Lecture 10 Rehabilitation and Recovery Following a Stroke

Question 1

What does rehabilitation’s collective approach involve?

Answer 1

Speech and language therapists
Clinical psychologists
Doctors/Nurses
Physiotherapists
Occupational therapists
Family/friends

Question 2

What is the aim of rehabilitation?

Answer 2

To reduce disability and improve quality of life

Involving a multidisciplinary stroke team

Question 3

What do the multidisciplinary stroke team provide?

Answer 3

Cognitive therapy, psychotherapy
Pharmacological treatment
Exercises
Adaptation/Training - e.g. stair lifts, occupational therapists
Social support

Question 4

What are the physical impairments post-stroke?

Answer 4

Reduced muscle strength, altered sensation, coordination problems, balance impairment, hemiparesis/hemiplegia, altered gait pattern

Question 5

What are the ways of assessing physical impairment?

Answer 5

The National Institute of Health Stroke Scale (NIHSS)
The Barthel Index
The Modified Ranking Scale (mRS)

Question 6

Outline the NIHSS

Answer 6

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

Question 7

Outline the Barthel Index

Answer 7

An assessment of activities of daily living, easy to administer, and good reliability.
Not suitable for those paralysed or bed bound

Question 8

Outline the mRS

Answer 8

A global disability scale, good reliability and a broad measure
But may not be able to identify specific problems because it is quite broad

Question 9

Outline the physiotherapy used for physical impairments

Answer 9

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

Question 10

How is TMS used as therapy?

Answer 10

Used to promote neural plasticity, forming new neural connections and focusing on reducing disability at the brain level

Question 11

How does TMS work?

Answer 11

It sends electrical currents and increases cortical excitability in target areas, allowing areas to be focused on except those deep within the brain.

Question 12

What is the effectiveness of TMS as a therapy?

Answer 12

Been shown to improve motor function after just 2 weeks of therapy
Dependent on lesion location - not suitable for deep lesions
Further research required

Question 13

Outline robotics as a therapy

Answer 13

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

Question 14

Outline virtual reality as a therapy

Answer 14

Combines robotics with video games and makes it more engaging.

Has mixed results and further studies are needed

Question 15

How is mirror therapy used post-stroke?

Answer 15

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

Question 16

How does mirror therapy work?

Answer 16

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

Question 17

What is occupational therapies role in stroke?

Answer 17

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

Question 18

What are some factors which affect recovery?

Answer 18

Age, co-morbidities, stroke severity, motivation, family support, level of dependency

Question 19

What is involved in the early neurological recovery?

Answer 19

In the first few days - weeks:
Resolution of post stroke swelling
Reperfusion of ischaemic tissue
Recovery of partially damaged neurons

Question 20

What is involved in the later neurological recovery?

Answer 20

Training

Modification in structural and functional organisation

Question 21

How will an ageing population affect stroke prevalence?

Answer 21

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

Question 22

What is the most common and widely recognised impairment caused by stroke?

Answer 22

Motor impairment

It affects around 80% of patients to varying degrees

Question 23

What can the variety of impairments experienced have an impact on?

Answer 23

Motivation
Interaction with rehabilitation staff
Carry-over of learned activities

Question 24

Why is stroke recovery complex?

Answer 24

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

Question 25

What is an alternative method of stimulating a patient’s affected limb?

Answer 25

Electromyogram biofeedback delivers an auditory or visual stimulus to the patient via electrodes placed on the skin which can positively influence the patient’s use of their affected limb

Question 26

What is an additional therapy for motor recovery?

Answer 26

Meaningful Task Specific Training (MTST) has also proven effectiveness in motor recovery in the upper and lower limbs and gait-related activities

Question 27

How is stem cell therapy used post-stroke?

Answer 27

A new therapeutic approach
Enormous potential for the repair of the infarcted area of the brain through enhancing neuroprotective and repair mechanisms
Larger trials need to be conducted