Neuropsychological Rehabilitation of Stroke

Question 1

What might be evaluated in attention?

Answer 1

Focused attention
Divided attention (multitasking and cognitive flexibility)
Speed of processing

Question 2

What are the types of apraxia?

Answer 2

Ideational apraxia - loss of concept of an action
Ideomotor apraxia - inability to imitate a gesture

Question 3

What side of space does the left hemisphere attend to?

Answer 3

Right

Question 4

What side of space does the right hemisphere attend to?

Answer 4

Left and right

Question 5

A lesion in which hemisphere is the most likely to cause neglect?

Answer 5

Right hemisphere
(A lesion to the left hemisphere will be compensated for by the right)

Question 6

What problems may exist with speech?

Answer 6

Aphasia - impairment of language
Dysarthria - speech impairment - slow, weak movements cause slurred speech
Apraxia - oral motor planning dysfunction - difficulty articulating words

Question 7

According to the RCP, when should people be screened for mood and cognitive function after stroke?

Answer 7

Within 6 weeks

Question 8

How prevalent is emotional lability after stroke.

Answer 8

20% if people in first 6 months

Question 9

What areas of damage are related to emotional lability?

Answer 9

Frontal lobes, brain stem, thalamus, cerebellum

Question 10

How prevalent is post stroke anxiety?

Answer 10

25%

Question 11

What area of damage to the brain is related to apathy?

Answer 11

Medial prefrontal cortex and basal ganglia

Question 12

What’s another name for emotional lability?

Answer 12

Pseudobulbar affect

Question 13

How might one screen for mood?

Answer 13

Observation - Signs of depression scale
Self report

Question 14

What are the levels of the stepped care model?

Answer 14

Level 1 - emotional distress - support from peers or ward staff
Level 2 - mild/moderate mood, anxiety or behavioural issue - specialist staff or psychologist recommendations
Level 3 - severe mood, anxiety or behavioural issue - psychological intervention and risk assessment

Question 15

What interventions are there for pseudobulbar affect?

Answer 15

Psychoeducation
Self distraction strategies
Antidepressants are being trialled

Question 16

What interventions are there for depression and anxiety?

Answer 16

Psychological interventions
Family work
Behavioural activation
Medication

Question 17

What is the frontal lobe paradox?

Answer 17

Patients perform well in test settings but have impairments in everyday life (eg impulsivity even though they know what they should do)
It’s important to get collateral information and do observation

Question 18

What areas would be affected by an occlusion in the right internal carotid artery?

Answer 18

Right frontal lobe

Question 19

What symptoms would you see I. Someone with a right internal carotid artery stroke?

Answer 19

Cognitive inflexibility
Emotional lability
Disinhibition
Distractibility
Hemispatial neglect

Question 20

What percentage of strokes are ICH?

Answer 20

~10%

Question 21

What percentage of strokes are SAH?

Answer 21

5%

Question 22

What deficits would left side MCA stroke result in?

Answer 22

Speech - aphasia
Performance (slow)
Muscle movement - hemiplegia/paresis
Vision - hemianopia
Verbal memory
Orientation - Gerstmann (L-R)
Apraxia

Question 23

What deficits would right side MCA stroke result in?

Answer 23

Judgement
Impulse control
Vision - left hemianopia
Attention span
Attention to left side - hemispatial neglect
Insight - anosagnosia
Visual memory
Personality

Question 24

How many HASUs are there in London?

Answer 24

6
<45 mins away from anywhere in London

Question 25

Once medically stable, how soon are people repatriated to their local stroke unit?

Answer 25

Within 72 hours

Question 26

Outside of their local SU, where else might a patient be repatriated to?

Answer 26

End of life care
Home (maybe with referral to community rehabilitation)

Question 27

After rehab at SU, where are patients discharged to?

Answer 27

Home with community rehabilitation
Post acute rehabilitation
Residential/nursing home

Question 28

What types of attention might be evaluated?

Answer 28

Focused attention
Divided attention
Sustained attention
Speed of processing

Question 29

What interventions might be put in place for attention?

Answer 29

Compensatory - time pressure management
Environmental - reducing distractions, organising work area, writing a plan

Question 30

What are the main elements of time pressure management?

Answer 30

Recognise time pressure in the task at hand

Prevent as much time pressure as possible

Dealing with time pressure quickly and effectively

Urging the patient to monitor themselves while using the strategy

Question 31

What tests are specific to executive function?

Answer 31

Behavioural assessment of dysexecutive syndrome

Trail making tests

Dells Kaplan Executive Functioning Systems

Hayling & Brixton Tests

Question 32

Damage to what area is typically responsible for hemispatial neglect?

Answer 32

Right parietal lobe
(Right covers both sides of the body, so left damage would be compensated for)

Question 33

What strategies are used to rehabilitate hemispatial neglect?

Answer 33

Scanning training - Eye Search, Readright
Alerting techniques - wrist band, auditory alert
Prism lenses