6 - Stroke Rehabilitation Flashcards
What are some immediate causes of death in stroke?
- Raised ICP
- Brainstem involvement
What are some causes of raised ICP in stroke?
- Haematoma expansion
- Malignant oedema
- Haemorraghic transformation
- Hydrocephalus
What are some early stroke complications?
(NB)
- Haemorrhagic transformation of ischaemic stroke
- Cerebral oedema
- Seizures
- Infection (e.g. aspiration pneumonia)
- Cardiac arrhythmias
- VTE
- Death
What are some late stroke complications?
(NB)
- Mobility & sensory issues (spasticity)
- Constipation and UTIs
- Post strome pain and fatigue
- Secondary Epilepsy
- Cognitive problems
- Visual problems
- Emotional and psychological issues (depression)
- Issues with swallowing, hydration and nutrition
What stenosis level does a carotid artery have to be at for a CEA?
Over 50%
How long after a stroke can you not drive for?
- Cars and motorcycles: stop driving one month. Need to check visual fields before driving again. Only inform DVLA if ongoing symptoms after one month and can be referred to Regional Driving Assessment centres for car modifications
- Larger vehicles (e.g. buses, lorries): stop driving, inform the DVLA, 1 year no driving
What is a malignant MCA infarction?
Rapid neurological deterioration due to cerebral oedema following MCA territory stroke.
May require urgent decompressive hemicraniectomy
What services make up the complete stroke service?
- Acute stroke unit
- Interventional neuroradiology
- TIA clinic
- Rehabilitation services
- ESDS (early supported discharge schemes)
Patients should not stay in a particular setting longer than necessary after a stroke so how can we prevent this?
Early discharge planning from initial contact with patient
What is early supported discharge services (ESDS) and who is eligible for this?
- Short term hospital level of therapy at home
- Reduces average level of hospital stay by 8 days
What criteria must a stroke patient meet before being transferred from an acute stroke unit to a community stroke unit for rehab?
- Medically stable
- Needing no more than 24% oxygen
- NG feeding established with no risk of refeeding
- Transfer around day 7 (flexible)
What causes patients with a stroke to improve during rehabilitation?
Initial phase
- Reperfusion of hypoxic brain
- Reduction of brain oedema
Late Phase
- Brain remodelling. Utilise the healthy brain tissue next to dead brain tissue
What are some good and bad prognostic factors for a patient undergoing rehab following a stroke?
What are some issues that need addressing in stroke rehabilitation?
When should stroke patients be given a PEG tube over an NG tube?
- If they cannot tolerate NG feeds
- If inadequate intake orally after 4 weeks of stroke and NG
How often should post-stroke patients have mouth care and why?
3 times a day
What is the amber care bundle?
For patients whose recovery is uncertain and who may be approaching the end of their lives despite treatment
How do stroke patients transition so quickly from the community up to thrombolysis?
RAPID ASSESSMENT PROTOCOL
Fill in the following table for the symptoms of a stroke in each of the following regions.
Is there forehead sparing in a stroke or Bell’s palsy?
Stroke as UMN and bilateral innervation LMN
How will a stroke appear on CT?
Ischaemic: darker area with white clot
Haemorraghic: whiter/lighter
