A stroke, also referred as a cerebrovascular accident (CVA), is a medical emergency that happens when a portion of the brain’s blood supply is cut off or diminished, depriving the brain’s tissue of oxygen and nutrients. Brain cells start to die within minutes. Strokes are the world’s leading cause of mortality and permanent disability.

According to Ayurveda, stroke is PAKSHAGHATA, which is primarily linked to an imbalance in the VATA dosha. VATA controls all bodily movement and communication, including the nervous system, and its disruption can result in paralysis, weakness and numbness—all of which are symptoms of a stroke. Depending on the particular symptoms, the pitta and kapha doshas are also taken into account in the Ayurvedic understanding of stroke.

TYPES OF STROKES:

There are two main types of strokes:

• Ischemic stroke.
• Hemorrhagic stroke.

1.ISCHEMIC STROKE:

• Of all strokes, approximately 85% are ischemic strokes.
• Caused by a thrombus, which is a blood clot that forms in the brain or an embolus which is a clot that forms elsewhere in the body and travels to the brain, blocking the cerebral artery.

      Common causes include:

• Arteries narrowing as a result of plaque accumulation is known as  atherosclerosis.
• An irregular heartbeat that can result in blood clots is known as atrial fibrillation.
• Cardiovascular disease.

2.HEMORRHAGIC STROKE:

• Is more lethal but accounts for only about 15% of strokes.
• causes bleeding in or around the brain as a result of weak blood vessels rupturing.

      Common causes:

• Aneurysm: An irregular enlargement or protrusion in the wall of a blood vessel like an artery, is called an aneurysm.
• An aberrant network of blood vessels that connects veins and arteries is known as an arteriovenous malformation (AVM).
• Hypertension that is not under control.
• Any damage or trauma to the head.

TRANSIENT ISCHEMIC ATTACK (TIA):

• Frequently called a “mini stroke.”
• The symptoms go away in a matter of minutes or hours and are caused by a brief obstruction of blood flow to the brain.
• TIAs should be addressed as emergencies since they are reliable indicators of future strokes.

CAUSES AND RISK FACTORS:

• The main risk factor for strokes, particularly hemorrhagic strokes, is high blood pressure or hypertension.
• Atherosclerosis: Plaque accumulation causes the arteries that leads to it’s narrowing.
•  Heart ailments that raises the risk of clot development is atrial fibrillation.
• Diabetes: Raises the risk of damage to blood vessels.
• Increased risk of clotting and arterial damage are caused by alcohol and smoking.
• The risk of stroke-causing diseases is increased by obesity and inactivity.

CAUSES OF STROKE IN AYURVEDA

• DEFECTIVE DIET: Consuming too many dry, cold and stale foods might upset the VATA dosha.
• SEDENTARY LIFESTYLE: Insufficient exercise can cause kapha imbalance, which can result in metabolic problems and stroke.
• STRESS AND ANXIETY: Because mental stress affects the neurological system, it aggravates vata and raises the risk of stroke.
• TRAUMA OR INJURY: Neurological impairment can result from physical trauma that upsets the dosha balance.
• AGING: People’s VATA naturally rises with age, making the aged more vulnerable to neurological conditions like stroke.

SYMPTOMS OF STROKE

Strokes can impact many body areas and can occur abruptly. The most prevalent symptoms of a stroke include

• Face drooping is characterized by sudden weakness or numbness, particularly on one side of the face. In addition to that the person may also be unable to smile.
• One arm or limb, especially on one side of the body, may suddenly become weak or numb. The individual could find it difficult to raise both arms steadily.
• Slurred speech, trouble finding words or trouble understanding spoken language are examples of speaking  difficulties. The individual may also have difficulty, in speaking intelligibly.

OTHER STROKE SYMPTOMS:

• Confusion that strikes suddenly: The person may experience sudden confusion or find it difficult to grasp what other people are saying.
• Suddenly experiencing vision problems: blurred vision in one or both eyes.
• Problems in focusing or double vision.
• Very severe headache in hemorrhagic stroke.
• One side of the body is usually affected by this impairment (hemiparesis or hemiplegia).
• Swallowing difficulties: Some people may have dysphagia, which makes it more likely that they will choke.
• Loss of awareness: Patients may go into a coma or lose of consciousness in more serious cases.
• Suddenly having difficult walking, issues with coordination and balance.
• Vertigo or dizziness.

