Stroke (Paralysis) Rehabilitation

Stroke rehabilitation is a personalized, technology-supported process carried out through interdisciplinary collaboration. Thanks to modern devices, it is possible to achieve greater functional gains in a shorter time.

Stroke, medically known as a cerebrovascular accident, is a serious health problem caused by the interruption or reduction of blood flow to the brain. Paralysis, on the other hand, is a loss of muscle movement that can occur as a result of brain damage from a stroke. The damage caused by a stroke in the brain tissue can lead to paralysis in one half or certain areas of the body. Timely and scientifically guided paralysis rehabilitation can significantly improve patients’ quality of life.

Early intervention and the right team are crucial for a healthy recovery process.
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What are the types of paralysis?

Paralysis is classified not only by the location of brain damage but also by the affected body region. These distinctions are very important for planning the rehabilitation process.

1. Hemiplegia (Hemiparesis/Partial Paralysis)

This is the loss of movement or weakness in the right or left half of the body.

• It is the most common type of paralysis.
• It typically develops as a result of a cerebral artery blockage (ischemic stroke).
• For example, damage to the left side of the brain can lead to paralysis in the right arm and leg.
• In hemiplegic individuals, the hand, arm, and leg can be affected to different degrees.

2. Paraplegia

This refers to the involvement of both legs, meaning the lower half of the body from the waist down.

• It usually results from spinal cord injury.
• It is more common in traumatic spinal cord injuries than in stroke.
• There may be loss of sensation and movement from the waist down.
• Pelvic organs (bladder, bowel) may also be affected.

3. Tetraplegia (Quadriplegia)

This is the condition where both arms and both legs are paralyzed.

• It develops in severe neck spinal cord injuries or brainstem damage.
• It is typically seen in severe hemorrhagic stroke or trauma.
• Patient independence can be severely limited.
• Respiratory muscles may also be affected, and in some cases, respiratory support may be required.

4. Monoplegia / Triparesis / Incomplete Paralysis

• Monoplegia: Paralysis is observed in only a single limb (e.g., only the right arm).
• Triparesis: Three limbs are affected (e.g., two legs and one arm).
• Incomplete paralysis: These are mild forms of paralysis where muscle strength is partially, not entirely, lost.

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Importance of Post-Stroke Rehabilitation

Individuals who have suffered a stroke can develop many problems such as muscle weakness, balance disorders, and difficulty swallowing and speaking. The rehabilitation process aims to regain these functions as much as possible and help the patient become independent. Early and regular physical therapy directly impacts the recovery rate.
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Methods Used in Stroke Rehabilitation

Gait Robot (Robotic Gait Rehabilitation)

For individuals who have lost or have limited walking ability after a stroke, regaining walking skills is one of the most important goals of the rehabilitation process. Gait robots, developed for this purpose, aim to restore the natural gait pattern in paralyzed individuals by supporting motor learning.

What is a gait robot?

A gait robot is a high-tech physical therapy device that simulates walking with motor assistance, using support systems attached to the patient’s legs and waist. The patient is suspended over a treadmill and the device helps the patient take steps. This system can provide both active and passive walking support.

Benefits of Gait Robotics in Stroke Rehabilitation

1. Enables Early Mobilization
   One of the most crucial factors in post-stroke recovery is getting the patient on their feet as soon as possible. With a gait robot, patients can be safely brought to an upright position from the very first weeks.
2. Teaches Natural Gait Pattern
   After paralysis, signals between the brain and muscles weaken or are completely lost. Robotic systems provide repetitive, smooth gait patterns that help re-establish these signals.
3. Activates Muscle Memory
   Through repetitive stepping movements, muscles “re-learn” how to walk. This supports the brain’s adaptation process, known as neuroplasticity.
4. Provides a Safe and Controlled Environment
   Robotic systems eliminate the risk of falls, offering a safe therapy environment for both the patient and the physiotherapist. Additionally, parameters such as weight distribution, stride length, and speed are digitally monitored throughout the session.
5. Increases Motivation
   The gait robot rekindles the feeling of “I can walk again” in paralyzed individuals. This motivation accelerates adherence to treatment and the recovery process.

Who is a gait robot suitable for?

• Individuals who have suffered a stroke and have weakness in their legs.
• Patients who have lost the ability to walk after brain trauma.
• Individuals with spinal cord injuries.
• Those with neurological diseases such as Multiple Sclerosis (MS), Parkinson’s disease.
• Elderly individuals experiencing imbalance when walking.

CPM (Continuous Passive Motion) Devices

After a stroke, immobility, muscle stiffness (spasticity), and joint restrictions are common in arm or leg joints. CPM (Continuous Passive Motion) devices are highly effective, safe, and widely used physical therapy equipment for the prevention and treatment of these issues.

What is a CPM device?

A CPM device is a rehabilitation tool that attaches to a patient’s joint and passively moves that joint with motor assistance. The patient is exposed to repetitive joint movements through the device without using muscle strength. These movements activate muscles and connective tissues, increase circulation, and preserve joint flexibility.

Knee CPM Device

Used in patients with knee paralysis or loss of leg movement, especially after total knee replacement or prolonged bed rest, to maintain knee range of motion. It reduces the risk of muscle atrophy, joint stiffness, and knee rigidity.

Shoulder CPM Device

In hemiplegic patients, the shoulder joint is often one of the earliest affected areas. Through CPM, slowly moving the shoulder at various angles helps the joint capsule and surrounding tissues maintain their flexibility. It reduces the risk of developing frozen shoulder.

