Hippocrates, the father of medicine, first recognized stroke over 2,400 years ago. It was not until the mid-1600s that Jacob Wepfer found that patients who died with apoplexy had bleeding in the brain.

He also discovered that a blockage in one of the brain’s blood vessels could cause apoplexy.

Medical science continued to study the cause, symptoms, and treatment of apoplexy and, finally, in 1928, apoplexy was divided into categories based on the cause of the blood vessel problem. This led to the terms stroke or “cerebral vascular accident (CVA).”

Stroke occurs when blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures) leading to brain cell death due to part of the brain not getting the blood and oxygen it needs.

Prevalence Stroke is a very significant health issue, which contributes to the majority of mortalities and morbidities for all developed, developing and under developed countries.

Globally stroke is ranked as the second most common cause of death and the third commonest cause of disability.

Pakistan has the world’s highest rate of strokeper capita. Among Asian countries, Pakistan shares a significant burden of this devastating disease, which contributes towards expenditure of resources in terms of finances, community manpower, health services, and the economy as a whole Risk Factors

According to recent research findings, traditional and well-known risk factors of stroke, like diabetes and hypertension. According to recently published literature, currently Pakistan has an enormous proportion of its population suffering either from diabetes or hypertension or both.

Lack of Awareness Unfortunately, a majority of people are unaware of their comorbid conditions. This primarily is due to a lack of awareness for routine medical check-up, availability of screening services for endemic diseases locally, and ignorance on the part of the community regarding personal healthcare. Even those who have been timely diagnosed mostly do not follow the standard practice of a regular follow-up and compliance with medications and rehabilitation.

Life after stroke in Pakistan Pakistan being one of the low to middle income countries (LMIC) two thirds of the population pays out of pocket for health care expenses.

Here not all stroke patients are assessed by a neurologist. General physician and internists also take care of patients. There are no inpatient or outpatient rehabilitation services or organized chronic home support services, and the stroke caregiver is often a close family member.

Studies suggest that most of the post stroke patients in Pakistan spend their life from moderate to complete disability completely depending on their family members physically and financially. Whereas in other developing Asian countries like Malaysia, Singapore, Thailand, etc. more than 75% of the stroke patients after appropriate neurological rehabilitation not only live their lives physically independent but also gain financial independence by completely returning to work.

Neurological Rehabilitation Neurological Rehabilitation focuses on patient centered Eclectic Approach to manage the patients by integrating them with Motor Learning Strategies to achieve the patient required goals by consuming minimum time and maximum practice.

It allows the rehabilitation consultant to pin point the forgotten tasks and makes the patient relearn them as efficiently as possible.

Need of the hour There is an absolute requirement of inpatient and outpatient neurological rehabilitation services to bring stroke patients to their complete recovery with independent lifestyle and return to work.


The writer is Dr Behram Subazwari MSPT (Neurology) (Malaysia), MMPA (Malaysia), DPT(Pak) Neurological Rehabilitation Consultant.