Factors affecting Recovery Flashcards
List the main prognostic factors for recovery in stroke
- type of stroke
- severity/type of impairment
- site of lesion
- age at onset
- gender
- handedness
- ethnic/cultural background
- bilingual recovery
How does type of stroke affect recovery?
-better recovery with hemorrhagic than ischemic
How does severity/type of impairment affect recovery?
- larger lesion = less recovery
- severity of dysfunction is predictive of recovery (estimation of severity for prediction of recovery is most stable after 2 weeks)
- initial severity of auditory comprehension appears to be a factor in recovery, but not with severe aphasia
- good initial word comp is predictive of good recovery in naming
- severity of anomia associated with functional language gain
How does site and extent of lesion affect recovery
- large effect, depending on whether the lesion is in the primary language zone, or in borderline areas around that zone
- initial extent of infarct important predictor of recovery
- subcortical and cortical lesions recover differently, patients with subcortical lesions usually recovery dramatically over time
How does age of onset affect recovery?
- mixed results
- language severity correlated with age, but age not correlated with functional communication or language recovery
- age is a positive predictor of functional outcome and ADL recovery
How does gender affect recovery
- evidence mixed
- women may have greater stroke severity and poorer functional outcomes, with higher incidences of depression & cognitive impairment
How does handedness affect recovery
-evidence scarce and mixed
How does ethnic/cultural background affect recovery?
- Africans and caucasians don’t differ
- Minority populations at risk for brain injuries, greater severity of consequences and reduced rehab outcomes in US
What is the Rule of Ribot in bilingual recovery?
the first learned or native language recovers first
What is the rule of Pitres
the most frequently used language recovers first
If the Rule of Ribot or Pitres more common in recovery?
-Rule of Pitre (esp for patients under 60, and more for multilingual than bilinguals)
What is the synergistic parallel recovery pattern?
both languages impaired to same degree and recover at same rate
What is the synergistic differential recovery pattern?
languages are impaired to different degrees but recover at same rate
What is the selective pattern?
one language is affected more than the other
What is the successive recovery pattern?
one language improves first, followed by the other language improving
What is the antagonistic recovery pattern?
one language improves to the detriment of the other
What is the intermingled recovery pattern?
you get a lot of code switching
What is the alternate antagonism recovery pattern?
a see-saw, while one language improves, the other has a slight decrease and then it switches
Paradis found that the most likely recovery pattern for bilinguals was what?
synergistic parallel
How does pre-stroke depression affect stroke recovery?
associated with reduced stroke and aphasia recovery
How does post-stroke depression affect stroke recovery?
associated with poorer functional outcomes
The likelihood of post-stroke aphasia is _________ with aphasia
higher
How does educational level affect stroke recovery
evidence mixed
How does SES affect stroke recovery?
Lower SES associated with power functional recovery
For Time Post onset to SLP treatment, the greatest gains function occur within the first ________ months
3-4
How does exercise affect stroke recovery?
no studies on aphasia per se, but aerobic exercise has positive effects on brain function
How do spouses affect stroke recovery?
- marital status predictive of discharge location
- spouse either enriches or diminishes recovery process
- psychosocial attributes of spouse important
How does family affect stroke recovery?
positive emotional and social support from family predictive of positive outcomes
How do friends affect stroke recovery?
satisfaction with social support from friends associated with increased QOL
How does society affect stroke recovery?
access to community vs. barriers has impact on QOL
Incidence of aphasia after first ischemic stroke ranges from what percentages
23-35%
Stoke is the ________ leading cause of death
third
Compared to stroke patients without aphasia, patients with aphasia are …
- older
- have more severe strokes
- have more severe disabiity
- discharged to LTC more frequently
Presence of aphasia is predictive of …
- longer hospital stays
- increased use of rehab disability
- higher rates of thrombolytic therapy
T or F: out of many diseases and health conditions, aphasia was found to have the largest negative relationship with health related QOL measure in LTC settings
true
-Only ____% of society has a basic knowledge of aphasia
6
What is recovery at the micro level?
at a cellular or neural level
What is recovery at the macro level?
at a system or behavioural level
What are the 4 mechanisms of recovery at the micro level?
- resolution of diachisis
- restoration
- recruitment
- retraining
Define resolution of diaschisis
Diaschisis is the temporary inhibition of brain areas connected to the infarcted area. Due to affected neuronal pathways.
-Resolution involves the process of diaschisis getting better
Define restoration
- reactivation of brain areas that are immediately dysfunctional after injury
- occurs to a certain extent without therapy
Define recruitment
-the brain enlists parts of the brain that weren’t originally involved in the lost function to now be a part of carrying out that function
Define retraining
- as a result of rehabilitation, the brain areas now can perform the tasks that they were unable to as a result of the injury
- basically restoration after training
What are the primary changes that occur within a week post stroke and then stabilize
- necrosis
- inflammation
- retrograde/anterograde degeneration
What are the secondary changes that occur as a result of primary changes and evolve over time?
- transneuronal degeneration
- denervation supersenstivity
- development of diaschisis
- vascular disruption
- collateral sprouting
Describe transneural degeneration
Refers to the loss of connections between areas that are in communication with the cells. The communication lines degenerate between connected cells
Describe denervation supersensitivity
Neurons that have lost most of their input from the infarcted area, become increasingly sensitive to any residual input
Secondary changes can either be ________(changes within individual cells) or ________ (changes to neuronal connectivity)
structural
functional
What are the 4 behavioural mechanisms that occur as a result of intervention
- restitution
- reorganization
- relearning
- compensation
Define restitution
- behavioural mechanism
- the idea that the original site of activity is reinnervated and will be able to carry out the function it was previously doing before the injury
Define reorganization
- behavioural mechanism
- Rerouting different parts of the brain to carry out the same task, being able to do what you used to do but via different means
Define relearning
- behavioural mechanism
- You have to relearn how to do something that you lost how to do. Relearn it from scratch rather than re-accessing it
Define compensation
- behavioural mechanism
- A different system that is supported by a different brain area, one that remained intact. The original system won’t be able to do this task either by restitution, reorganization or relearning.
What cognitive factors are implicated in aphasia
- attention
- working memory
- executive function
What executive function skills are required for communication?
- attending to partner
- sequence information
- monitor ongoing communication
- shift strategies
- inhibit irrelevant information