Benefits of CPM Devices for Paralyzed Patients

• Maintains and increases joint range of motion.
• Prevents muscle shortening and contractures (muscle-joint stiffness).
• Reduces pain and supports the resolution of edema.
• Increases synovial fluid circulation, providing joint nourishment.
• Eliminates the negative effects of immobility in the early stages.
• Provides passive exercise for patients unable to perform physical activity.

Who is it suitable for?

• Patients with reduced arm or leg movement after stroke.
• Individuals at risk of developing spasticity.
• Patients who have been bedridden or immobile for a long time.
• Paralyzed patients in the recovery phase after joint surgery.

Hydrotherapy (Water-Based Rehabilitation)

In individuals who have suffered a stroke, muscle weakness, balance problems, and movement limitations are frequently observed. **Hydrotherapy**, an effective and safe method in combating these complaints, provides great physical and psychological benefits for paralyzed patients.

Hydrotherapy involves aquatic exercises performed in therapeutically heated pools, accompanied by a physiotherapist. The buoyancy, resistance, and warmth of the water environment are utilized to support the treatment process. It particularly enables paralyzed individuals with limited mobility to exercise without putting stress on their joints.

Benefits of Hydrotherapy for Paralyzed Patients

• Reduces the load on joints and muscles.
• Reduces pain and spasticity.
• Improves balance and coordination.
• Increases muscle strength.
• Supports psychological recovery.

Trunk Balance Device

One of the common problems in post-stroke patients is weakened trunk control. Weakness of the trunk muscles leads to loss of sitting balance, balance disorders, and an increased risk of falls. Therefore, exercises performed with special devices targeting trunk stability in the early stages are of great importance.

Trunk balance devices help the patient reactivate their core muscle group while sitting or standing and improve neuromuscular coordination.

With these devices, the patient is encouraged to lean in different directions in a controlled manner, and the system provides feedback by measuring the body’s responses. Especially in individuals with one-sided paralysis (hemiplegic), it prevents the unaffected side from becoming dominant and supports bilateral balance development. Regular exercises prolong sitting time, increase participation in daily living activities, and strengthen the patient’s independence.

Electrotherapy (Electrical Stimulation Methods)

Electrotherapy is one of the most effective methods used in paralyzed patients to reactivate muscles and support nerve-muscle communication. Electrical stimulation involves applying low-voltage electrical current externally to immobile or weakened muscles after a stroke, causing them to contract in a controlled manner. This method is primarily used to prevent muscle wasting and increase muscle tone in patients with motor function loss in their hand, arm, and leg muscles.

Electrotherapy is not limited to physical effects; it also provides healing effects on the nervous system. It helps reactivate neural pathways while supporting neuroplasticity, which is the brain’s ability to reorganize itself. It is also frequently preferred for reducing spasticity, increasing circulation, and managing pain. When applied as part of a comprehensive stroke rehabilitation plan, alongside gait training, hand-arm exercises, and balance work, electrotherapy yields the best results.

Hand and Arm Rehabilitation

After a stroke, weakness, coordination deficits, and loss of fine motor skills are common in the hand and arm muscles. This can severely limit the patient’s independence in daily living activities. Hand and arm rehabilitation encompasses goal-oriented exercises and treatment programs applied to help paralyzed individuals regain functions such as grasping, holding, writing, and using cutlery. During therapy, simple tools like rubber balls, hand exercisers, and sandbags can be used, as well as robot-assisted hand-arm devices.

The goal of this rehabilitation process is not only to increase muscle strength but also to re-establish the neural connection between the brain and the hand. Therefore, therapies are often planned based on repetitive tasks and functional movements. Hand and arm rehabilitation, especially when supported by virtual reality applications, mirror therapy, and occupational therapy, provides faster and more lasting gains by enhancing both physical progress and patient motivation.

Virtual Reality

Virtual reality technology is a modern application that adds an interactive and motivating dimension to the rehabilitation process for paralyzed individuals. In these systems, patients perform various tasks in virtual environments through specialized software: holding objects with their hand, touching targets, walking, maintaining balance, and so on. Since the brain perceives these tasks as if they were real, nerve-muscle coordination and motor planning skills are reactivated.

Virtual reality applications are particularly effective in hand and arm rehabilitation, balance disorders, and attention-concentration deficits. As exercises become enjoyable, patient participation in treatment increases, which supports neuroplasticity and accelerates the recovery process. Additionally, sessions can be customized, and the difficulty level can be adjusted according to the patient’s progress.

Suspension Gait System

The suspension gait system is a gravity-supported rehabilitation technology that allows paralyzed individuals to stand safely and perform walking exercises. In this system, the patient is supported by a special harness and suspension mechanism while walking on a treadmill. Since a portion of the body weight is borne by the system, the patient can focus on taking steps without worrying about losing balance.

This method, which is highly effective in re-teaching gait patterns, activates muscle memory and mimics the natural gait cycle. It leads to significant physical and psychological improvements, especially in paralyzed individuals who have partially lost their walking ability or experience balance problems. When combined with gait robots, the suspension gait system can achieve faster and more lasting gains.

Tilt Table

A tilt table is a special inclined table system used to prevent circulatory disorders and blood pressure imbalances caused by prolonged bed rest in stroke patients. The patient is secured with special straps and gradually brought from a horizontal to an upright position. This process habituates the body to gravity again, increasing standing tolerance.

For individuals who are immobile in bed after a stroke, early upright positioning is of great importance for the healthy functioning of muscles, joints, and the circulatory system. The tilt table provides a safe start for patients at risk of orthostatic hypotension; it is also used as a preparatory stage for balance training and walking. This device is an effective tool for safe mobilization, especially in the initial stages of rehabilitation.