Geriatrics - Immobility, Post-stroke care Flashcards
Immobility
Causes
Immobility
Approach
Immobility
Complications
Immobility
Management
Stroke rehabilitation
Recommended setting
Benefits of specilaized rehab
Stroke is a leading cause of adult disability, with significant impacts on physical function, self-care, and quality of life.
Recovery after stroke occurs through a combination of spontaneous neurological recovery and experience-induced neuroplasticity.
Rehabilitation: clinically meaningful improvements with physical/occupational therapy, such as increased independence in activities of daily living and walking speed.
Inpatient rehabilitation is recommended for patients too disabled to return home but able to participate in 3 hours of daily therapy, requiring ongoing medical care and supervision.
Inpatient rehabilitation in a specialized stroke unit improves outcomes compared to general hospital care.
Community-based rehabilitation with caregiver training can achieve similar functional outcomes to inpatient rehab for less disabled patients.
Caregiver training in assisting with swallowing, speech, walking, and daily activities is beneficial and can be monitored by outpatient therapists.
Coordination of outpatient therapies, community resource referrals, and counseling on issues like sexuality are important for supporting long-term recovery.
List examples of clinically significant post-stroke rehabilitation exercises
Aphasia:
- Speech therapist intervention
- More intensive aphasia therapy (40-100 hours) leads to greater improvements, especially in the first 6 months
Self care and arm function:
- Functional training emphasizes compensatory strategies for those with moderate disability, not severe disability
- Task-oriented practice shows greater benefit than general rehabilitation
- Constraint-induced movement therapy can improve affected arm use
Walking:
- Independent walking is a common goal, requiring practice even with assistance
- Slow walkers (< 0.4 m/s) can improve with 12-20 hours of task-oriented exercise over 4 weeks
- Treadmill training with partial body-weight support may help
Stroke related complications
Stroke related iatrogenic complications
Risk of recurrent stroke
Stroke recurrence prevention strategies
BP targets post-stroke
HbA1c targets post stroke
Use of anticoagulant post-stroke
Stroke risk in AF calculation
Stroke prevention anticoagulant choice
Estimate risk of major bleeding for patients on anticoagulant?