STROKE TYPES AND SYMPTOMS VARIATION

• ISCHAEMIC STROKE: Although symptoms may manifest abruptly, they usually develop more gradually. Common symptoms include speech difficulties, weakness of arm and facial drooping.
• HEMORRHAGIC STROKE: This form of stroke is characterized by sudden intense headache, nausea, stiff neck and unconsciousness. These strokes might have more serious neurological effects and usually proceed more quickly.

DIAGNOSIS OF STROKE:

The following are crucial components in the diagnosis of stroke:

1.Analyzing clinical presentations like:

• Hemiplegia.
• Loss of balance.
• Drooping face.
• Disruption of speech.
• Unexpected perplexity or trouble understanding communication.
• An intense headache that comes on suddenly.

2.Neurological Examination:.

• To determine the degree of motor, sensory and cognitive impairments, a thorough physical and neurological examination is necessary.
• Assessment of mental state, reflexes, muscle strength, sensitivity, coordination and cranial nerve function etc are needed.

3.Imaging Studies:

• MRI
• CT Angiography/MR Angiography
• CT scan

4.Blood Tests:

• Blood Glucose
• Lipid Profile
• Electrolytes and Renal Function Tests
• Complete Blood Count
• Coagulation Profile

5.Cardiac Evaluation:

• Electrocardiogram(ECG).
• Echocardiography.

6.Carotid Ultrasound

7.Other Diagnostic Tests:

• Cerebral Angiography.
• Transcranial Doppler Ultrasound.
• Lumbar Puncture.

TREATMENT OF STROKE IN MAURYA AYURVEDA

The primary cause of stroke in ayurveda  is considered to be VATA dosha, so the treatment protocol aims mainly in pacifying vata dosha. Our hospital specializes in complete stroke care, combining the knowledge of Ayurveda, the therapeutic benefits of Naturopathy and contemporary physiotherapy methods. Restoring mobility, regulating the body’s energy and improving overall recovery are the main goals of our individualized therapy approach.

EXTERNAL TREATMENT FOR STROKE

1.PODI KIZHI:

PODI KIZHI,is also known as CHOORNA PINDA SWEDAM, is an ayurvedic treatment in which herbal powders are wrapped in a cloth bundle and applied to the body for massage. KOLAKULATHADI CHOORNAM is normally used in our hospital for podi kizhi.

Benefits of podikizhi:

• Reduces pain or discomfort and releases tense muscles.
• Lessens joint stiffness.
• Increases flexibility and circulation.
• Reduces back pain and other ailments including arthritis.

2.UDWARTHANAM:

• In  Udwarthanam, dry herbal powders are applied to the body and then a vigorous massage is performed. Either KOLAKULATHADI CHOORNAM or KOLAKULATHADI mixed with TRIPHALA is used for the above.

Benefits of Udwarthanam:

• Improves circulation.
• It helps in reduction of muscle spasticity.
• It loosens up tight muscles and joints and improves the  range of motion.
• Aids in bettering the muscle tone. 

3.NADI SWEDAM:

• Nadi Swedam is a type of  sweating therapy or sudation treatment in which a hose or tube is used to apply medicinal steam to particular body areas. Here DASHAMOOLA KASHAYA is used to produce steam. In Ayurveda, it is regarded as one of the best remedies for ailments like neurological disorders, stiff joints, cramping muscles and other ailments brought on by an imbalance between the vata and kapha doshas.

Benefits of Nadi Swedam:

• Nervous system assistance.
• Increased blood flow.
• Pain alleviation.
• Aids in elimination of toxins from the body.
• Helps in attaining more flexibility of joints.

4.LEPAM:

• In Ayurveda, lepam (Pooch) is a topical treatment ,that is applied to the skin using herbal pastes .Depending on the ailment being treated, these pastes are applied to particular body parts and are made with a variety of medicinal powders. Here normally RAASNADI and GRAHADHOOMADI lepam is used for CVA.

Benefits of lepam:

• Aids in pain Relief.
• Reduce inflammation and  swelling.
• Helps in reduction of spasms and muscle stiffness.

