recovery after stroke

Question 1

what are the two important questions during the assessment of a stroke patient?

Answer 1

• do you know where you are?
• can you hear me?

Question 2

how many times does stroke approximately occur in the UK a year?

Answer 2

• approximately 152,000 times a year

Question 3

how many first time incidence occurs in a year?

Answer 3

-17 million

Question 4

how many stroke survivors are there in the UK?

Answer 4

• 1.2 million stroke survivors in the UK

Question 5

how many per 10 stroke survivors go onto having recurrent strokes or TIA?

Answer 5

• 3 in 10 stroke survivors

Question 6

how many strokes are fatal within the first 30 days compared to within a year?

Answer 6

• 1 in 8 strokes are fatal within the first 30 days
• 1 in 4 strokes are fatal within a year

Question 7

what number is stroke the cause of death in the UK and in the world?

Answer 7

• fourth single largest cause of death in the UK
• second in the world

Question 8

by the age of 75, how many women and men will have a stroke?

Answer 8

• by 75, 1 in 5 women and 1 in 6 men will have a stroke

Question 9

what race are more likely to have a stroke? how much by?

Answer 9

• black people are twice as likely to have a stroke compared to white people

Question 10

how does race affect stroke onset?

Answer 10

• black and south asian people have strokes at a younger age compared to white people

Question 11

what is stroke one of the largest of?

Answer 11

• largest causes of disability

Question 12

how much stroke survivors in the UK depend on others? how many of these are family/ friends?

Answer 12

• over a third of stroke survivors in the UK are dependent on others
• of those 1 in 5 are cared for by family and/ or friends

Question 13

how much is spent on medical research each year for stroke patients?

Answer 13

• £48 a year for every stroke patient

Question 14

what percentage of first stroke survivors regain independence?

Answer 14

• 58% of first stroke survivors regain independence

Question 15

what percentage of first stroke survivors can walk?

Answer 15

• 82% walk independently
• with or without an aid

Question 16

what time frame is most recovery? when is least recovery?

Answer 16

• most recovery in first 2 months
• less recovery at 4-5 months
• at 6 months, little further recovery expected

Question 17

what are needed for stroke management and heterogeneity?

Answer 17

• reliable predictors needed

Question 18

what do we need to know to assess stroke intervention?

Answer 18

• need to know about recovery patterns

Question 19

what needs to be set in stroke management?

Answer 19

• set realistic/ attainable goals (inform communication with patient)

Question 20

what should stroke management and heterogeneity facilitate?

Answer 20

• should facilitate proper discharge planning
• anticipate home adjustments/ community support

Question 21

what are prognostic indicators of stroke? (9)

Answer 21

• disability on admission
• urinary continence
• degree of motor paresis
• sitting balance
• age
• comorbidity
• level of consciousness in first 48 hours
• orientation in time and place (cognitive status)
• depression

Question 22

what percentage of stroke patients walk at 6 months?

Answer 22

• 60-80% of stroke patients are walking at 6 months

Question 23

what occurs in the affected lower limb at 2-4 weeks? what is this associated with?

Answer 23

• sitting balance and strength in the affected lower limb at 2-4 weeks associated with achieving independent gait

Question 24

what percentage of stroke patients do not show any recovery in upper limb function at 6 months?

Answer 24

• 33-66% of stroke patients do not show any recovery in upper limb function at 6months

Question 25

what percentage of stroke patients show full recovery in upper limb function?

Answer 25

- 5 to 20% show full recovery

Question 26

what do those who make functional gains later show?

Answer 26

- those who make functional gains later show some improvement in impairment within first 4 weeks

Question 27

when do greatest gains occur in treatment?

Answer 27

- greatest gains occur within the first three months after stroke

Question 28

what should be kept in mind when using predictors?

Answer 28

- keep in mind that exceptions to the prediction rules exist

Question 29

what is the main classification system used for ischaemic stroke?

Answer 29

- Bamford classification

Question 30

what are the 4 classifications of stroke?

Answer 30

- total anterior circulation stroke - partial anterior circulation stroke - lacunar syndrome - posterior circulation syndrome

Question 31

what is TACS?

Answer 31

- total anterior circulation stroke - large cortical stroke affecting the area of the brain supplied by both the middle and anterior cerebral arteries

Question 32

what three things need to be present for a diagnosis of TACS?

Answer 32

- unilateral weakness (and/ or sensory deficit) of the face, arm and leg - homonymous hemianopia - higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 33

what is PACS?

Answer 33

- partial anterior circulation stroke - only part of the anterior circulation has been compromised

Question 34

what two of the three need to be present for a PACS diagnosis?

Answer 34

- unilateral weakness (and/ or sensory deficit) of the face, arm and leg - homonymous hemianopia - higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 35

what is POCS?

Answer 35

- posterior circulation syndrome - damage to the area of the brain supplied by the posterior circulation e.g., cerebellum

Question 36

what one of the five need to be present for a POCS diagnosis?

Answer 36

- Cranial nerve palsy and a contralateral motor/sensory deficit - Bilateral motor/sensory deficit - Conjugate eye movement disorder (e.g. horizontal gaze palsy) - Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia) - Isolated homonymous hemianopia

Question 37

what is LACS?

Answer 37

- lacunar stroke - subcortical stroke that occurs secondary to small vessel disease

Question 38

is there loss of higher cerebral function in LAS?

Answer 38

- no loss of higher cerebral functions e.g., dysphasia

Question 39

which one of the four following need to be present for a diagnosis of LACS?

Answer 39

- pure sensory stroke - pure motor stroke - sensori- motor stroke - ataxic hemiparesis

Question 40

what are the 4 physiotherapy approaches for stroke?

Answer 40

- restorative vs compensatory - bobath; brunstrom, PNF, motor learning programme - controversies - guidelines e.g., arm re-education

Question 41

what are you likely to need help with after a stroke? what is this known as?

Answer 41

- need help to regain old abilities, learn new skills an cope with any remaining disabilities - known as rehabilitation

Question 42

what do physiotherapists use for stroke patients? why?

Answer 42

- use specific exercises, techniques and massage to keep muscles and joints in working order

Question 43

what is neural plasticity?

Answer 43

- process that involves adaptive structural and functional changes to the brain

Question 44

what are the three evidence- based therapies used in stroke management?

Answer 44

- constraint- induced movement therapy (CIMT) - upper limb robotics - functional electro- stimulation of the arm

Question 45

what are early supported discharge policies by a stroke team dependent on?

Answer 45

- dependent on appropriate selection of stroke patients that may benefit most from a particular intervention

Question 46

what is constraint induced movement therapy based on?

Answer 46

- based on scientific principles

Question 47

what are the three factors that constraint- induced movement therapy depends on?

Answer 47

- commitment of patients - service users - willingness of therapists to deliver