The vascular system and stroke - Stroke rehabilitation Flashcards
What are the long term effects of stroke?
- Spasticity, stiffness in muscles, painful muscle spasms
- Problems with balance and/or coordination
- Aphasia
- Bodily neglect or inattention
- Pain, numbness or odd sensations
- Problems with memory, thinking, attention or learning
- Being unaware of the effects of a stroke
- Dysphagia
- Problems with bowel or bladder control
- Fatigue
- Difficulty controlling emotions (emotional liability)
- Fatigue
- Difficulty controlling emotions (emotional lability)
- Depression
- Difficulties with daily tasks
List the members of the multidisciplinary team for stroke patients
Doctors
Nurses
Speech and language (SALT)
Dieticians
Physiotherapy
Occupational therapy
Social services
Optometry and ophthalmology
Psychologist
Orthotics
Rehabilitation specialist
Describe the physiotherapy role of the MDT
- Social history + neuronal assessment
- Vison + perception
- Functional assessments
- Cognitive screen
- Mood screen
- Upper limb management
- Assessment of equipment and needs
- Assessment of care needs
- Assessment of further “rehab potential”
- Family liaison and education
a) How soon should early mobilisation occur?
b) What are the benefits of early mobilisation?
a) Within 24 to 48 hours of admission
b)
- It reduces the risk of complication
- it has strong positive psychological benefit for the patient
What factors in stroke require rehabilitation management?
- Mobility
- Activity of daily living
- Communication
- Swallowing
- Orthosis
- Shoulder pain
- Spasticity
- Cognitive and perception
- Mood
- Bowel and bladder continence
List therapeutic exercises and traditional functional retraining involved in the rehabilitation of stroke patients
- ROM exercises
- Muscle strengthening exercises
- Mobilisation activities
- Fitness training
- Compensatory techniques
List neurophysiological approaches
- Muscle re-education approach
- Neurodevelopmental approaches - sensorimotor approach, movement therapy approach,
- Motor relearning program for stroke
- Contemporary task orientated approach
- Proprioceptive Neuromusclar facilitation
Positioning should be assessed over a 24-hour period including in a bed and chair. What areas should be considered for positioning?
- Type of chair/equipment
- Transfer technique
- Pressure management
- Positioning for feeding
- Tone management
- Engagement and interaction
Describe the treatment options for dysphagia
- Posture change
- Heightening sensory input
- Swallowing manoeuvres
- Active exercise
- Diet modification
Describe the treatment of aspiration pneumonia
- Antibiotic treatment
- Chest physiotherapy for positioning, suctioning and percussion as indicated
What are some examples of orthosis used in
- Shoulder slings for subluxation
- Hand splint - for spasticity, stiffness, positioning and ROM
- Foot slings - to prevent/correct foot problems w.g., foot dram and helps ROM
What are the management options for shoulder pain?
- TENS
- Shoulder strapping
- Mobilisation
- Medical (pharmacological) - analgesia
- Intraarticular injections
- Modalities: ice, heat, massage
- Strengthenings
a) What is shoulder subluxation in stroke a consequence of? and how does it cause pain?
b) What are the management options for shoulder subluxation?
a) It is a consequence of weakness around the shoulder girl that occurs as a result of stoke. The weight of the upper limb can drag on the shoulder capsule and ligament causing pain
b) Management is good moving and handling, positioning, analgesia and orthotics
What is spasticity?
A condition in which there is abnormal tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain
Describe the harmful effects of spasticity according to the different ICF levels
Describe the management of spasticity
Physical
- Eliminating aggravating factors
- Splinting and casting
- Positioning in bed and chair
- Passive stretches
Pharmacological
- Generalised spasticity –> oral agents
- Regional spasticity –> Intrathecal baclofen (muscle relaxant)
- Focal and multi-focal spasticity –> Botulinum toxin, phenol blockade
- Avoid diazepam
Surgical management
- Neurosurgical procedure (selective dorsal rhizotomy)
a) What problems with cognition and perception can stroke patients have?
b) What is the treatment for cognitive and perception problems?
a) What problems with cognition and perception can stroke patients have?
b) What is the treatment for cognitive and perception problems?
a) - Attention deficits
- Visual neglect
- Unilateral neglect
- Memory deficits
- Problem solving difficulties
b) - Orientation - time, place, person
- Memory
- Repetitive
- Environment
- Problem solving
How is mood impacted in stroke?
- Post stroke depression (PSD)
- Anxiety
- Emotionalism (emotional ability improves with time)
50% of stroke patients have urinary incontinence during the acute phase. This improves with time
a) What are the risk factors
b) Describe the management of bladder incontinence
a) Age, increased stroke severity, diabetes
b) Indwelling urinary catheter (Foley catheter) - aids in management of fluid, prevents urinary retention
Describe the management of bowel incontinence is stroke patients
- Adequate intake of fluid
- Bulk and fibre food
- Bowel training
a) What are the communication problems that stroke patients suffer with?
b) What is the goal of treatment when it comes to treatment of communication problems?
a) Aphasia and Dysarthria
b) Facilitate recovery of communication and develop strategies to compensate e.g., gesture, picture, communication board, computer
What anatomical areas in the brain are affected in stroke patients with aphasia
Broca’s area (frontal lobe of left hemisphere)
Wernicke’s area (superior temporal gyrus in the dominant (usually left) cerebral hemisphere
Describe the location and role of Broca’s area and Wernicke’s area
Broca’s area
- Left frontal lobe
- Motor speech (speech production and articulation)
Wernicke’s area
- Superior temporal lobe
- Receives information from auditory cortex (comprehension of speech)
