Week 4 Flashcards
(19 cards)
Ischaemic stroke vs Haemorrhagic stroke
Ischaemic stroke: caused by a block (clot) in blood flow
Haemorrhagic stroke: caused by a bleed in the brain
Acute Stroke Pathway
Patients progress from ED → triage → neurology review → stroke unit/ward. A full Allied Health assessment is completed.
Stroke Team
Includes neurologists, nurses, OTs, physiotherapists, speech pathologists, social workers, dietitians, and psychologists
MCA infarct Aetiology
MCA infarcts are ischemic strokes due to a blockage (clot) in the brain’s largest artery
MCA infarct Symptoms
- Hemiparesis or hemiplegia (face/arm > leg)
- Aphasia (if dominant hemisphere)
- Neglect (if non-dominant hemisphere)
- Visual field deficits (e.g. homonymous hemianopia)
- Cognitive-perceptual impairments (e.g. attention, memory, apraxia)
MCA infarct prognosis
Varies based on location, severity, time to intervention and rehabilitation intensity. Early OT involvement improves outcomes.
Stroke Guidelines
OTs must assess stroke patients within 1 working day of admission. Early identification of cognitive, visual, and motor impairments informs intervention and discharge planning.
The Cognitive Model
focuses on how cognitive processes (attention, memory, executive function, awareness) affect performance in daily tasks.
- Assessment: Use tools like MoCA and OCS to evaluate cognitive domains post-stroke
Intervention:
- Use task-based rehab (eg. dressing, meal prep) to build real-world cognitive strategies
- Implement environmental modifications or external aids (eg. checklists)
- Focus on metacognitive strategies (eg. self-monitoring)
The Motor Control Model
- explains how movement is controlled and re-learned following CNS damage. Emphasizes task-oriented training and neuroplasticity.
Application in OT:
Assessment: - Motor scales (eg. MAS, MMT, 9-Hole Peg Test),
- Observe functional tasks (Eg. drinking, writing)
Intervention: - Early, high-dose therapy (eg. 2+ hours/day of active therapy for 2 weeks - per stroke guidelines)
- CIMT (Constraint-Induced Movement Therapy)
- Repetitive, purposeful task training (eg. grasp/release, buttoning)
UInilateral neglect
Definition: Failure to attend/respond to stimuli on one side (usually left, from right MCA stroke)
3 areas of space that neglect may affect,
- Personal space: on the body (Eg. fail to groom one side)
- Peripersonal space: within arm’s reach (Eg. ignore items on left tray)
- Extrapersonal space: far environment (Eg. ignore people entering from one side)
Hemianopia
Aetiology: Damage to visual tract/post. brain
Awareness: Often aware of vision loss
Compensation: Can learn scanning strategies
Implication: Visual loss only
Neglect
Aetiology: Damage to parietal cortex
Awareness: Often unaware of the deficit (anosognosia)
Compensation: May not attempt to scan the neglected side
Implication: Broader attentional/perceptual deficit
2 observational assessments an occupational therapist might conduct to identify limitations in occupational performance following stroke.
- ADL observation (Eg. grooming, dressing, feeding) - reveals motor/cognitive/visual deficits
- Functional use of the upper limb at bedside (Eg. drinking, writing, buttoning)
3 cognitive assessments
- MoCA: Rapid screen of mild cognitive dysfunction (good general tool but less stroke specific)
- OCS: Stroke-specific screen covering multiple domains (language, attention, memory, praxis, visual fields)
- BIT: Assesses visual inattention/neglect
Oxford Cognitive Screen OCS
- Designed for stroke, takes ~ 15 mins
Screens: - Language (naming, semantics)
- Memory (verbal and episodic)
- Attention and executive function
- Visual field (field deficits)
- Praxis (motor planning)
- Suitable even for aphasic patients
- Informs goal-setting and functional rehab planning
RBMT-II:
- Behavioural memory test designed to reflect everyday memory demands
- Includes tasks like remembering names, messages, appointments and belongings
- Results guide intervention planning for memory strategies and independence support
- Useful for identifying how many memory problems affect daily occupational performance
Other Stroke Assessments
- FIM (Functional Independence Measure) – for independence in ADLs
- SIS (Stroke Impact Scale) – patient-perceived stroke impact
- SADQ-H – screens for post-stroke depression
- AMPS – assesses motor and process skills in ADLs
- MET – tests real-world executive functioning (e.g., task planning and switching)
Recovery and Reassessment
- Baseline: Especially important after a first stroke
- Day 3 post-stroke: Correlates with functional recovery in most inpatients
- Weeks 8-12: Review after discharge to adjust therapy and assess recovery progress
