Stroke and Physical Medicine & Rehabilitation
A stroke occurs when blood flow to a region of the brain is interrupted — either by a clot (ischemic stroke, 87% of cases) or a ruptured blood vessel (hemorrhagic stroke). The resulting brain tissue injury produces focal neurological deficits whose pattern depends on which brain region is affected. Physiatry — physical medicine and rehabilitation — is the medical specialty that leads the post-acute recovery process, beginning in the hospital and continuing through outpatient and community settings.
The first three to six months after stroke represent the period of greatest neuroplasticity — the brain's capacity to reorganize and form new neural connections. Intensive, goal-directed rehabilitation during this window maximizes recovery. However, neurological improvement can continue for years with sustained effort and appropriate rehabilitation.
Common Post-Stroke Deficits
- Motor — hemiplegia or hemiparesis (weakness on one side), spasticity, abnormal movement patterns, and foot drop
- Balance and gait — impaired balance, fall risk, and difficulty walking safely
- Upper extremity function — reduced hand and arm use for daily activities
- Speech and language — aphasia (language processing) or dysarthria (speech motor control)
- Swallowing — dysphagia increases aspiration risk
- Cognition — memory, attention, and executive function impairment
- Pain — central post-stroke pain, shoulder pain from subluxation, and spasticity-related pain
- Emotional — post-stroke depression affects up to 30% of survivors
Rehabilitation Goals and Interventions
Stroke rehabilitation at CHLMD is highly individualized, with goals established collaboratively with the patient and family. Motor retraining uses task-specific practice, neuromuscular re-education, and progressive therapeutic exercise to rebuild functional movement patterns. Gait training addresses walking safety, endurance, and efficiency. Spasticity is managed with stretching, positioning, pharmacological agents, and — for appropriate candidates — targeted injection therapy.
Shoulder pain, one of the most common and undertreated complications of stroke, is addressed with joint protection strategies, appropriate sling use, and injections when indicated. Pain management is integrated throughout to ensure patients can participate actively in rehabilitation.
Ongoing Physiatric Management
Stroke recovery requires sustained medical oversight. Dr. Lichtblau provides long-term physiatric management — monitoring recovery trajectory, adjusting the rehabilitation program, managing secondary complications (spasticity, contracture, pain, depression), and supporting return to community activities. Family and caregiver education is essential and is incorporated throughout care.
