be caused by a sudden occlusion of arteries
