Introduction to Stroke

Question 1

Difference between stroke and transient ischemic attack.

Answer 1

Stroke - acute episode of focal dysfunction of the brain lasting longer than 24h, imaging shows focal infarction.
TIA - focal dysfunction less than 24h, resolve on its own, no evidence in imaging that shows focal infarction.

Question 2

Name 3 ways to classify stroke.

Answer 2

1. by location (e.g. total anterior circulation syndrome, partial anterior circulation syndrome, lacunar syndrome, posterior circulation syndrome, etc.) - OCSP classication
2. by cause (e.g. atherosclerosis, cardiac pathology, etc.) - TOAST classification
3. by pathology (e.g. ischemic and haemorrhagic)

Question 3

List the possible causes for haemorrhagic stroke.

Answer 3

hypertension, bleeding disorder, overdose of anticoagulant, vascular malformation, artery dissection.

Question 4

List the possible causes for ischemic stroke.

Answer 4

atrial fibrillation, atherosclerosis, small vessel disease.

Question 5

List risk factors of stroke, highlight the major risk factor.

Answer 5

• High blood pressure (most impt factor)
• High BMI
• Smoking
• Diabetes
• Alcohol
• High cholesterol
• Lack physical activity

Question 6

What does F.A.S.T represent in detecting stroke.

Answer 6

F - face droop/ weakness
A - arm weakness
S - speech difficulty
T - time loss = brain loss

Question 7

List the possible management for stroke.

Answer 7

1. medications (e.g. Tissue plasminogen activator TPA, aspirin, warfarin, heparin, anti-hypertensives, lipid modification drugs)
2. Thrombectomy (e.g. stenting)
3. Neurosurgery (e.g. clipping aneurysm)
4. Patient education (e.g. lifestyle modification to control risk factors)

Question 8

Describe the roles of physiotherapy in Stroke rehabiliation.

Answer 8

• chest physiotherapy
• regain indepedence in activities as much as possible
• determine rehabiliation potential
• determine discharge plans
• liase with other healthcare professionals

Question 9

Is early mobilisation post-stroke beneficial?

Answer 9

Yes, but only after 24h post-stroke. Include intensive task-specific practice for all activities.
One-on-one, semi-supervised, independent exercise.

Question 10

What do you need to consider when planning rehabilitation for stroke patients?

Answer 10

• conduct a good assessment that incorporate both impairments (e.g. muscle weakness, sensation loss, visual loss, etc.) and activity limitations.
• decide treatment based on patient’s goals, refer closely to ICF framework.
• emphasis on high-repetitive task-oriented and task-specific training.

Question 11

What are the practice variables that influence training of a motor skill?

Answer 11

1. intensity of practice (high amount/dosage to induce neuroplasticity) - 2-3h/day of active practice + 100 reps/day
2. specificity of practice (practice should be similar to actual functional movement and context)
3. variability of practice (vary parameters of exercise to enhance learning)

Question 12

What do you need to consider when setting up semi-supervised practice?

Answer 12

• cognition of patient
• selection of task and difficulty
• environment set-up to ensure safety and reducing compensatory behaviour
• set-up to provide feedback (either performance/results)

Question 13

Describe ways to motivate a patient.

Answer 13

• ensure relevance of exercise to goals/skills
• ensure goals are identifiable and specific to patient
• ensure exercise not too easy or hard.
• Let patient choose exercise
• provide encouraging feedback
• assess outcome regularly
• use reward system