Lecture 2 Flashcards
What is a stroke?
A rapidly developed disturbance of cerebral function laster more than 24 hours
Signs of a stroke: FAST
F: face - drooping?
A: arms
S: speech
T: time
Signs of a stroke
- Weakness or numbness
- Difficulty speaking
- Dizziness
- Loss of vision
- Headache
- Difficulty swallowing
What is the Ischaemia mechanism of a stroke?
A blockage
Types of ischaemia stroke
- Thrombosis: where blockage is formed is where it stays
- Embolus: blockage develops through system and blocks in a smaller passage
- Systemic hypoperfusion: less pressure and blood flow through veins
What is the Haemorrhage mechanism of a stroke?
A bleed
- Release of blood into surrounding brain tissue and extravascular spaces
Total Anterior Circulation stroke symptoms
- Weakness or at least 2 of 3 body areas (face/arm/leg)
- Homonymous hemianopia (vision impairment)
- Higher cerebral disfunction (dysphasia, cognitive impairment)
Partial Anterior Circulation stroke symptoms
- 2 of 3 of TAC criteria OR
- Restricted motor/sensory deficit e.g. one limb, face, and hand or
- Higher cerebral dysfunction alone
Lacunar stroke symptoms
- Pure motor
- Pure sensory
- Sensorimotor
- Ataxic hemiparesis
Posterior Circulation stroke symptoms
- Cranial nerve plasies with contralateral motor and/or sensory deficits
- Bilateral motor and/or sensory deficits
- Conjugate eye movement disorders
- Cortical blindness
Types of recovery following stroke
- Intrinsic recovery
2. Extrinsic recovery
What is intrinsic recovery following stroke?
Local processes such as resolution of oedema
What is extrinsic recovery following stroke?
Functional improvements that are not necessary linked with impairment resolution (e.g. motivation, ability to learn, family supports, quality and intensity of therapy)
What is the best time for recovery following a stroke?
The first 2 months
Factors that impact recovery
- Previous stroke
- Comorbidities
- Site of lesion
- Age
What makes goal setting client centred?
- Based on the client’s goals and needs
- Goal is measurable and directly related to ability to engage in meaningful occupation
- Develop short and long term goals
What is a SMART goal?
- Significant/specific
- Measurable
- Agreed upon/achievable
- Realistic/relevant
- Timely
Enabling strategies: remediation
Strategies that aim to improve the person’s abilities required for occupational performance and engagement
>approaches remediate, restore and establish skills
Enabling strategies: compensation
Strategies that aim to adapt the environment or the task to match a person’s ability
>aims to reduce the impact of impairment on occupational performance
Enabling strategies: education
Strategies that empower a client with information/knowledge that will enable them to change their behaviour, attitude, confidence, skills and decision making ability
OT process in acute care
- Occupational history/initial interview
- Observational assessment of ADL
- Assessment of performance based components
- Early focus on prevention of secondary physical complications by working with
OT process in rehab
Assessment as per acute setting
- move from screening to comprehensive assessment
- Increase focus on occupation and environment
Aims of OT process in rehab
- Facilitate occupational performance using a rehab approach e.g.
> remediation
> compensation
> edu
Acute & rehab enabling strategies
- ADL retraining (adapted techniques or use of assistive devices) - Environmental modification - Motor and sensory remediation - Prevention of secondary complications
Principles for one handed activity training
- Always include affected upper limb to maximise use of current abilities + assist in restoring function to the extremity
- Trial multiple methods
- If you teach, you must be competent and bale to demonstrate
ADL retraining e.g.
- One handed shoe lace tying
- Donning a bra
- How to put hair in ponytail
Transition to community living (what to consider)
- Discharge planning
- Client, family and caregiver edu
- Return to work, leisure and driving
- Sexuality
What is the difference between recovery and compensation?
Recovery: achieving function through original process
Compensation: achieving task using alternate behavioural processes
Stages of neurological recovery
- Spontaneous: neurological repair mechanisms
- Forced: therapy-driven recovery
What is neural plasticity?
- Basis for learning (in tact brain)
- Basis for re-learning (damaged brain)
- Plasticity is important to recover function after neural injury
10 principles of neurorehab for neural plasticity
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition matters
- Intensity matters
- Time matters
- Salience matters
- Age matters
- Transference
- Interference
Use it or lose it & use it and improve it
- Brain functions will start to degrade if not actively engaged
- Training will protect and enhance brain function
Specificity
The nature of the training dictates the nature of the plasticity - training is specific to each person and their needs
Repetition matters
- Neurological reorganisation requires repetition
- Also induces lasting neural changes
- MUST occur outside of therapy (not just in)
Intensity matters
- Training must be intense enough to stimulate experience-dependent neural plasticity
- Also must be progressively modified to match the changing level of skill
Time matters
- Some plasticity requires learning and functions that occur early in the process
- Specific interventions may be more or less effective depending on when they are introduced
Salience matters
Neural plasticity is maximised by training that the individual wants to do
- Sparks motivation and thus increased likelihood for neural adaptation
Age matters
Brain processes reduce with ageing
- changes occur with ageing but may be less prominent and slower
Transference
- Plasticity in response to a training experience may help to enhance the person’s ability to do similar behaviours
Interference
- Plasticity in response to a training experience can interfere with the person’s ability to do other behaviours
