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OPIC (Y4) > 2- Stroke: Classification and rehabilitation > Flashcards

2- Stroke: Classification and rehabilitation Flashcards

1
Q

stroke assessment tools

A
  • NIHSS
  • ASPECTS
  • Oxford community stroke project
  • modified rankin scale
  • the rosier scale
  • CHA2DS2-VASCc
  • HAS-BLED
  • TOAST
  • ABCD2
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2
Q

National Institutes of Health Stroke Scale (NIHSS)

A

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

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3
Q

The Alberta Stroke Programme early CT score (ASPECTS)

A

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.

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4
Q

The Oxfordshire Community Stroke Project (OCSP) Classification

A
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5
Q

modified rankin scale

A

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.
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6
Q

Rosier scale

A

helps medical staff differentiate patients with stroks vs stroke mimics

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7
Q

the FAST test

A
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8
Q

CHA2DS2-VASc and HAS-BLED

A

tools to guide anticoagulation in patients with AF

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9
Q

TOAST classification

A
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10
Q

ABCD2 score

A

for stroke risk assessment after a TIA

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11
Q

the strpke bundle

A
  • 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
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12
Q

how well do patients do

A
  • 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.
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13
Q

stroke rehab def

A

›Rehab is an active participatory process to minimise neurological impairment sec to stroke

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14
Q

5 Rs of rehab

A
  • ›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
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15
Q

stroke rehab pathway

A
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16
Q

what is early supported discharge

A
  • 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
17
Q

criteria for early supported discharge

A
  • 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
18
Q

community stroke units criteria

A
  • 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)
19
Q

stroke rehab is based around

A

›Brain Plasticity – peak neurological recovery is from 1 to 3 months.

20
Q

phases of stroke rehab

A
  • 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.
21
Q

prognostic factors

A

›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
22
Q

rehab MDT

A

›Experts in their field›

  • Nurses›
  • Speech and Language therapy›
  • Occupational therapy›
  • Physiotherapy›
  • Dietician›
  • Neuropsychology (limited)
23
Q

problems during rehab

A
  • 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
24
Q

management of aphasia and dysarthria

A

SALT

25
Q

dysphagia

A

›people with swallowing difficulty after acute stroke should:›

  • be immediately considered for alternative fluids;›
  • have a comprehensive specialist assessment of their swallowing;›
  • be considered for nasogastric tube feeding within 24 hours;›
  • be referred to a dietitian
26
Q

intervention for impaired swallowing

A
  • are unable to tolerate nasogastric tube feeding;
  • are unable to swallow adequate food and fluids orally by four weeks from the onset of stroke
27
Q

intervention for impaired swallowing

A
  • are unable to tolerate nasogastric tube feeding;
  • are unable to swallow adequate food and fluids orally by four weeks from the onset of stroke
28
Q

hydration and nutrition

A

›Patients with stroke who are unable to maintain adequate nutrition and fluids orally should be:›

  • referred to a dietitian for specialist nutritional assessment, advice and monitoring;›
  • be considered for nasogastric tube feeding within 24 hours of admission;
29
Q

balance and walking

A

›These patients should be

  • ›be assessed, provided and trained in how to use appropriate mobility aids should receive progressive balance training, functional task-specific training and lower limb strengthening exercises
30
Q

continence

A
  • Incontinence of urine greatly increases the risk of skin breakdown and pressure ulceration.›
  • Incontinence of faeces is associated with more severe stroke
31
Q

management of continence

A
  • timed toileting;›
  • review of caffeine intake;›
  • medication review›bladder retraining;›
  • pelvic floor exercises;›
  • minimise use of constipating drugs;›
  • oral laxatives
32
Q

spasticity and contractures

A
  • Spasticity affects up to a quarter of patients.›
  • simple measures to reduce spasticity e.g. positioning, passive movement, and/or pain control.›
  • focal spasticity is treated with intramuscular botulinum injection›
  • generalised spasticity treated with skeletal muscle relaxants (e.g. baclofen, tizanidine)
33
Q

mouth care

A
  • ›Poor oral hygiene cause›
    • ulceration,›
    • soreness›
    • cracked lips›
    • increased bacteria in the mouth and in saliva; in people with dysphagia this increases the risk of aspiration pneumonia and sepsis›
  • People with stroke, especially those who have difficulty swallowing or are tube fed, should have mouth care at least 3 times a day
34
Q

cognitive impairment

A
  • Cognitive impairment is associated with poor outcomes after stroke, such as increased length of hospital stay and reduced independence›
  • People with continuing cognitive difficulties after stroke should be considered for›
    • interventions aimed at developing compensatory behaviours and learning adaptive skills.›
    • should receive specialist assessment and treatment from a clinical neuropsychologist
35
Q

anxiety and depression can be helped by

A
  • increased social interaction;›
  • increased exercise;›
  • other psychosocial interventions such as psychosocial education groups
36
Q

doctor role in patient rehab

A
  • ›Optimise a patient medically›
  • Assess for depression›
  • Assess cognitive function›
  • Medical review and treatment plan for bowel and bladder continence shared with nurses›
  • Manage neuropathic pain›
  • Manage spasticity
37
Q

doctor role in patient rehab

A
  • ›Optimise a patient medically›
  • Assess for depression›
  • Assess cognitive function›
  • Medical review and treatment plan for bowel and bladder continence shared with nurses›
  • Manage neuropathic pain›
  • Manage spasticity
38
Q

amber care bundle

A

›Patients who are very unwell and not a rehab candidate should have advance care plan discussed with the family and documented clearly in the discharge letter for GP

39
Q

drugs used to help with spasticity

A

Baclofen
Botox injections

OPIC (Y4) (20 decks)

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