Stroke | Everything you need to know

stroke types and treatment aqua therapy at fish and field biokineticists in bryanston, sandton.

What is a Stroke?

A stroke is often called a brain attack and should be treated as seriously as a heart attack. A stroke occurs when blood flow to a region of brain is obstructed, resulting in a rapid loss of brain function. Majority of strokes are ischemic, resulting from a thrombosis or embolism. Some are hemorrhagic, caused by rupture of a vessel in the brain and consequent leaking of blood into brain tissue/cerebrospinal fluid.

Signs of stroke called cerebrovascular accident (CVA)

  • Sudden numbness or weakness of face, arm or leg, especially on one side of the body (65%)
  • Sudden confusion and trouble speaking (81%)
  • Sudden trouble seeing in one or both eyes (58%)
  • Sudden trouble walking, dizziness, loss of balance (7%) or coordination
  • Sudden severe headache with no known causes

Types of stroke

  • Acute ischemic stroke (CVA) – “white stroke” – 87 % caused by thrombosis, embolism and arteriosclerosis.
  • Transient ischemic stroke (TIA) – caused by a blood clot which dissolves and the symptoms will clear up a few minutes after start.
  • Intracerebral haemorrhage (ICH) – Occurs as a result of bleeding from arterial source directly into brain parenchyma
  • Local accumulation of blood destroys parenchyma, displaces nervous structures and dissects tissue
  • At bleeding sites: fibrin forms around collections of platelets = formation of oedema
  • Subarachnoid haemorrhage (SAH) – “red stroke” – caused by the bleeding around the brain instead of in the brain – aneurysm

Modifiable risks for stroke

  1. Hypertension (most NB risk factor for stroke)
  2. Hyperlipidemia
  3. Cigarette smoking
  4. Diabetes Mellitus
  5. Cardiac or arterial disease
  6. Atrial fibrillation
  7. Metabolic syndrome
  8. Poor diet
  9. Physical inactivity
  10. Alcoholism

Lack of blood flow to the brain during a stroke causes both primary neuronal cell death and secondary impairments. The resulting neurological impairment depends on:
a. Size and location of the lesion and
b. Speed with which the lesion occurs (e.g. Slowly forming lesions: collateral blood flow formation occurs = less impairment occurs as a result).

Symptoms of stroke

Usually appear suddenly

  1. Weakness of the face, arm or leg on one side of the body
  2. Numbness in the face, arm or leg on one side of the body
  3. Inability to understand spoken language
  4. Inability to speak
  5. Inability to write
  6. Vertigo and/or imbalance of gait
  7. Double vision
  8. Strong and/or unusual headache

Problems following stroke

  1. Paralysis or motor control problems

One of the most common disabilities resulting from stroke

  • Paralysis is usually on the side of the body opposite the side of the brain damaged by stroke
  • May affect the face, an arm, a leg, or the entire side of the body
  • Damage to the cerebellum = affects the body’s ability to coordinate movement (Ataxia)
    • Problems with posture, walking and balance
  1. Sensory disturbances, including those involving pain

Stroke survivors may lose the ability to feel touch, pain, temperature, or position

  1. Problems using or understanding language (Aphasia)

Stroke survivors experience language impairments involving the ability to

  • speak
  • write
  • understand spoken and written language
  1. Problems with thinking and memory

Dramatically shortened attention spans or experience deficits in short-term memory

  1. Emotional disturbances

Stroke survivors experience fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses

Management and medications

Medical treatment for stroke patients

  1. Short-term use of anticoagulants
  2. Long-term use of platelet-inhibiting agents. E.g. Heparin, Aspirin.
  3. Vasodilators
    • Need to increase cool down period required after exercise to prevent hypotension
  4. Antihypertensive – following hemorrhagic stroke
    • Strict control of BP is required
    • Examples: ACE inhibitors, beta blockers, calcium channel blockers and diuretics
    • Diuretics reduce fluid volume and may alter electrolyte balance, causing dysrhythmias

Recommendations for exercise programming

Majority of recent stroke survivors are elderly and also have comorbidities, such as osteoarthritis and additional CVD that may limit function.

Goal phase 1: Return to function

Goal phase 2: Decrease the risk of additional strokes and CVD by influencing glucose regulation, decreasing BW and BP, and managing blood lipid levels.

Goal phase 3: Improve aerobic fitness and decrease stroke risk

  • Exercise 20-60min, 3-7 days/week

Effects of exercise training

Exercise after a stroke is associated with

  • increased walking speed
  • decreased ambulation assistance
  • improved functional mobility

Aerobic training

Improves fitness and gait- No improvement in ADLs

Strength training

Associated with improved ADLs and increased walking speed and distance

  • Stretching, flexibility, balance and coordination exercises 2-3 times per week
  • Strength training with light resistance 2-3 times per week
  • NB! Avoid overtraining as this can be detrimental

Benefits  of Hydrotherapy

  • Postural stability and balance
  • Coordination and functional mobility
  • Local muscle strength and endurance
  • Decrease in muscle tone
  • Huge psychological benefits like relaxation

If you suffered from a stroke, here at Fish and Field Biokinetics we offer hydrotherapy as an exercise tool for recovery.

Make an appointment with one of our aqua therapists to begin your journey to recovery. Contact Us.

Author: Taariq Patel, Biokineticist at Fish & Field Biokineticists


  • Durstine, J.L., Moore, G.E. & Painter, P.L., 2016. ACSMs exercise management for persons with chronic diseases and disabilities, Human Kinetics


  1. A friend of mine said he has suffered 3 strokes, due to his high pressured job. He is in his 50’s. I can’t see any lasting side effects. What kind of stroke would this be, and what exercises, as a lifestyle change, would you recommend?

    • I would assume that your friend did go to see their GP and probably a neurologist after having these events? From what you have describe, it was most like TIAs (transient ischemic attack). These are also known as mini-strokes, with symptoms such as weakness on one side of the body, blurred vision or slurred speech lasting for less than 24 hours. As mentioned, this would still need medical attention and they would’ve been advised whether or not to go onto medication and what lifestyle-changes should be made. I would suggest though that he needs to reduce his work stress – start including things like meditation, walking in a park where he can de-stress, etc. Exercise would include more cardio and low resistance work, and would have to be graded (starting off slower and progressing intensity). He might want to start off an exercise program with a professional, as to make sure he is not exerting himself too much.

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