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1

what skills does a stroke affect

orientaiotn
short term memort
attention
problem solving
planning and sequening
judgement
insight

2

what is attention

The ability to redirect thoughts and actions towards a stimulus or event for a defined period of time, despite the presence of extraneous or unrelated stimuli.

3

whats the different types of attention

sustained attetnon
selective atenton
alternating attention
divided attenton

4

what is sustain attention

maintains focus on relevant information without interference from irrelevant stimuli. Sustained attention requires control over internal and external competing stimuli.

5

what is selective attention

maintains attention in the presence of conflicting or competing sensory information. To facilitate or direct thoughts and actions, whilst simultaneously inhibiting our response to interference. Eg looking at an item on the shelf will you be distracted by prices, brands etc

6

what is alternating attention

: move attention flexibly between tasks and responds appropriately to the demands of each task. Eg looking for a friends house in a new neighbourhood do you look at the map at the traffic lights and resume drining

7

what is divided attention

: responds simultaneously to two or more tasks. Eg preparing a sandwhich at home ad talking to a friend on the phone.

8

clinical signs to impaired attention

• Level of alertness – drowsy, fluctuating, easily fatigued?
• Can they finish sentence, give history?
• Do they go off on tangents or lose thread of conversation?
• Do they interrupt conversation/activities with unrelated comments
• Do they have difficulty ignoring distractions (including noise, pain etc)
• Are they unable to do more than one thing at a time

9

strategies to improve attention and concentration

• 'Put blinkers on' by reduce all possible distractions in the environment
• Take regular rest breaks, have a nap or a walk
• Meditation, deep breathing and other strategies for relaxation
• Plan tasks with a simple step-by-step approach
• Break significant tasks down into small and achievable steps
• Write information down using notes and keep them in specific place
• Use a white board to help organize, plan and store information
• Use 'association' techniques e.g. medication on table with every meal
• Get into a structured regular daily routine
• Schedule tasks when levels of energy and alertness are greatest
• Eat a healthy diet and sleep well.

10

what is neglect

unilateral neglect is ‘lateralised’ in the sense that patients typically fail to respond to stimuli occurring in the side of space opposite the lesioned hemisphere”.

11

why is understanding neglect important for Occupation Therapy

• Major factor limiting occupational performance in Stroke rehab
• People with ULSN have more trouble resuming usual daily activities
• Have poorer recovery of function in the body side that is ‘neglected’
• Have longer hospital and rehab stays
• Increased risk for accidents and injury

12

neglect of specific areas

Parietal lobe:
- Primary area:
Self and personal self
- Secondary area: Immediate environment and less complex reactions
- Tertiary area: interpretation of complex environmental input plus 1 and 2

13

types of neglect

• Modality - visual, auditory and/or tactile.
• Space - personal, peripersonal (reaching) or extrapersonal (locomotor).
• Object or environment focus.
• Always stronger when the damage is to the right hemsiphere

14

evaluation of neglect

- USN (Unilateral Spatial Neglect) problem identification was high, but evidence-based assessment and intervention use were less than optimal
-Behavioural Inattention Test.
- Star cancellation (54 small stars to be crossed, 2 7 on right, 27 on left, 2 prompts. Acceptable range: 52-54)
-Line Crossing
- Line Bisection (each line is scored according to the amount of deviation from the scoring template).

15

mobility assessment of OP in neglect

• Does not symmetrically weight-bear while standing.
• Difficulty initiating movement through left side (ie: transferring)
• Does not spontaneously move affected side (despite movement being present).
• Difficulty completing left turns.

16

daily activities assessment of OP neglect

• Fails to dress or groom left half of body or does not complete activity.
• Ignores food on left side of plate, does not empty left side of mouth when eating.
• May complete the activity in half the space available (ie: placing biscuits on half the biscuit tray).
• Overly attentive to items/objects on the right side

17

functional assessment of neglect

• Impaired general attention and distracted by tasks, events and conversation on right side.
• Requires prompting to care for and attend to self and events on left side.
• Drops items from left hand and does not appear to notice (soap, toothbrush).
• Does not scan environment effectively for hazards when mobilising (overhanging cupboards, objects on floor etc).

18

evaluation of neglect

Patients with unilateral neglect can be trialed with one or more of the following interventions:
 simple cues to draw attention to the affected side
 visual scanning training in addition to sensory stimulation  prism adaptation
 eye patching
 mental imagery training or structured feedback.

19

intervention in cognitive impairment

Visual scanning training
 Trunk rotation
 Nek muscle vibration
 Mental imagery training
 Video feedback training
 Prism therapy training

20

whats a ischaemic stroke

blockage from a clot

21

what are types of ischaemic strokes

embolic stroke
thrombotic stroke

22

whats embolic stroke

if the blood clots forms somewhere in the body, it can travel in the blood stream to the brain. It gets stuck there and stops blood from getting through

23

whats thrombotic stroke

: over time plaques increase in the blood vessels and narrow or blow the artery and stop blood getting through. Eg TIA stroke “mini stroke” signs may disappear after 24 hours but often a warning sign that a stroke may occur.

24

whats a haemorrhagic stroke

blood on the brain due to burst of the blood vessel wall. Stops oxygen and nutrients getting to the brain.

25

whats types of hemorrhagic stroke

aneurysm
arteriovenous malformation

26

what aneurysm stroke

is a weak or thin spot on a blood vessel wall that usually present at birth but is undetectable until they break

27

what is arteriovenous malformation

is a tangled mass of blood vessels, usually present at birth. If it is located in the brain can cause a stroke when the walls burst.

28

what do Occupation Therapy do with stroke victims

• Help stroke survivors manage day to day tasks, such as dressing and showering, as well as helping people to return to work and leisure activities after stroke. Occupational therapists also can also help with thinking or memory problems, and upper limb (hand or arm) problems.

29

acute Occupation Therapy role in stroke management

• Initial assessment**
• Cognitive-Perceptual Screen/Assessment**
• Vision assessment**
• Upper Limb assessment**
• Personal ADL assessment
• Light domestic ADL assessment
• Home Assessment
• Pressure Care/Seating

30

whats the initial assesment involve

• Complete within 1 working day of administration
• May be completed with patient and or family
• Includes: allied health pre morbid assessment (before accident) and OT initial assessment.