Enquiry 5, Stroke Part 2 Rehab + neuroanatomy Flashcards
What knowledge/evidence should be integrated during an assessment for stroke?
- neuroanatomy - neurophysiology - biomechanics - motor control and learning - pathophysiology
what are the four ways of classifying stroke?
TACS - total anterior circulation stroke PACS - partial anterior circulation stroke LACS - lacunar syndrome POCS - posterior circulation syndrome
what are the criteria for all four Bamford stroke classifications?
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what is assessment?
A continuous process by which information is gathered from a variety of sources and then interpreted with the aim of identifying key problems and a treatment plan relevant to the needs of that individual
Using the ICF framework, what must you consider when choosing an outcome measure?
- Purpose of the measure – relevant - Clinical utility – simple, easy to use - Scientific properties – reliability, validity, detect change, effective in the patient population - Standardisation *picture
In a subjective assessment what questions would you ask your patient?
- Social history: working/ retired; hobbies; who’s at home, husband, pets? - Home environment - Prior level of function - How has she been feeling? - Questions about stroke? - What are her goals?
What are you measuring and assessing in an objective neuro assessment?
- General functional ability (bed mobility, transfers) - Cognition - Posture - Passive Range of Movement PROM of UL and LL - Active movement (selectivity, range, strength) AROM of UL (e.g Box and Blocks test) and LL - Tone - Sensation - Pain - Co-ordination/ Ataxia e.g walking TUG/ 10 metre walk test - Balance e.g Postural assessment scale for stroke/ Trunk impairment scale - Vision - Cranial Nerve assessment - Mental Status Cranial Nerves Motor Exam Reflexes Coordination and Gait Sensory Exam
When providing stroke patients with a goal what must you consider?
Goals: - Something measurable (SMART) to work toward during treatment - Generally can use identified impairments from exam to develop your goals - Should be meaningful to the patient: Based on either activity or participation - Factors such as cognitive functioning, mood, fatigue, environmental issues and carer involvement will all need to be considered
When providing stroke patients with a treatment plan what must you consider?
Treatment Plan: - How you will go about reaching your goals - Evidence based as well as based on clinical experience Treatment plans work at an impairment level to achieve the goal Example goal: Carry out a stand and step transfer from wheelchair to bed to the R side with a wheeled zimmer frame and verbal prompts twice a day, within 2 weeks. Treatment plan: Lower limb strengthening, balance exercises, full and part task practice, sit to stand practise, gait retraining, core stability exercises
What are the key aims of neurological physiotherapy to optimise movement and function for the patient?
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What physical managment is put in place to prevent secondary complications?
- Control of posture over a 24-hour period is the core of physical management - Uncontrolled positions at night can cause/or contribute greatly to many secondary complications - Management rather than treatment is the primary goal - Maintain optimal alignment and ROM with a 24-hour postural management regime that considers: • supine, side lying, sitting out - Employ appropriate use of positioning equipment: • rolls, towels, pillows, v-cushions, wedges, sleep systems - Enhance communication, awareness, swallow, social interaction - Three main aims: Maximise remaining functional ability Minimise secondary complications Minimise the effort of care
What kind of secondary complications result in inability to move or stabilise posture?
- Contracture and deformity - Tissue damage - Pain and discomfort - Infections - Osteoporosis
Thinking about NICE guidelines, what should the intensity of therapy be?
- At least 45 minutes of each therapy for a minimum of 5 days/week - If more therapy is needed then tailor the intensity to the person’s needs - If people cannot tolerate 45 minutes then offer 5 days per week of a shorter time interval
What are the main functional skills to relearn?
- Bed mobility / rolling - Unsupported sitting - Sit to stand - Transfers - Walking - Steps / stairs - Reach to grasp - Fine dexterity / manipulation
What are the interventions that are put in place for a stroke patient by a physiotherapist?
Exercises, strengthening Core stability training Postural management Soft tissue / joint mobilisations Stretches Splinting / casting Taping Gait re-education Balance work CV fitness work Specific task practise Pain management Spasticity management Provision of aids / orthoses supports Education / advice
Think of the flow diagram, what is the best way to develop your treatment session as a physiotherapist?
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