5.DHARA:

 

• A prevalent therapeutic procedure in Ayurveda is dhara, which entails continuously pouring  medicated liquids to particular body parts, such as the forehead, the entire body or specific areas. This therapy has been known for calming the mind, reducing stress  and treating a number of illnesses.
• Dhara is thought to be very useful in balancing the body’s doshas (Vata, Pitta and Kapha) and it is especially helpful in the treatment of VATA-PITTA problems.
• DHANYAMLA DHARA (DHANYAMLA) and KASHAYA DHARA (DASHAMOOLA KASHYAM) are generally helpful for stroke patients.

Benefits of DHARA:

• Due to the pouring of warm liquid to the affected area, it improves the blood circulation to the affected area.
• It reduces muscle stiffness and spasticity.
• Since it has an anti-inflammatory nature, it reduces pain and inflammation.
• It aids in regeneration of nerve pathways and improved nerve function.
• It also improves lymphatic drainage  and elimination of toxins from the body.

6.SHIRODHARA:

• A continuous stream of warm, medicinal oil or other liquids(like milk ,buttermilk) is gently poured across the forehead as part of the therapeutic ayurvedic procedure known as shirodhara. It helps with stress management and neurological problems, which makes it helpful for stroke rehabilitation. Normally Ksheerabala taila is used .

Benefits of Shiro dhara:

• It improves the sleep quality, reduces anxiety and depression.
• It enhances the cognitive function of the patient.
• It helps in reduction of muscle tension and spasticity.
• It helps in calming the nervous system.

Once the AMATVA(Inflammation/indigestion)get reduced by the above treatments we can give,

7.ELA KIZHI:

• In Ela kizhi or herbal poultices containing medicinal leaves are applied after being dipped in warm medicinal oil and massaged.
• Castor leaves(Eranda, Ricinus communis),Tamarind leaves(Tamarindus indica),Arka leaves(Calotropis gigantea) etc are generally used to make elakizhi.
• KOTTAMCHUKKADI and MURIVENNA are normally used.

Benefits of Elakizhi:

• Aids in strengthening muscle.
• Relieves aching of joints and muscles.
• Reduces stiffness and discomfort in the body.
• Increases the flow of blood.
• Quite beneficial for individuals with paralysis.

8.NJAVARA KIZHI:

• In Shashtika shali pinda sweda (njavara kizhi), a heated rice poultice is applied to the body and massaged. This treatment makes use of a particular kind of medicinal rice called Shastika( njavara )rice, which is prepared with milk and herbal decoctions.

Benefits of Shashtika shali pinda rice:

• It helps in nourishing tissues.
• It aids in strengthening of muscle and tissues.
• Helps in reduction of muscle stiffness and spasticity.
• It supports nerve health.
• It aids in attaining pain relief.

9.NASYAM:

Nasal administration of medicinal oils or powders is known as NASYA. It has got benefits in neurological and respiratory conditions. Initially a light head massage is done, after making the patient lie down. Then medicine is administered pt is asked to remain in that position ,to get the medicines absorbed.

Benefits of Nasya:

• Enhances circulation.
• Stimulation of Nervous system.
• Improves mental clarity and cognitive functions.
• Improves mobility and strength.
• Clear out toxins.

ROLE OF PHYSICAL THERAPY IN STROKE

1.RANGE OF MOTION EXERCISES:

The purpose of range-of-motion exercises is to increase joint mobility and flexibility. Depending on whether someone is helping with the movements, these exercises can be either passive, active or active assistance. An outline of the various kinds of range-of-motion exercises is provided below:

A)PASSIVE RANGE OF MOTION EXERCISES(PROM):

In passive range-of-motion exercises, the patient’s muscles are not used; instead, an outside force, such as a therapist, moves the joint through its range of motion.

Few  PROM movements:

• Flexion, extension, abduction ,adduction of shoulders.
• Flexion and extension of elbow, wrist, fingers, hip, knee, ankle, toe.

All done passively by patients.

B)ACTIVE ASSISTED  RANGE OF MOTION(AAROM) EXERCISES:

The patient starts the movement, but the therapist, caregiver or their unaffected limb helps them finish the entire range of motion(an assistance is present).

AAROM Exercises:

• Flexion and extension of shoulder, elbow, wrist, finger, hip, knee.
• Ankle dorsiflexion and plantar flexion.
• Assisted hand to mouth motion.

