2- Stroke: Classification and rehabilitation Flashcards
stroke assessment tools
- NIHSS
- ASPECTS
- Oxford community stroke project
- modified rankin scale
- the rosier scale
- CHA2DS2-VASCc
- HAS-BLED
- TOAST
- ABCD2
National Institutes of Health Stroke Scale (NIHSS)
The NIHSS is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. Used in assessing stroke severity, patient selection for various acute therapies, estimating prognosis and charting stroke recovery. Training available after registration a
The Alberta Stroke Programme early CT score (ASPECTS)
ASPECTS is a 10-point quantitative topographic CT scan score used in patients with middle cerebral artery (MCA) stroke. Segmental assessment of the MCA vascular territory is made, and 1 point is deducted from the initial score of 10 for every region involved. Used in revascularisation therapies for patient selection and outcome prediction.
The Oxfordshire Community Stroke Project (OCSP) Classification
modified rankin scale
Modified Rankin Scale – measure of global disability used to assess baseline function and evaluate outcomes and treatment impact after interventions. The scale runs from 0-6, running from perfect health without symptoms to death.
- 0 - No symptoms.
- 1 - No significant disability. Able to carry out all usual activities, despite some symptoms.
- 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.
- 3 - Moderate disability. Requires some help, but able to walk unassisted.
- 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk without assistance.
- 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent.
- 6 – Dead.
Rosier scale
helps medical staff differentiate patients with stroks vs stroke mimics
the FAST test
CHA2DS2-VASc and HAS-BLED
tools to guide anticoagulation in patients with AF
TOAST classification
ABCD2 score
for stroke risk assessment after a TIA
the strpke bundle
- Admission to the stroke unit
- Revascularisation therapy
- Optimising physiology (via surveillance, prevention and early intervention of complications) and nutritional support
- Secondary prevention
- Rehabilitation and reablement
how well do patients do
- Early, high functioning plateau – the extreme version of this is a TIA or minor stroke, signifying excellent functional prognosis.
- Early, low functioning plateau – the extreme version of this is a TACS with no meaningful improvement in function as time passes, signifying poor functional prognosis.
- Delayed and medium functioning plateau – this will likely define recovery in most moderate strokes. These patients will benefit from a chance at sustained rehabilitation efforts until a functional plateau is achieved.
stroke rehab def
Rehab is an active participatory process to minimise neurological impairment sec to stroke
5 Rs of rehab
- Realisation of potential
- Re-ablement – to maximise the functional independence
- Resettlement – to provide safe transfer of care
- Role fulfilment – to establish personal autonomy
- Readjustment – to adapt to new lifestyle
stroke rehab pathway
what is early supported discharge
- 40% of stroke patients eligible
- Hospital level of therapy at home
- Reduces average level of hospital stay by 8 days
- For every 100 treated 5 more are living at home and 6 more gain independence
- Increase patient satisfaction
criteria for early supported discharge
- Transfer independently or with one carer
- Suitable home environment
- Willing to participate in rehabilitation
- Identified rehabilitation goals
- Family carers happy
- Can be accepted from acute and rehab and TIA clinic
community stroke units criteria
- Medically stable
- Needing no more than 24% oxygen
- NG feeding established with no risk of refeeding
- Stroke consultant review twice a week
- Do not need to await echo etc before transfer unless urgent.
- Transfer around day 7 (flexible)
stroke rehab is based around
Brain Plasticity – peak neurological recovery is from 1 to 3 months.
phases of stroke rehab
- Initial phase is due to
- Reperfusion of hypoxic brain
- Reduction of brain oedema
- Late phase
- Brain remodelling
- Dead brain does not regrow but the ability to utilise the adjacent healthy brain is associated with good outcome
- This modification is user dependent.
prognostic factors
Good factors
- Absence of coma
- Early motor recovery
- Continence
Poor factors
- Severe communication deficit
- Old age
- Incontinence
- Neglect
- No leg movement at 2 weeks
- Severe upper limb weakness at 4 weeks
rehab MDT
Experts in their field
- Nurses
- Speech and Language therapy
- Occupational therapy
- Physiotherapy
- Dietician
- Neuropsychology (limited)
problems during rehab
- aphasia and dysarthria
- impaired swallowing
- hydration and nutrition
- balance and walking
- fatigue
- continence
- spasticity and contractures
- sensation
- mouth care
- cog impair
- anxiety and depression
- neuropathic pain
management of aphasia and dysarthria
SALT
