STROKE : STROKE
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 : Symptoms
Slide 6: 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 : Factors affecting LOCATION
DURATION
PROGNOSIS
OTHER ILLNESS
AGE
Risk Factors : Risk Factors
Slide 9: OBESITY
Slide 10: SMOKING
Slide 11: DRUG ABUSE
Slide 12: OLD AGE
Slide 13: ALCOHOL
Stroke Classification : Stroke Classification TACI (Total Anterior Circulation Infarct)
PACI (Partial Anterior Circulation Infarct)
LACI (Lacunar Infarct)
POCI (Posterior Circulation Infarct)
Pathophysiology : 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
Slide 26: 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.
Slide 33: 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
Slide 34: 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