Neuropsychological rehabilitation of stroke Flashcards
(85 cards)
1
Q
Learning objectives
A
- Understand what causes stroke and the range of impairments this may lead to
- Understand the range of neuropsychological sequalae that may be seen following stroke
- Have an awareness of neuropsychological assessment and intervention within stroke care
- Understand the wider national guidelines on neuropsychological care within stroke service
2
Q
what are the risk factors for stroke
A
- age
- hypertension
- atrial fillbrillation
- family hx
- cocaine
- smoking
- diabetes
- sleep apnea
- obesity
- ethnicity
3
Q
which cerebral artery supplies the majority of the brain
A
the middle cerebral artery
4
Q
what are the two main types of stroke
A
ischaemic and heamorrhagic
5
Q
which type of stroke is most common
A
ischaemic
6
Q
ishcemic stroke
A
neuronal damage due to decreased cerebral blood flow caused by an obstruction
7
Q
embolic
A
blockage by material brought to the blockage site by blood flow, such as a blood clot
8
Q
thrombolic
A
blockage material formed at the blockage site, often in a previously stenosed (narrowed) area
9
Q
what are the the most common causes of hemorrhagic stroke
A
- hypertension
- ateriovenous malformation
- aneurysm
10
Q
types of hemorrhagic stroke
A
- epidural
- subdural
- subarachnoid
- intraventricular
- intracerebral
11
Q
infarct
A
irreversible loss of neurons
12
Q
penumbra
A
peripheral region of neurons around the infarct at risk of necrosis
13
Q
ischemic stroke secondary injuries
A
- vasospasm
- enchanced collateral circulation resulting in hemorrhagic transformation
- decreased blood flow in other brain areas
- oedema
13
Q
within what time frame should blood flow ideally be restored
A
3-6 hours
14
Q
hemorrhagic stroke secondary injuries
A
- raised intracranial pressure
- seizures
15
Q
inital recovery of function
A
due to restoration of perfusion in the penumbra and resolving cerebral oedema
16
Q
markers of small vessel disease
A
- lacunar strokes
- white matter hyperintensities
- microhemorrhages
- microinfarcts
17
Q
neuropsychological symptoms following left middle cerebral artery stroke
A
- right hemianopia/ neglect
- right hemiplegia/ paresis
- impaired verbal memory
- slow performance
- aphasia
- awareness of deficits
- anxiety
- depression
18
Q
neuropsychological symptoms following right middle cerebral artery stroke
A
- impulsivity
- left hemianopia
- poor insight
- visual memory difficulties
- personality changes
- social cognition changes
- spatial-perceptual difficulties
- left sided neglect
- impaired judgement
- short attention span
18
Q
neuropsychological symptoms following anterior cerebral artery stroke
A
- lower limb sensory loss
- lower limb weakness
- apathy
- lack of initiation
- personality changes
19
Q
neuropsychological symptoms following posterior cerebral artery stroke
A
- contralateral visual field defect
- visual agnosia
- homonymous hemianopia
20
Q
symptoms of larger posterior cerebral artery infarcts involving the thalamus and internal capsule
A
- hemisensory loss
- hemiparesis
21
Q
symptoms of posterior cerebral artery stroke lesions extending to the temporal lobe and hippocampus
A
memory deficit
22
Q
guidelines
A
- NHS improvement psychological care after stroke
- NHS long term plan
- national stroke service model integrated stroke delivery networks
- national clinical guidelines for stroke
- NICE guidelines
- the sentinel stroke national audit programme (ssnap)
23
level 1 neurorehabilitation unit
for people with highly complex rehabilitation needs that need high-intensity rehabilitation
24
stepped care model
three-level model for the provision of psychological interventions after stroke
25
# define
level 1
sub-threshold problems at a level common to many or most people with stroke
26
# describe
level 1
* general difficulties coping
* mild and transitory symptoms of mood/ cognitive disorders
* little impact on engagement in rehabilitation
* support via peers and stroke specialist staff
27
# define
level 2
mild/ moderate symptoms of impaired mood and/ or cognition that interferes with rehabilitation
28
# define
level 3
severe and persistent disorders of mood and/ or cognition that are diagnosable and require specialised intervention, pharmacological treatment and risk ax
29
neuropsychological impairments following stroke
* attention and processing speed
* executive function
* memory
* apraxia
* perception
* agnosia
* neglect
* communication
* fatigue, sleep, pain
* behaviour
* mood
30
Categories of attention and processing speed
* focused attention
* divided attention
* sustained attention
* processing speed
31
interventions for attention and processing speed impairments
* compensatory strategies
* environmental modification
32
compensatory strategies
time pressure management
33
environmental modification
* reduce distractions
* create a written plan of tasks
* organise/ declutter work area
34
main objectives of time pressure management
* recognise that the upcoming task will have some time pressure
* prevent as much time pressure as possible
* deal with the pressure as quickly and effectively as possible
* self monitoring while using the strategy
35
measures of executive function
* planning and executing tasks
* inhibiting automatic impulses
* regulating emotional responses
* reasoning risk and weighing up
36
assessment of executive function
* behavioural assessment of dysexecutive function (BADS)
* trail making
* delis-kaplan executive functioning system (DKEFS)
* hayling & brixton tests
37
interventions for executive functioning impairments
