Stroke and its treatment – Kenyan scenario
Stroke is the most deliberating disease in the world which makes the survivors limited for living their life with fulfilled commitments. Every 6 second someone in the world suffers stroke. In Kenya, 4% of death incidence is because of stroke and most of them, they do not have enough medical or financial resources to identify or manage the disease. While Africa is countable for total 8% of stroke death worldwide.
Globally, stroke is the second leading cause of death and the third leading cause of disability. Globally, 70% of strokes and 87% of both stroke-related deaths occur in low- and middle-income countries. 84% of stroke patients in low- and middle-income countries (versus 16% in high income countries) die within 3 years of diagnosis and incidence of stroke is doubled in low income countries while it’s reducing in high income countries. Availability of medical facility and resources are quite great challenge for locals in Kenya where only many few facilities are offering specialized stroke management services.
Education and awareness penetration about stroke is also quite poor locally where many few knows signs & symptoms of stroke. 0nly 27 % of population knows signs and symptoms of stroke in Europe so can’t imagine the number in developing country like Kenya.
Neurologists are specialized to treat stroke survivors are also very least available in the county with lowest availability in western part of Kenya. Profound rehab services and specialized neuro rehab professionals are also very hard to find. In 60.7% of low-income countries, no neurological rehabilitation service is available. No neurological rehabilitation service is present in 81.2% of countries in Africa.
Myths and taboos within local population about stroke is again a great concern where, they feel its devil’s eye or curs from the god. It’s not rare when you find stroke survivor left alone in blanket for crippled death or most of them do not know that they can recover and live their life near normal or normal.
Being a profound neuro rehab professional, we also need to spread more awareness among medical professionals where they can prescribe for early rehab after stroke and prevent many of the complications. Early initiation of rehabilitation is advisable and in developed world stroke unit refers rehabilitation starting for first 24 hours of admission.
Specialized stroke unit where all professionals are trained specifically for stroke and other neurological diseases. Early rehabilitation will help to get back the motor control and develop purposeful neuroplasticity. Different concept of therapies like bobath, roods, brunnstrom approaches helps to regain the physical function early and prevent secondary complications. This approaches advices to use the affected part more often to prevent nonuse unlearned principle, which states that if we don’t use the part; the brain will forget its work. With controversial with many of the older theories when they instruct not to use affected part, we now prescribed client to use the affected limbs maximum up to their physical capability.
Basic neurological knowledge also helps to prevent contracture and stop developing wrong methods of recovery. For an example, most of the professionals ask to press smiley ball though which is wrong and makes the hand/fingers tighter. Most of the stroke survivors develops flexion synergy (tends to bends the body parts) and if we ask to press the ball than it would be tighter, instead we need to develop opposite movement pattern where they can open their hands. Many time patients are only treated with passive movement of the limbs which is again not effective. In short, learning skills is more important for functional reorganization than simply repeating movements. With improvement in local academics, we are sure we can achieve standards of neuro rehabilitation in upcoming futures in Kenya.
Many newer techniques of rehabilitation like virtual reality based rehab, robotics, Neuro functional rehab, neuro-chemical prosthetics, many more are enriching the field of rehabilitation globally, but due to the lack of resources, Kenya and Africa is still need to wait for such advance management options. Because of this modern advancement of technology clients are becoming more functional and fulfilled their life with joy. National Kenya stroke association is also doing good work where they meet on regular basis to enrich each other as survivors, though they need more support from other fraternity.
We are coming up with newly advanced rehab center within urban locality of capital Nairobi, which will be one of its kinds in the country to provide state of the art rehab management for stroke. With better technology and skills, we will be delivering alike management of stroke in developed world. Many of local clients travelled to India, UK or South Africa due to unavailability of better resources but shortly with this center we are trying to develop inbound health tourism in Kenya from pan Africa.
Neurorehabilitation utilizes the help of occupational therapy, physical therapy, recreational therapy, speech therapy with patients and their families to build back the skills and attitudes of people affected by stroke. The main goal is to get their function to work at the highest level, so patients can rebuild self-esteem and a positive mindset. Recovering from a stroke can be a long, sometime hopeless process, but with the new adaption skills patients learn, they become empowered and gain the skills for community reintegration.
Stroke unit is compromised with professionals’ ranges from neurologist to counsellor and they work hand in hand for patient’s betterment. Neurorehabilitation therapies teach or retrain patients how to improve or recover their communication and mobility skills, as well as other aspects of their daily lives. In its treatments, neurorehabilitation focuses on the psychological, creative, and nutritional elements of each individual’s recovery.
Developing stroke advocacy and registry among pan-African region would be next step and I am sure with the help of international organizations like world stroke organization and others, it will be possible in near future. I would be happier to share any of the related queries or needed education on rehab genre.
Author is only profound stroke & neuro rehab professional of Kenya.
By-
Bhavan Bhavsar | Specialized physical therapist | Neuro & Pain rehab professional
MSPT, ASNR, FOMT, Fellowship Neurological sciences (UK), Fellowship in Stroke rehabilitation (UK), Diploma in Football medicine FIFA
bbhavsar@mpshahhosp.org/bhavan@ualberta.ca
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