“Time is brain”: rehabilitation must begin in the hospital bed | Report

One of the mottos of professionals who work with patients who have suffered a stroke is the phrase “time is brain”. After the speed of the first care, which directly influences the severity of the sequelae, rehabilitation is the next step that demands urgency.

In the first 72 hours after the stroke, called the acute phase, the patient should begin receiving attention from a multidisciplinary team, including a physiotherapist, speech therapist, occupational therapist and psychologist.

Still in the bed at the Hospital Regional do Sertão Central (HRSC), located in Quixeramobim, rehabilitation begins. “The sooner this relearn process, the fewer the consequences”, says the neurologist at the HRSC stroke unit, Vitor Abreu.

He explains that neuroplasticity — the brain's ability to adapt — is what makes neurons learn the functions of those that “died” due to the stroke. “The sooner rehabilitation happens, the faster and more neurons will learn. If this starts too late, it will be difficult for those neurons to learn”, he says.

Neuroplasticity is also lower in older people. Despite this, Vitor states that it is not “impossible” for an elderly person to fully recover from a stroke.

To begin with, it is determined what type of therapy will be needed. “To identify the level of sequelae, it is necessary to carry out several tests to find out what the person can and cannot perform. Functional tests, such as putting your hand in your mouth, brushing your teeth, picking up something from the floor”, reports Ramon Távora, coordinator of the Physiotherapy course at the Federal University of Ceará (UFC).

One of the ways to assess this is through the Rankin Scale. Ramon explains that the patient is evaluated on seven levels, from someone without symptoms, represented by zero, to death, the last outcome on the scale represented by the number 6.

The assessment mechanism goes through different conditions of disabilities and deficiencies, such as not being able to carry out daily activities or being bedridden.

Dysphagia — difficulty swallowing food or liquids — is also one of the first aspects analyzed.

“Before the patient's first diet is given, we need a speech assessment, to ensure safe feeding. If he has significant dysphagia, he will not continue with an oral diet, but rather through a tube”, says the coordinator of Nursing at the stroke unit, Mara Cibelly Pinheiro.

Manipulating the paralyzed limb, placing the patient in a sitting position and even encouraging them to walk are some of the exercises performed constantly in the hospital. “We also use devices such as bicycles and stairs, so that this patient can begin to prepare for home and perhaps even return to work”, says Mara.

“We know that hospital admission is quick. However, the neuromuscular rehabilitation of these patients is long-term. It takes a long time for them to recover. So, we have one main objective: to make the patient more independent”, explains José Antônio Almeida Neto, physiotherapist at the HRSC stroke unit.