Rehabilitation and Recovery after Stroke Flashcards
collectivist approach
- speech and language therapist
- clinical psychologist (emotional impact)
- doctors/nurses (pharmacology)
- physiotherapists
- occupational therapist (adaptation and training)
- family and friends (social support)
> multidisciplinary stroke team specialising in different areas
physiotherapy
- 80% have physical disability after stroke
- want to help retention of independence
- usually offered to people with weakness in the limbs, sensory disturbances, balance problems
- strength training - rebuild muscles
- fitness training - might have small changes to mobility
- walking therapies - use treadmill
> might have to do this multiple times per day
physical impairment
- reduced muscle strength (usually 1 side)
- altered sensation (reliant on sensory info so change can be confusing)
- coordination problems
- balance impairment
- hemiparesis (paralysis to one side of body)
- altered gait pattern
> can be a combination
assessment of physical impairment
- national institute of health stroke scale (NIHSS)
- Barthal index
National Institute of Health Stroke Scale (NIHSS)
- stroke deficit scale
- brief scale with good reliability
- sensitive for serial monitoring (over time) as it doesn’t have practice effects
- not as sensitive as others as its brief, often cant pick up deficits together
Barthal index
- used widely in different circumstances
- brief and easy to administer
- high reliability
- used daily
Transcranial magnetic stimulation (TMS)
- promotes neural plasticity (forming new neural connections)
- electrical current, working at the level of the brain, increases neural activity
- can be combines with other methods of therapy
- Ganguly et al (2013)
Ganguly et al (2013)
- repetitive TMS
- slight evidence but depends if damage is deep within the brain as its hard to locate
- Hsu, Cheng and Liao (2012) - found short and long term overall benefits
robotics
- used to help regain use of arms
- adds variety to rehabilitation
- uses information about ability of limbs, put into computer, to help build muscles struggling
- as function improves, computer does less
- wearable robotic devices for upper and lower limb rehabilitation can match treatment of 1-on-1 therapy (Bowden et al, 2013)
- Brannin and Zorowitz (2012)
Brannin and Zorowitz (2012)
- robotics improves activity of daily living
- improves arm function
- no strength improvement (need physio too)
mirror therapy (MT)
+ very low cost
- uses unaffected limbs whilst looking at the reflection in a mirror
- this tricks brain into thinking its the affected side
- neurons fire in damaged area
- small trials have found it to be effective
- Brewer et al (2013)
Brewer et al (2013)
MT daily combined with other rehabilitation has shown some benefit
- visual feedback has shown increased connectivity between motor cortex and somatosensory cortex
-
virtual reality
- more exciting that robotics
- can combine with video games and robotics = mixed results have been found
occupational therapy
- involves re learning basic everyday activities
- helps focus on therapy
- physical and emotional therapy
- repeated daily training
- assessment determines what they struggling with (then need repeated training)
family function
stroke and family go hand in hand
- can make individuals who were one the supporter of the family, very dependant on others
- everyones involved
- better support from family, better road to recovery
- clinical psychologists often involve family in therapy (especially if stoke is personality changing)
