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Stroke Overview







Population Characteristics:1

  • Prevalence: 2.8% in America
  • 6.8 million Americans greater than the age of 20 years have had a stroke
  • Incidence: Approximately 795,000 experience a new or recurrent stroke
    • 610,000 are first attacks
    • 185,000 are recurrent attacks
  • 55,000 more women have strokes than men
  • 87% strokes are ischemic, 10% are intracranial hemorrhagic, and 3% are subarachnoid hemorrahagic 
  • Someone in the US has a stroke every 40 seconds 


  • Ischemic: Decreased or absent circulation of blood within the brain; primarily caused by three mechanisms:
    • Thrombosis: A blood clot forms within the cerebral vascular network 
    • Embolism: A portion of a thrombus that has been dislodged and travelled to the central circulation of the brain
    • Global ischemia: Caused by an overall reduction in systemic blood pressure, leading to decreased perfusion of blood within the brain 
  • Hemorrhagic: Caused by a rupture within a cerebral blood vessel 

Signs and Symptoms:3,4

  • The onset of symptoms of a stroke are usually very sudden and include:
    • Numbness and weakness of the face, arm, and/or leg (generally unilateral)
    • Decreased vision out of one or both eyes
    • Severe headache
    • Difficulty speaking or comprehending language, sudden confusion
    • Decreased balance, gait cycle, and coordination
    • Dizziness
    • Increased spasticity and tone become evident after the first few weeks or months of a stroke in 30% of patients 

FAST Principle for calling 911:

  • Facial drooping
  • Arm weakness
  • Speech difficulty 
  • Time to call 911


  • Comprehensive medical examination with emphasis on screening for above signs and symptoms
  • MRI and/or CT scans of the brain are used to assess presence of bleeding, amount of damage to the brain cells, and location of stroke
  • Carotid ultrasounds and carotid angiographies are used to assess blockage and quantity of blood flow through the carotid arteries in order to assist in the diagnosis process


  • Strokes are the fourth leading cause of death in America
  • 75% of stroke victims survive 1 year after the stroke and over 50% survive after 5 years
  • The chances of survival are higher in ischemic versus hemorrhagic strokes, however hemorrhagic stroke survivors have a higher likelihood of regaining function than ischemic stroke victims
  • 25% of stroke victims will be left with permanent minor disabilities where as 40% will have moderate-severe impairments
  • 14% of stroke survivors make a full recovery 

According to the long-term Framingham Study, ischemic stroke survivors 65 years or older exhibited the following 6 months post-stroke:

  • 50% had lingering hemiparesis
  • 46% had cognitive deficits 
  • 35% had symptoms of depression
  • 30% needed assistance with ambulation
  • 26% were dependent in ADL's
  • 26% were in a nursing home
  • 19% had some form of aphasia 

Physical Therapy Interventions:8,9

  • Balance, postural stability, tolerance to upright positioning, and transfer/transitional movement training are initially emphasized during the acute recovery phase
  • As patient progresses, emphasis shifts to gait training with appropriate assistive device 
    • Overground ambulation training over level/unlevel surfaces and stair training
    • Body weight support treadmill training
  • Strenthening and flexibility exercises are critical in order to regain function and maintain adequate ROM/manage tone and spasticity for functional activity and mobility 
    • PROM/AAROM/AROM/AROM with resistance as tolerable
    • PNF exercises 
  • Mirror therapy has been shown to have a significant effect on regaining motor function in the hemiparetic side
  • Endurance training is important in regaining cardiovascular fitness and in prevention of recurrent strokes 







1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014;129: e28-e292. 

2. Shah, S. Stroke pathophysiology. Foundation for Education and Research in Neurological Emergencies. Available at: Accessed April 28, 2014. 

3. Know stroke. Know the signs. Act in time. National Institute of Neurological Disorders Web site. Available at: Accessed April 28, 2014. 

4. Thibaut A, Chatelle C, Ziegler E, et al. Spasticity after stroke: physiology, assessment and treatment. Brain Injury. 2013;27(10): 1093-1105. 

5. How is a stroke diagnosed? National Heart, Lung, and Blood Institute. Availble at: Accessed April 29, 2014. 

6. Stroke. University of Maryland Medical Center Web site. Available at: Accessed April 29, 2014. 

7. Kelly-Hayes M, Beiser A, Kase CS, et al. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003;12: 119-126. 

8. Gordon NF, Gulanick M, Costa F, et al. Physical activity and exercise recommendations for stroke survivors. Ciruclation. 2004;109: 2013-2041. 

9. Thieme H, Mehrholz J, Pohl M, et al. Mirror therapy for improving motor function after stroke. Stroke. 2013;44(1): e1-2.