C)ACTIVE RANGE OF MOTION(AROM):

The patient moves the joint independently without any  external help from a therapist  or device.

• Flexion and extension of elbow, wrist, fingers, hip, knee ,ankle, toe.
• Flexion, extension, abduction ,adduction of shoulders.

All these performed actively.

Benefits of Range of Motion exercises:

• Helps in preventing  stiffness.
• Increased blood flow.
• Pain alleviation.
• Strength Preservation.
• Increases the tone of muscles.
• keeping muscles from atrophying.
• Facilitation of neurological healing.
• Enhanced self-reliance and day-to-day functioning.
• Preventing subsequent problems(secondary complications).

2.EARLY MOBILIZATION 

In stroke ,early mobilization is helping getting the patients out of bed and moving as soon as it’s safe to do so. Usually, it begins with modest range-of-motion exercises or activities like sitting up in bed. However in order to prevent exhaustion, feeling dizzy or other issues, this needs to be closely monitored.

Benefits of Early mobilization:

• Prevention of immobility related problems.
• Enhanced cardiovascular health and circulation.
• Rapid restoration of functional abilities and mobility.
• Decrease in joint stiffness and muscular atrophy.
• Enhancement of emotional and mental well-being.
• Improved coordination and balance.
• Improved long-term results.

3.POSITIONING 

For stroke patients, positioning during physical therapy is an essential component of recovery, particularly in the initial phases. In stroke therapy,  the main advantages  of appropriate positioning are:

• Prevention of contractures and joint deformities.
• Reduction of pressure ulcers (bed sores).
• Management of spasticity.
• Promoting coordination and balance.
• Improvement of respiratory and cardiovascular function.
• Facilitation of early mobilization and functional recovery.
• Helps in reduction of shoulder subluxation.

4.STRETCHING EXERCISES:

Stretching exercises are shown to be particularly helpful because stroke patients experience muscle weakness or stiffness. Here are some common stretching exercises:

• Shoulder stretch.
• Pectoral stretch.
• Forearm and wrist stretch.
• Hamstring stretch.
• Calf stretch.
• Quadriceps stretch.

Benefits of stretching:

• Become more flexible.
• Lessen the stiffness in the muscles.
• Avoid contractures.
• Improved balance and posture.
• Pain alleviation.
• Improved alignment of the muscles and joints.
• Improved neuromuscular coordination.

5.STRENGTHENING EXERCISES:

These are intended to increase functional movements, strengthen muscles and improve motor control. These are a few strengthening exercises that are commonly utilized in stroke recovery.

• Leg lifts while seated: Build up your thighs and hip flexors.
• Bridgers: Build strength in your lower back, glutes and core.
• Sit to Stand: Increases balance and strengthen your legs, hips and core.
• Resistance bands, arm pulls: Develop shoulder and arm strength.
• Biceps curl: Increases arm function and biceps strength .
• Flexion and extension of the wrist.
• Toe taps: Enhance foot control and build stronger ankle muscles.
• Squeeze your hands to strengthen your grip and hand muscles.
• Clamshell exercises: Increase leg control and strengthen the hip abductors.

6.BALANCE AND COORDINATION EXERCISES:

They improve functional mobility, which is essential for recovering independence  and lower the chance of falls.

BALANCE EXERCISES:

• Single Leg Stance
• Heel to Toe Walk
• Chair Stand
• Tandem Stance
• Side leg raises

COORDINATION EXERCISES:

• Tapping exercises
• Ball Toss
• Marching in place
• Finger to Nose Exercise
• Crossing the midline

7.FACILITATION APPROACHES FOR NEUROPLASTICITY:

The goal is to improve the brain’s capacity for self-recognition and the creation of new neural connections. Because neuroplasticity enables the brain to repair damaged areas and enhance motor function, coordination and general independence, it is essential for stroke recovery. These are a few successful facilitation techniques to promote neuroplasticity in stroke patients.

• Sensory Stimulation.
• Repetitive Task Practice.
• Functional Electrical Stimulation(FES).
• Neuromuscular Electrical Stimulation(NMES).
• Cognitive Training.
• Task specific training.
• Constraint Induced Movement therapy.
• Bilateral Training.

