A stroke occurs when a blockage or bleeding of blood vessels interrupts or reduces blood flow of the brain. Because of that the brain can’t get enough oxygen or nutrition and the brain cells start to die.
Stroke is a cerebrovasculer disease. If the brain can not get enough oxygen , damaging may be occur.
Stroke is an emergeny situation because it may causes death and permanent disabilities. If there is any stroke sign the treatment should be started in the first few hours.
Temporary ischemic attack ( TIA ) is the short-term ischemic stroke which can be dissolve spontaneously.It needs an emergency evaluation due to reduce the risk of future stroke.By definition, if the symptoms dissolve in 24 hours , the stroke can be defined as TIA.

Otherwise , stoke can be origin by ischemic or hemorrhagic.

ISCHEMIC STROKE
The reasons of the ischemic stroke are narrowed or blockaed arteries.Main goal of the treatment is producing adequate blood flow to brain. Clogging the brain artery by a thrombosis is a common reason of the stroke.The area of the brain fed by clotted blood vessel is deprived of blood and oxygen. The cells in the part of the brain stop working due to deprived blood and oxygen.
The risk factors of the narrowed brain blood vessels are same with myocard infarct risk factors.These are the ;

• Hypertension
• High cholesterol
• Diabetes and smoking

HEMORRHAGIC STROKE
When a brain blood vessel ruptures and bleeds to outside of the brain, the cerebral bleeding occurs.
Cerebral bleeding causes the stroke symptoms and blood flowing to some area disappears.In addition, the blood so irritating and causes the cerebral oedema.Blood pool due to oedema and cerebral bleeding increases pressure of the head and compresses the brain to bony cranium. Additionaly this situation decreases blood flowing to brain tissue and cells.

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WHAT SYMPTOMS MAY OCCUR AS A RESULT OF STROKE ?
The problem types and degrees which follow a stroke depends on the which area of the brain is damaged.Generally , it causes 5 type of problems : problems which control paralysis and motion ; sensation problems ; language problems ;thinking and memory problems ; emotional problems.

PARALYSIS OR PROBLEMS CONTROLLING MOVEMENT ( MOTOR CONTROL )
Paralysis is one of the most common problems caused by the stroke.Paralysis is the opposite side in the body damaged by the stroke and may affects face , one arm,one leg and all parts of the body.The unilateral paralysis is the hemiplegia and unilateral weakness is the hemiparesis. Stroke patients with hemiplegia or hemiparesis may have difficulty in daily activities such as walking and grapping objects.In some patiens , the muscles of the swallowing may be damaged and this is called the “ dysphagia”.Any damaged in the cerebellum , may affects the ability to coordinate movement.It causes the posture , gait and balance problems.

PROBLEMS USING AND UNDERSTANDING LANGUAGE ( APHASIA )
At least ¼ people of patients with stroke have language problems which include understanding and writing ability. Injury according to paralysis in the brain language control centre may be ruin the verbal communication seriously. Dominant centre of the language is on the left side of the brain. The language centre in the brain is known as the Broca area and if this area is damaged leads to aphasia.Patients with this kind of aphasia have difficulty to transfer their thoughts with writing and words.They lose the ability of putting words together grammatically. Damage to area called the Wernicke of the brain leads to permanent aphasia.The most severe aphasia is the spherical aphasia.Patients with this kind of aphasia lose almost all the language abilities. They can not understand the language or not use to transmit thoughts.

PROBLEMS WITH THINKING AND MEMORY
Stoke can damage areas of the brain involved in learning,memory and responsibility . Patients with stroke may have short-term memory deficits.Also,people may lose the ability of planning,learning new responsibilities and joining other complex mental activities.

SENSATION PROBLEMS
Patients with stroke may lose feeling ability of the touching,pain,temperature and position senses. Sensation issues may obstruct with patients’ ability to recognize objects they’re holding.Additionally, patients may lose the ability of recognizing their extremities.Some patients with stroke feel tingling ,pain,numbness and interesting feelings in their weak or paralytic limbs ( paresthesia ) .
After a stroke , the losing of urinary continence is quite common due to combination of sensory and motor disorders.People who had a stroke may not be able to control their bladder muscles. Some of patients can’t have enough mobility to go to the toilet in the time and furthermore the loss of intestine control and constipation occur. After the stroke , permanent constipation is rare.
In some stroke survivors various chronic pain syndromes due to damage in the nervous system are seen . Sensory pathways in the brain are damaged , causing the false signals to be transmitted resulting in a sensation of pain in a sensory-deficient limb or side of the body.The common pain syndrome is the thalamic pain syndrome which is difficult to treatment even with medicines.Lastly , the reason of some pain syndromes after the stroke is mechanic problems. Patients who have a paraliytic arm generally experince moderate to severe pain that radiate outward from the shoulder.Most often , pain is caused by a lack of movement in a joint that has been immobilized for a long time and tendons are fixed in only one position ( frozen joint ) .

STROKE REHABILITATION
The stroke rehabilitation helps to regain the independence and increase your life quality. The severity of stroke complications and healing ability of each individual change significantly.Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don’t have stroke rehabilitation. There are many approaches to stroke rehab. Your rehabilitation program will depend on the part of
the body of type of ability affected by the stroke.

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PHYSICAL ACTIVITIES ARE INCLUDING THAT ;

1-) MOTOR SKILL ACTIVITIES
These exercises may improve your muscle strength and coordination.It also strengthens swallowing.
2-) MOBILITY EDUCATION
Walker , cane , wheelchair and ankle brace are may be used. The ankle brace stabilizes and
strengthens the ankle to supports body weight.
3-) ROM TREATMENT
Some exercises and treatments may reduce the spasticity . Also , they help to regain range of
motion.

WHEN TO START THE STROKE REHABILITATION ?
The sooner you begin stroke rehab. , the more likely you are to gain lost abilities and skills.
Doctors’ emercengy ideas are ;

• Stabilize your medical condition
• Control the conditions that threat your life
• Prevent the other stroke attack
• Prevent the stroke complications
• Stroke rehabilitation starts 24-48 hours after stroke in the hospital

HOW LONG DOES THE STROKE RAHABILITATION TAKE ?
The rehabilitation duration depends on stroke severity and complications.Some survivors heal quickly but most of the patients need long duration the stroke rehabilitation . As you learn skills and your needs change , your rehab. plan will change as you recover.

HOME BASED REHABILITATION PROGRAMMES
Rehabilitation at home provides flexibility to do rehabilitation plans and follow individual programmes.People with stroke can join an intense therapy several hours in a week. The biggest disadvantage of home therapy is the lack of special equipment. However, receiving home treatment gives people the advantage of practicing skills and developing
compensatory strategies in the context of their own living.