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Clinical Neuro and Rehab > Recovery Following a Stroke: the basis of rehabilitation > Flashcards

Recovery Following a Stroke: the basis of rehabilitation Flashcards

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1
Q

What is rehabilitation?

A

a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interactions with their environment

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2
Q

What are the 4 principle steps of the neuro-rehabilitation process?

A

1-assessment
2-goal setting
3-interventions
4-outcome measurments

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3
Q

What was the initial international classification of impairments, disabilities and handicaps?

A

disorder/disease -> impairment -> disability -> handicap

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4
Q

What did handicap refer to?

A

how much someone can engage with society

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5
Q

What is changed in the new and improved international classification of impairments?

A

-health condition instead of disease
-if you have a problem with body function and structure they are called impairments, activity limitations or participation restrictions

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6
Q

What is meant by activity in the international model?

A

what can you do? e.g. can you go to the toilet on your own
-integrate environmental factors, can you do it with a change in environment e.g. going up the stairs by a stair lift

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7
Q

What is meant by participation in the international model?

A

vocation, leisure that you can get involved in

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8
Q

What is meant by personal factors in the international model?

A

you may be living with a spouse, effecting your ability to cope

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9
Q

What is health condition an umbrella term for?

A

disease
disorder
injury
trauma

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10
Q

What are impairments?

A

problems in body functions or structure as a significant deviation or loss

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11
Q

What are activity limitations?

A

difficulties an individual may have in executing activities

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12
Q

What are participant restrictions?

A

problems an individual may experience in involvement in life situations

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13
Q

What are environmental factors?

A

make up the physical, social and attitudinal environment in which people live and conduct their lives
-environment may facilitate or act as a barrier to functioning

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14
Q

What are personal factors?

A

particular background of an individual that are not part of a health condition or health state

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15
Q

What are the conditions of assessment?

A

-Essential 1st step- difficult to plan without it
-multi-disciplinary
-facilitates a holistic view
-allows description of all aspects of disability

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16
Q

What are the conditions of goal setting?

A

-set specific short and long term goals
-relate to patients capacity, performance and participation
-meaningful for patients and challenging
-SMART

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17
Q

What are interventions?

A

environmental factors that you can change

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18
Q

For many, what is rehabilitation synonymous with?

A

training

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19
Q

What is the main outcome of rehabilitation?

A

-Training an individual to do something in a new way

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20
Q

What do you need to think about when creating an intervention?

A

-aid
-equipment
-self-management

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21
Q

What should the outcome measures be?

A

-standardised measures to capture the result of the intervention
-need to capture the change in impairments, activities and participation

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22
Q

How many times a year do strokes occur in the UK?

A

152,000x a year

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23
Q

How many stroke survivors are there in the UK?

A

1.2million

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24
Q

How many stroke survivors will go on to have another stroke in the future?