8.FUNCTIONAL ELECTRICAL STIMULATION:

It’s a therapeutic approach used in stroke rehabilitation to enhance motor recovery and improve functional mobility in individuals with weakness or paralysis. It involves applying electrical currents to stimulate nerves and muscles.

Application of FES in Stroke Rehabilitation:

• Restoration of motor function.
• Enhancing muscle strength.
• Improving coordination.
• Neuroplasticity.
• Gait Training.

9.TENS AND ULTRASOUND:

• TENS(Transcutaneous Electrical Nerve Stimulation) is used for pain management, reduction of spasticity, neuro muscular re-education.
• ULTRASOUND is used for soft tissue healing, reduction of inflammation and spasticity.

ROLE OF ACUPUNCTURE IN STROKE

Acupuncture uses needles to stimulate certain places on the body called acupoints in order to impact physiological processes. A variety of acupuncture techniques are used to treat stroke, and depending on the patient’s condition, each has unique advantages. Below is a summary of common acupuncture procedures and their advantages for stroke recovery.

TECHNIQUES OF ACUPUNCTURE IN STROKE

1.Manual Acupuncture(Needling):

It’s  placing sterilized needles into particular  acupoints. To encourage the flow of  energy in meridians, the needles can be moved.

Points in stroke:

• GV20(Baihui): Helps in improving circulation to the brain, betterment of consciousness and cognitive function.
• GV26(Shuigou):Aids in stimulating the central nervous system.
• ST36(Zusanli):it helps in strengthening weakened muscles.
• L14(Hegu):it’s good for pain relief, reduction of inflammation and helps in muscle recovery.
• L11(Quchi):It reduces muscle spasticity.
• SP6(Sanyijiao):It enhances circulation, relaxation, emotional balance and helps in muscle control.
• SP10(Xuehai):It aids in reduction of numbness or tingling.
• BL23(Shenshu):Bettering the patient with post-stroke fatigue.
• PC6(Neiguan):It helps  the calming of the mind by reducing stress and anxiety.
• HT7(Shenmen):It helps with reduction in agitation that follows post stroke, good for curing insomnia and improves overall emotional stability.

2.Electroacupuncture:

Combines traditional needling with electrical stimulation. Once needles are inserted into the acupoints, a small electrical current is passed between the needles.

Benefits:

• It improves activities of nervous system,
• Helps with restoring movements in paralyzed body parts.
• It helps in reduction of inflammation.
• It increases the blood flow to the affected area.

3.Acupressure:

In place of needles, blunt objects, fingers or palms are used to apply pressure to particular acupoints.

Benefits of Acupuncture in Stroke Rehabilitation:

• Improved circulation and blood flow.
• Recovery of speech and cognitive function.
• Enhances neuroplasticity.
• Lessens emotional disorders including depression and anxiety.
• Enhanced motor function.
• Diminution in the spasticity of muscles.
• Pain control.

CASE STUDY:

A case study of Ayurvedic Rehabilitation of a hemorrhagic stroke in a 62 year old female.

ABSTRACT:

This case study deals with rehabilitation of  a 62 year old female, who was affected with hemorrhagic infarction leading to  left side weakness of her body. The patient experienced significant improvement in motor and cognitive functions after 40 days of ayurvedic treatment from MAURYA AYURVEDA HOSPITAL. 

INTRODUCTION:

Maurya Ayurveda Hospital offers a holistic approach in post stroke rehabilitation by integrating Ayurveda, physiotherapy and acupuncture. The stroke rehabilitation focuses on improving motor, cognitive and speech functions of an individual.

Patient Information:

• Age:62 years.
• Sex: Female.
• Occupation: Homemaker.
• Medical History: Hypertension(longstanding).
• Family History: Nothing specific.
• Chief complaints :Left side weakness, with slurred speech.
• History of Present illness: The patient was found with left side weakness, inability to speak and deviation of mouth on 21/02/2023,morning. She was taken to the nearby allopathic hospital and upon admission her blood pressure was  220/110 mm hg. After the emergency care,3 weeks later(on 14/3/23) she was admitted to our hospital to get a better post stroke rehabilitation.

CLINICAL EXAMINATION:

A)PHYSICAL EXAMINATION:

-General condition:

•  Consciousness: Drowsy.
•   Orientation: Oriented to time, place and person.
•  Appearance: Distressed.