* compensatory techniques/ metacognitive strategies
* external strategies
* goal setting and feedback on functional tasks
38
compensatory techniques-metacognitive strategies
* metnal checklist
* stop-think
* goal management training
39
external strategies
* written checklists
* electronic reminders
* post it notes
40
measures of memory
* attention
* econding
* storage
* retrieval
41
types of memory
* non verbal memory
* immediate memory
* delayed memory
* working memory
* short term memory
* long term memory
* recall memory
* recognition memory
* prospective memory
* explicit memory
* implicit memory
* semantic memory
* episodic memory
* declarative memory
* procedural memory
42
frontal lobe
involved in working memory and accessing information from long-term memory
43
temporal lobe
where long-term memories and semantic information is encoded and stored
44
hippocampus
learning of new information
45
assessment of memory
* weschler memory scale (WMS)
* rivermead behavioual memory test (RBMT)
46
memory impairment interventions
* training and use of strategies (e.g. spaced retrieval, deep encoding, errorless learning)
* external aids
47
types of apraxia
ideomotor and ideational
48
ideomotor apraxia
inability to pantomime object use or imitate gesture
49
ideational apraxia
the loss of the concept of action
50
assessment of apraxia
test of upper limb apraxia (TULIA)
51
treatment of apraxia
compensatory strategies
52
components of perception
* awareness
* recognition
* discrimination
* orientation
53
assessment of perception impairment
* visual object and space peerception battery (VOSP)
* whole perceptual field deficit vs unilateral deficit
54
agnosia
the loss of ability to recognicve objects, people, sounds, shapes or smells despite intact sensory system nor significant memory loss
55
neglect
the failure to report, respond or orient to novel or meaningful stimuli presented to the side opposite a brain lesion despite intact sensory or motor systems
56
rehabilitation of neglect
* scanning training
* eye search and readright therapy
* alerting techniques
57
homonymous hemianopia
part or half of the visual field is lost affecting either the right or left side of the visual field in both fields
58
quadrantanopia
a quarter of the visual field is lost
59
communication impairments following stroke
aphasia (language)
dysarthria (motor speech)
apraxia of speech (articulation)
60
what proportion of stroke patients have communication difficulties
1/3
61
cognitive screening measures
* MoCA
* OCS
* MMSE
* ACE-III
62
mood screening measures
observational (SODS, SAD-Q H10)
self report (VAMS, DISCS, BASDEC, HADS)
63
SODS
signs of depression scale
* do they look sad/ miserable/ depressed
* do they seem tearful/ crying
* do they seem agitated/ restless/ anxious
* are they lethargic or reluctant to mobilise
* do they need a lot of encouragement
* are they withdrawn
scored out of 6
64
what proportion of patients are affected by post stroke depression
1/3
65
psychological effects of stroke
post stroke depression
post stroke anxiety
adjustment disorder
emotional lability
apathy
66
what percentage of patients are affected by post stroke anxiety
25%
67
emotional lability
increase in emotional behaviour following minimal provoking stimuli (e.g. uncontrollable laughing or crying)
68
emotional lability is associated with damage to with which brain regions
* frontal lobes
* brain stem
* cerebellum
* thalamus
69
apathy is associated with damage to which brain areas
basal ganglia
medial prefrontal cortex
70
interventions for depression, anxiety and distress following a stroke
direct psychological interventions
couple/ family work
behavioural activation
medication rx
71
interventions for emotionalism/ pseudobulbar affect
psychoeducation
self distraction
antidepressants
72
the two stage test for mental capacity
1. is there a disturbance in functioning of brain or mind
1. does this affect the ability to understand, retain, weigh up and/ or communicate a specific decision
All practicable steps should be taken to support someone to make a decision
73
frontal lobe paradox
patients with frontal lobe damage can perform well during clinical interview and test settings despite marked impairments in everyday life
74
frontal lobe paradox: masking
Decrements in executive and adaptive functioning are often masked by preserved language and verbal reasoning skills, so much so that an individual may appear remarkably
unimpaired.
75
hallmark of the frontal lobe paradox
lack of insight
76
insight
Patientss grossly overestimate their adaptive skills and consequently, underestimate their need for support or supervision. Individuals are typically able to describe what they should be doing logically but fail to use this knowledge to guide actions
77
impaired self awareness
lack of knowledge of changes in personal abilities and the implication of these changes for daily living and the future
78
anosagnosia
a deficit of self awareness
79
components of the model of awareness
* intellectual (self knowledge)
* emergent
* anticipatory
80
intellectual awareness
Patient is able to identify the problems they have and has the self knowledge required to understanding their strengths and limitations (can be assessed via questionnaires such as
the Dysexecutive Questionnaire [DEX])
81
emergent awareness
Patient recognizes when an impairment affects their ability as it occurs
82
anticipatory awareness
Patient is able to anticipate when an
impairment will affect performance and
implement strategies
83
two parts of online awareness
anticipatory and emergent
