Rationale for stroke rehab Flashcards
(24 cards)
What are the 4 principles of neuro-rehab?
Assessment -> goal setting -> interventions -> outcome measures -> ax
What framework guides measurement of rehab
ICF helps to understand how recovery and stroke needs should be measured
Enables thinking of whole person and counteracts ideas that as have health condition so can’t do anything
What is the purpose of rehabilitation?
To help regain or get as close to regaining functions, improving activity and participation.
What is a key aspect of the rehabilitation process
Goal setting:
- set specific short and long term goals
- relate to patient’s capacity, performance and participation
- goals meaningful for patient, realistic, challenging and measurable
e.g. SMARTER
What are the challenges in the measurement of rehab?
Good outcome measures, continous process.
What is the societal impact of stroke?
Occurs ~152,000 times a year in the UK
1.2 million stroke survivors in the UK
4th single largest cause of death in the UK and 2nd in the world
By 75 1 in 5 women and 1 in 6 men will have had a stroke
Black people 2x more likely to have a stroke
Black and south asian people have strokes at a younger age compared to white people
One of the largest causes of disability - half of all stroke survivors have a disability
According to stroke association between 5-10% of NHS budget
what are possible personal impacts of stroke?
3/10 stroke survivors go on to have a recurrent stroke or TIA
1/4 strokes are fatal within a year
1/3 of stroke survivors in the UK are dependent on other and 1/5 are cared for by family and/or friends
What is the epidemiology of stroke?
58% of 1st stroke survivors regain independence
82% walk independently (with or without an aid)
Most recovery occurs in the 1st 2 months
Less recovery at 4-5 months
At 6 months, little further recovery expected
What is the basis for recovery after stroke?
Most recovery occurence in first 1-2 months
sitting balance and strength affected LL at 2-4 weeks associated with achieving indep gait
in UL Those who make functional gains later show some improvement in impairment within first 4 weeks
What factors affect stroke prognosis?
Disability on admission
Urinary continence
Degreee of motor paresis
Sitting balance
Age
Comorbidity
Level of consciousness in first 48 hours
Orientation in time and place (cog status)
Depression
Walking
- 60-80% of pts are walking at 6 months
UL
- 33-66% stroke pts do not show any recovery in UL function at 6 months
- 5-20% show full recovery
Who classified strokes for prognosis?
Bamford et al., 1991 - Oxford Community Stroke Project
What are the classifications according to the Bamford Classifications
TACS - total anterior circulation stroke
PACS - partial anterior circulation stroke
LACS - lacunar syndrome
POCS - posterior circulation syndrome
Which classification has the worst outcomes
Although indiv patients can / do behave differently
5% of those classed as total anterior circulation strokes, 60% of them were dead in the first year in comparison to 10-20% in the other groups and only 5% were independent. (very crude data from Bamford et al., 1991)
What did SMith and Baer (1999) assess and create
In 238 consecutively admitted stroke patients in a UK hospital classified according to the OCSP.
Checked mobility milestones of 1 min sitting balance, 10s standing balance, 10 steps and 10m walk.
Proposed time scales dependent on each condition
What were the projection for each OCSP classification according to Smith and Baer 1999
PACS: SIt bal = 1 day, Stand Bal. = 1 week, 10 steps = 2 week, 10m = 3 weeks
LACS: Sit bal = 1 day, stand bal 5 days, 10 steps = 2 weeks, 10m = 3 weeks
POCS: Sit bal = 3 days, Stand bal = 1 week, 10 steps =2.5 weeks, 10m = 3.5 weeks
TACS: Sit ball = 3 weeks, stand bal = 8 weeks, 10 steps = 18 weeks, 10m = 20 weeks
PICH: Sit balance = 2 weeks, Stand balance = 5 weeks
What did Katz et al (1999) find
Found dramatic increase of length of stay with spatial neglect on admission
With = 118.7 without 78.4
At discharge with neglect: 15% went home indep, 78.9% went home with care and 5.3% went to nursing home
At discharge without: 81% went home indep, 19% went home with care (none nursing home)
Spatial neglect therefore should be considered
What are key points for prognostic factors?
Predicting outcome is not an exact science
Should always be on an indiv clinical decision and open to r/v
Should be integral part of rehab process
Prognostic indicators can inform process
What is the difference between restoration and compensation in rehabilitation?
Think more broadly. Consider whether someone should simply reach previous level of functioning as aim or adaption such as with aids, assistance and equipment
Define health condition
Umbrella term for disease, disoder, injury or trauma. Health conditions coded using the ICD-10
Define impairments
Problems in body functions or structure as a significant deviation or loss
Define activity limitations
Difficulties an individual may have in executing activities
Define participation restrictions
Problems an individual may experience in involvement in life situations
Define environmental factors
Make up the physical, social, and attitudinal environment in which people live and conduct their lives. Environments may facilitate functioning or be a barrier to functioning.
Define personal factors
Particular of an individual’s life and living, and comprise features of the individuals that are not part of a health condition or health state.