-Neurological Examination:

 *Cranial Nerve Examination:

• Facial weakness: Facial expressions are affected.
• Speech: Dysarthria(slurred speech).
•  Pupil reaction: equal.

*Motor Function:

• Left hemiplegia with muscle  power of grade 1/5 in both upper and lower limbs.
• Hyperreflexia noted on the left side.
• Increased muscle tone in both left upper and lower limbs.

 *Sensory Examination:

• Sensory deficits- present. ie, Sensation to touch-absent.in left side(face, hands and  legs).                                                         
• Seizures: No seizure activity noted at present.

B)IMAGING STUDY:

MRI shows , hemorrhagic infarction, Right temporal ,frontal and parietal lobe involving right ganglia capsular and right head of caudate nucleus.

Diagnosis:

• Modern Diagnosis: CVA( Cerebro Vascular Accident).
•  Ayurveda Diagnosis: Pakshaghaata

THERAPEUTIC INTERVENTIONS:

In our  hospital we advised 2 sessions of Ayurveda,2 sessions of physiotherapy ,1 session of speech/swallowing and 1 session of acupuncture.

AYURVEDA TREATMENT 

EXTERNAL TREATMENTS GIVEN:

• Rooksha kizhi, Udwarthanam,-done with Kolakulathadi choornam.
• Prathimarsha nasya-with Anu Taila -2drops.
• Marsha Nasya with Ksheerabala-(2,4,6,8,10(max) drops)
• Dashamoola kashaya dhara done.

INTERNAL MEDICATION GIVEN:

• Tab Amruthotharam ks:(1-0-1 after food).
• Tab Punarnarnavdi:(1-0-1 after food)
• Tab Shaddaraam.:(1-0-1 after food)
• Tab Vasulax.(0-0-1 after food).
• Manasamitram Gulika(0-0-1 after food).
• Insotreat(0-0-1 after food)
• Tab Kalyanakam ks(1-0-1 after food).

PHYSIOTHERAPY TREATMENT:

Two sessions of Physiotherapy were done daily in our hospital including,

• Active assisted movements on the left upper and lower limb.
• Proprioceptive neuromuscular facilitation(D2 flexion and extension).
• Cryotherapy And Thermotherapy alternatively.
• Scapular Mobilization(Superior and inferior glide).
• Weight training for knee flexors and extensor group of muscles.
• Stretching exercises for upper limb and lower limb.
• Manual mobilization for elbow, wrist and digits.
• Core strengthening exercises.
• Gait training.
• Balance and coordination exercises.
• Modalities(MST and FES).

DIET AND REGIMEN RECOMMENDATIONS IN OUR HOSPITAL:

FOOD ITEMS TO BE TAKEN:	FOOD ITEMS TO BE AVOIDED:
Hot kanji.	Milk, milk products, cold food, pickles, fruits, dry fruits, nuts, fast food, fried and oily foods.
Steamed food items like idiyappam, put, chapati.	Fermented foods like dosa, idli, fermented appam.
Vegetable in boiled form	Tuber items like potato, tapioca and sweet potato. Non vegetarian items like, Fish, egg and meat(Can be taken in curry form, if necessary).

General Suggestion:

• Avoid strenuous activities.
• Drink enough water(2.5L-3L).

OUTCOME:

The following results are shown by the patient after 40 days of treatment.

Motor function:

• Improved strength and coordination in the left side.
• Patient is able to walk with assistance.
• Stiffness reduced on the left side.
•  No pain reported while performing a range of motion exercises.

 Cognitive functions:

• Improved speech clarity

General Wellbeing:

• As per the Patient and family’s report, the patient gained improvement in mental clarity and reduction in fatigue.

CONCLUSION:

The combined application of Ayurveda, physiotherapy and acupuncture resulted in attaining a better functional recovery. This case demonstrates  the potential of Ayurveda in supporting the neurological rehabilitation, post a hemorrhagic stroke.

 

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

 

For consultation,

Maurya Ayurveda Hospital, opposite to Sabine Hospital, Pezhakkapilly P.O, Muvattupuzha, Ernakulam; PIN:686673, Contact no:9947183000,Email: [email protected]

Maurya Ayurveda Ortho & Neuro Rehabilitation Centre ( Ayurveda Hospital )