Lecture 10 Rehabilitation and Recovery Following a Stroke Flashcards
What does rehabilitation’s collective approach involve?
Speech and language therapists Clinical psychologists Doctors/Nurses Physiotherapists Occupational therapists Family/friends
What is the aim of rehabilitation?
To reduce disability and improve quality of life
Involving a multidisciplinary stroke team
What do the multidisciplinary stroke team provide?
Cognitive therapy, psychotherapy Pharmacological treatment Exercises Adaptation/Training - e.g. stair lifts, occupational therapists Social support
What are the physical impairments post-stroke?
Reduced muscle strength, altered sensation, coordination problems, balance impairment, hemiparesis/hemiplegia, altered gait pattern
What are the ways of assessing physical impairment?
The National Institute of Health Stroke Scale (NIHSS)
The Barthel Index
The Modified Ranking Scale (mRS)
Outline the NIHSS
A brief scale with good reliability, sensitive for serial monitoring, good for long term measurements
But lacks sensitivity to certain deficits due to briefness and doesn’t identify cause of deficit
Outline the Barthel Index
An assessment of activities of daily living, easy to administer, and good reliability.
Not suitable for those paralysed or bed bound
Outline the mRS
A global disability scale, good reliability and a broad measure
But may not be able to identify specific problems because it is quite broad
Outline the physiotherapy used for physical impairments
Strength training - rebuild muscles, reduce limb weakness
Fitness training - not too disabled but minor changes to mobility
Walking therapies - often use treadmills, in quite severe cases and altered gait
How is TMS used as therapy?
Used to promote neural plasticity, forming new neural connections and focusing on reducing disability at the brain level
How does TMS work?
It sends electrical currents and increases cortical excitability in target areas, allowing areas to be focused on except those deep within the brain.
What is the effectiveness of TMS as a therapy?
Been shown to improve motor function after just 2 weeks of therapy
Dependent on lesion location - not suitable for deep lesions
Further research required
Outline robotics as a therapy
Adds variety and interest to rehabilitation, but needs additional therapies, just provides assistance when individual is unable to perform some functions
Improves activities of daily living, improves arm function, but not improvement in muscle strength and needs to be combined with physiotherapy
Outline virtual reality as a therapy
Combines robotics with video games and makes it more engaging.
Has mixed results and further studies are needed
How is mirror therapy used post-stroke?
Maximised neural plasticity, use fMRIs whilst doing it, using the unaffected limb to write/draw but look in the mirror so it tricks the brain into thinking that the affected limb is working
Improves sensation in the affected arm, has the potential to be effective but not got much research. Further research to determine intensity and duration
How does mirror therapy work?
The primary somatosensory cortex and motor cortex are involved and are neighbouring regions,
In stroke brains during MT, the visual feedback that they receive from the reflection of unaffected limb can make it possible for it to perceive sensation in the affected limb.
Reactivates damaged pathways
What is occupational therapies role in stroke?
The re-learning of everyday activities e.g. getting out of bed, to help the individual focus on recovery and regain confidence
Requires a lot of repeated training after an initial assessment and formation of plans
What are some factors which affect recovery?
Age, co-morbidities, stroke severity, motivation, family support, level of dependency
What is involved in the early neurological recovery?
In the first few days - weeks:
Resolution of post stroke swelling
Reperfusion of ischaemic tissue
Recovery of partially damaged neurons
What is involved in the later neurological recovery?
Training
Modification in structural and functional organisation
How will an ageing population affect stroke prevalence?
It is thought that by 2030, stroke prevalence will have increased by 25% in the USA, due to an ageing population
This will lead to an increased demand on health services, as older people often suffer more severe functional loss
What is the most common and widely recognised impairment caused by stroke?
Motor impairment
It affects around 80% of patients to varying degrees
What can the variety of impairments experienced have an impact on?
Motivation
Interaction with rehabilitation staff
Carry-over of learned activities
Why is stroke recovery complex?
It is heterogeneous and complex
By creating specific learning situations in stroke recovery, neural plasticity is promoted
Stroke unit care has the greatest positive impact on disability levels - key component is a well coordinated MDT