A

3 in 10

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25
How many strokes are fatal in the first 30days after?
1 in 8
26
How many strokes are fatal in the first year after?
1 in 4
27
What is the 4th largest cause of death in the UK? 2nd in the world?
Stroke
28
How many people will have a stroke by 75 years old?
1 in 5 women 1 in 6 men
29
What individuals are more likely to have a stroke?
-Black people (2x more likely)
30
How many stroke survivors have a disability?
Half
31
How many stroke survivors in the UK are dependent on someone else?
one third
32
To assess interventions what do we need to know?
recovery patterns
33
What are the prognostic indicators of a stroke?
-disability on admission -Urinary continence -Degree of motor paresis -sitting balance -age -comorbidity -levels of consciousness in 1st 48hours -orientation in time and place (cognitive status) -depression
34
How many stroke patients are walking within 6 months?
60-80%
35
How many stroke survivors don't show any recovery in upper limb function at 6 months?
33-66%
36
How many stroke survivors show full recovery of upper limb function at 6 months?
5-20%
37
When does the greatest gain occur after a stroke?
In the 1st 3 months
38
When do patients seem to plateau in terms of recovery?
3-6 moths after onset
39
What do Total Anterior Circulation Strokes exhibit?
-unilateral weakness of the face, arm and leg -homonymous hemianopia -Higher cerebral dysfunction (dysphasia, visuospatial disorder)
40
What do Posterior Anterior Circulation Strokes exhibit?
2 of: -unilateral weakness of the face, arm and leg -homonymous hemianopia -Higher cerebral dysfunction (dysphasia, visuospatial disorder)
41
What do Lacunar Syndrome exhibit?
-Pure sensory stroke -Sensori-motor stroke -Pure motor stroke -Ataxic hemiparesis
42
What do Posterior Circulation Syndrome Strokes exhibit?
One of: -Cranial Nerve palsy and a contralateral motor/sensory deficit -Bilateral motor/sensory deficit -Conjugate eye movement disorder (e.g. gaze palsy) -Cerebellar dysfunction (e.g. ataxia, nystagmus, vertigo) -Isolated homonymous hemianopia or cortical blindness
43
What are the mobility milestones of stroke patients?
-1min sitting balance -10 second standing balance -10steps -10m walk
44
When is the behavioural inattention test (neglect assessment) performed?
on admission (mean 35days post stroke)
45
What is the difference in recovery between stroke patients that have neglect and those that don't?
Patients who have neglect don't do as well after stroke Only patients with neglect got discharged to a care home
46
What is restorative rehabilitation?
getting from A to B how they did before the stroke
47
What is compensative rehabilitation?
getting from A to B in a new way
48
When does recovery take place after a stroke?
first 2 months after stroke `
49
When to patients typically learn compensatory strategies?
Early stages post stroke
50
What are the guidelines if you have some movement in your upper limbs after a stroke?
-functional electrical stimulation -mirror therapy -mental practise -repetitive task practise- interaction and how a task is set up is important -constraint-induced movement therapy -robot-assisted movement therapy
51
What are the guidelines if you have no movement in you upper limbs after a stroke?
-functional electrical stimulation -training in how to care for the limb
52
What is involved in constraint induced movement therapy?
Constraining the patient of using their functioning limb, forcing them to use their impaired limb
53
What are the limitations of using constraint induced movement therapy?
-commitment of patients -service issues of providing it in the NHS -Willingness of therapist to deliver -Clinical impact seems minimal -Patients don't like/ want it
54
What is learned non-use?
-characterised by a motor deficit that is greater than it appears to be warranted by the organic status of the individual
55
What is an index of learned non-use?
the difference between a measure of what a person can do when requested to do the best he can and measure of what a personal actually does do spontaneously
56
What do individuals with impairments in the dominant hand demonstrate?
less impairment than those with the non-dominant hand affected
57
If you are right handed, what hand are you more likely to use to cross the mid line?
Right hand
58
In left brain damage patients who are right handed, what hand are they more likely to use to cross the mid line?
Right hand
59
In right brain damage patients who are right handed, what hand are they more likely to use to cross the mid line?
Shifts more to the left hand side
60
What patients does learned non-use mainly effect?
Patients with -right brain damage -non-dominant limb paresis
61
What patients should benefit more from contraint induced movement therapy?
Patients with right brain damage
62
How can we move from bench to beside effectively?
-select patients in a theoretically/scientifically coherent way -develop and define the intervention carefully and clearly -be prepared to look at subgroups
63
What happens if there is no intervention?
the reliance on non-paretic side leads to contralesional synaptic addition and maturation
64
When happens if the paretic limb is trained?
contralesional synaptic addition and maturation increases
65
What does rehab of the paretic limb support?
Maintenance and re-emergence of ipsilesional motor maps
66
How are the effects of rehab on the paretic limb reduced?
if they are proceeded by training of the non-paretic limb
67
What does successful motor command lead to?
positive sensory feedback
68
What is anosognosia?
Unawareness of impairment
69
What individuals does hemiplegia usually effect?
those with right hemisphere damage
70
How can Anosognosia hemiplegia present itself?
-small impairments in limb- -relatively spared function on the left -more impairment during bilateral activity (extinction) -impaired action inhibition on the right (allochiria)
71
What is lateropulsion or 'pusher syndrome'?
Affects of balance
72
How do Right brain damage and left brain damage patients present 'pusher syndrome'?
LBD= good at shifting weight to their left leg- compensatory strategy RBD= find it more difficult to shift their weight to their right leg

Clinical Neuro and Rehab (7 decks)

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