Column: Dr Watkins On Stroke, Rehab & More

[Column written by Dr Kimberley Watkins & Natasia Symonds]

A stroke happens when blood flow to part of the brain is suddenly cut off, and brain cells in that area begin to die from lack of oxygen. It’s one of the most serious medical events a person can experience and also one of the most misunderstood, particularly when it comes to what recovery actually looks like.

This week, as part of our World Physiotherapy Day series, we’re looking closely at stroke itself: what it is, and what rehabilitation really involves.

The Two Main Types

There are two main ways a stroke happens:

1. Ischaemic stroke [about 85% of cases] — a blood vessel gets blocked, usually by a clot
2. Haemorrhagic stroke — a blood vessel bursts and bleeds into or around the brain

There’s also a TIA [transient ischaemic attack], sometimes called a “mini-stroke” — same mechanism, but it resolves on its own, usually within minutes. Think of it less as a false alarm and more as the universe sending you a very direct memo.

The classic way to spot a stroke in progress is the BE FAST test:

• Balance – sudden loss of balance or coordination. The person might stumble, feel dizzy, or have trouble walking straight for no clear reason.
• Eyes - sudden vision changes. Double vision, loss of vision in one or both eyes, or a sudden visual disturbance that comes out of nowhere.
• Face — is it drooping on one side? Ask the person to smile [If one side of the mouth doesn't move up the way the other side does, that's facial droop].
• Arms —Ask the person to raise both arms in front of them and hold them there. If one arm drifts down or can’t come up at all, that’s arm weakness.
• Speech — is it slurred or trouble finding words or are they struggling to understand? Ask them to repeat the sentence: the sky is blue
• Time — if any of the above, call an ambulance immediately. Note the time the symptoms started and keep the person safe . Do not attempt to drive yourself to the hospital.

With stroke, minutes genuinely matter. “Time is brain,” as the saying goes — every minute counts. It is a medical emergency and left untreated, the brain gets injured.

What Happens After: Rehabilitation

This is where physiotherapy is one important part of the puzzle, and where a lot of misconceptions live. Rehab isn’t a waiting room where you sit until you’re “fixed.” It’s active, often starts within 48 hours of the stroke itself, and looks different for pretty much everyone.

A physiotherapist’s job in stroke rehab is to help the brain and body relearn how to work together, rebuilding movement, balance, and strength through repetition and targeted exercise. The brain has an impressive ability to rewire itself after injury [neuroplasticity, if you want the fancy term], and physiotherapy is essentially the training programme that helps that rewiring happen in the right direction.

Physiotherapists are the exercise experts and can help people who have had a stroke to:

• improve movement and strength in arms and legs so you can get back to living independently and doing the things you enjoy
• learn how to walk again, and how walk further and faster
• improve balance to minimise risk of falling
• improve stiffness, pain, and muscle tightness
• help you get fitter so that your heart and lungs work more efficiently
• improve your mood, decrease fatigue, and help fight depression
• practice everyday activities such as getting out of a chair, walking and talking at the same time, getting dressed, and using your arms to use items such as keys and taps

A few honest truths about recovery:

• It’s a marathon, not a sprint [and not even a marathon with a fixed finish line]
• Progress isn’t linear; plateaus happen, and then sometimes there’s a sudden leap forward
• Recovery can continuemonths and years after the incident of stroke
• It works best as a team: physiotherapists, occupational therapists, speech-language therapists, nurses and doctors, all pull in the same direction
• Family and community support matter just as much as the clinical side, and are important members of your recovery team.

The Picture Here in Bermuda

Stroke isn’t a rare, distant statistic for us. Approximately 230 people in Bermuda are affected by stroke each year – That’s a lot of survivors and families navigating exactly the kind of recovery we’ve just described.

If you or someone you know has experienced a stroke, there’s currently a survey running to help shape and improve stroke rehabilitation services on the island — take the survey here. It takes about 15–20 minutes and runs through October 31st, so there’s still time to have your say.

Coming Up Next

Next in the series, we’re looking at something that doesn’t get talked about enough: the surprisingly direct link between heart health and brain health and why looking after one means looking after the other.

- Dr Kimberley Watkins & Natasia Symonds

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