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Presentation Transcript



Definition Of Stroke : 

Definition Of Stroke “Rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin and of more than 24 hours” WHO TIA (Transient Ischaemic Attack) recovery is complete within 24 hours. 10% of patients will go on to have a stroke.

Stroke : 

Stroke Stroke is the third largest killer in the Western World. It accounts for up to 6% of in-patient hospital costs in Scotland. Stroke is one of the major causes of disability, particularly in the elderly. Stroke patients may present with a variety of physical, cognitive and psychosocial problems. Most stroke patients show signs of recovery over time.

Sub-types Of Stroke : 

Sub-types Of Stroke Ischaemic – obstruction to one of major cerebral arteries, brainstem strokes are less common. Haemorrhage – 9% are caused by haemorrhage to the deep parts of the brain. Patients are usually hypertensive.

Symptoms : 


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If MCA is affected then both parital and frontal lobes are affected. If PCA is affected then cerebellum and occipital lobe is affected. If ACA is affected corpus callosum is affected.

Factors affecting : 


Risk Factors : 

Risk Factors

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Stroke Classification : 

Stroke Classification TACI (Total Anterior Circulation Infarct) PACI (Partial Anterior Circulation Infarct) LACI (Lacunar Infarct) POCI (Posterior Circulation Infarct)

Pathophysiology : 


Adverse Prognostic Indicators : 

Adverse Prognostic Indicators Prior Stroke Older Age Persistent urinal and faecal incontinence Visuo-spatial deficits Additional Influences Consciousness at onset, severity of paralysis, sitting balance, admission ADL score, level of social support, metabolic rate of glucose outside the infarct area in hypertensive patient.

Physiotherapy Aims : 

Physiotherapy Aims To normalise muscle tone To restore muscle function To control compensation strategies To maintain muscle length To re-educate balance To retrain walking and restore mobility To maximise functional ability while allowing on-going neuromuscular recovery

Physiotherapy In Stroke : 

Physiotherapy In Stroke Size Of BOS Large to reduce tone Small to increase tone Alignment Flexor eg sitting/prone Extensor eg standing/supine Positioning Strategies Handling Proximal/Distal/Anatomical Communication Volitional/Automatic/Voice

Stroke Assessment : 

Stroke Assessment Motor function Muscle tone (high/low) Sensation/Proprioception/Co-ordination Alignment/Stability in various positions Neuromuscular anatomy Compensation Strategies Balance Mobility

Outcome Measures : 

Outcome Measures Mobility Milestones 1minute sitting balance 10 second standing balance 10 independent steps 10 metre walk Berg Balance Scale 9 Hole Peg Test Elderly Mobility Scale Motor Assessment Scale

Treatment Strategies : 

Treatment Strategies Approaches Bobath, Motor Relearning etc. Hydrotherapy AFO/Calipers/Malleolar Locks Strapping Electrical Stimulation Positioning

Positioning : 

Positioning Base Of Support Alignment Flexor Extensor Combination Bed Type Mattress Pillows – how many? Chair Type Cushion – soft, firm, intermediate

The Stroke Team : 

The Stroke Team Doctor Nurse Physiotherapist Occupational Therapist Speech & Language Therapist Social Worker Dietician Psychologist Dentist Podiatrist Art Therapist Volunteers Carers

Other Problems To Consider : 

Other Problems To Consider Multipathologies UTIs RTIs D & V Emotional Conditions Lability Depression Speech and Language Deficits Dysphasia (expressive/receptive) Dyspraxia Dysarthria

Compliactions : 

Compliactions Shoulder subluxation Unilateral neglect T/C/D Shoulder hand sydrome/ RSD Edema DVT Periarthiritis

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OT Management

Management : 

Management Based on prognosis Severity Duration Prob . Involved Etiology Circulation and the artery involved

Approaches : 

Approaches NDT Brunnstrom’s app. PNF Rood’s Rehablitative approach

Acute phase : 

Acute phase Initially medical prob.s are addressed. Like hypertension, diabetes, cardiac problems. After medical care To improve muscle tone Prevent further complications Positioning NDT Shoulder sling Hands in pockets Unilateral neglect should be avoided

Brunnstrom’s app. : 

Brunnstrom’s app. Depending on Brunnstrom’s stages of Arm Hand Leg.

NDT : 

NDT Scapular protraction Weight bearing with weight shifting Forward leaning Positioning Trunk rotation

Sub-acute phase : 

Sub-acute phase Duration of 3 to 9 months Bed activities Rolling , coming upto to sit Bilateral activites, by clasping both the hands Improve Hand fns Functional activities PNF techniques- Using diagonal patterns, holding the affected limb Rowing techniques and weight bearin accordin to Brunnstrom’s app.

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Movts in gravity eliminated position Mirror therapy FES Icing and quick strech over finger extensors. Training in ADL skills Remedial treatment Functional abilities Cognitive training-Depending on the deficit

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Perceptual prob.- Form board activites, depth perception board, copying a fig. … Co-ordination activities. Outdoor activites

Chronic phase : 

Chronic phase Duration more than 6 months Prognosis is poor Remedial is difficult One handed techniques Home modifications Constrained induced therapy

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