Lecture 2

Question 1

What is a stroke?

Answer 1

A rapidly developed disturbance of cerebral function laster more than 24 hours

Question 2

Signs of a stroke: FAST

Answer 2

F: face - drooping?
A: arms
S: speech
T: time

Question 3

Signs of a stroke

Answer 3

• Weakness or numbness
• Difficulty speaking
• Dizziness
• Loss of vision
• Headache
• Difficulty swallowing

Question 4

What is the Ischaemia mechanism of a stroke?

Answer 4

A blockage

Question 5

Types of ischaemia stroke

Answer 5

1. Thrombosis: where blockage is formed is where it stays
2. Embolus: blockage develops through system and blocks in a smaller passage
3. Systemic hypoperfusion: less pressure and blood flow through veins

Question 6

What is the Haemorrhage mechanism of a stroke?

Answer 6

A bleed

- Release of blood into surrounding brain tissue and extravascular spaces

Question 7

Total Anterior Circulation stroke symptoms

Answer 7

• Weakness or at least 2 of 3 body areas (face/arm/leg)
• Homonymous hemianopia (vision impairment)
• Higher cerebral disfunction (dysphasia, cognitive impairment)

Question 8

Partial Anterior Circulation stroke symptoms

Answer 8

• 2 of 3 of TAC criteria OR
• Restricted motor/sensory deficit e.g. one limb, face, and hand or
• Higher cerebral dysfunction alone

Question 9

Lacunar stroke symptoms

Answer 9

• Pure motor
• Pure sensory
• Sensorimotor
• Ataxic hemiparesis

Question 10

Posterior Circulation stroke symptoms

Answer 10

• Cranial nerve plasies with contralateral motor and/or sensory deficits
• Bilateral motor and/or sensory deficits
• Conjugate eye movement disorders
• Cortical blindness

Question 11

Types of recovery following stroke

Answer 11

1. Intrinsic recovery

2. Extrinsic recovery

Question 12

What is intrinsic recovery following stroke?

Answer 12

Local processes such as resolution of oedema

Question 13

What is extrinsic recovery following stroke?

Answer 13

Functional improvements that are not necessary linked with impairment resolution (e.g. motivation, ability to learn, family supports, quality and intensity of therapy)

Question 14

What is the best time for recovery following a stroke?

Answer 14

The first 2 months

Question 15

Factors that impact recovery

Answer 15

• Previous stroke
• Comorbidities
• Site of lesion
• Age

Question 16

What makes goal setting client centred?

Answer 16

• 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

Question 17

What is a SMART goal?

Answer 17

• Significant/specific
• Measurable
• Agreed upon/achievable
• Realistic/relevant
• Timely

Question 18

Enabling strategies: remediation

Answer 18

Strategies that aim to improve the person’s abilities required for occupational performance and engagement
>approaches remediate, restore and establish skills

Question 19

Enabling strategies: compensation

Answer 19

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

Question 20

Enabling strategies: education

Answer 20

Strategies that empower a client with information/knowledge that will enable them to change their behaviour, attitude, confidence, skills and decision making ability

Question 21

OT process in acute care

Answer 21

1. Occupational history/initial interview
2. Observational assessment of ADL
3. Assessment of performance based components
4. Early focus on prevention of secondary physical complications by working with

Question 22

OT process in rehab

Answer 22

Assessment as per acute setting

• move from screening to comprehensive assessment
• Increase focus on occupation and environment

Question 23

Aims of OT process in rehab

Answer 23

• Facilitate occupational performance using a rehab approach e.g.
  > remediation
  > compensation
  > edu

Question 24

Acute & rehab enabling strategies

Answer 24

- ADL retraining 
(adapted techniques or use of assistive devices) 
- Environmental modification 
- Motor and sensory remediation 
- Prevention of secondary complications

Question 25

Principles for one handed activity training

Answer 25

- 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

Question 26

ADL retraining e.g.

Answer 26

- One handed shoe lace tying - Donning a bra - How to put hair in ponytail

Question 27

Transition to community living (what to consider)

Answer 27

- Discharge planning - Client, family and caregiver edu - Return to work, leisure and driving - Sexuality

Question 28

What is the difference between recovery and compensation?

Answer 28

Recovery: achieving function through original process Compensation: achieving task using alternate behavioural processes

Question 29

Stages of neurological recovery

Answer 29

- Spontaneous: neurological repair mechanisms | - Forced: therapy-driven recovery

Question 30

What is neural plasticity?

Answer 30

- Basis for learning (in tact brain) - Basis for re-learning (damaged brain) - Plasticity is important to recover function after neural injury

Question 31

10 principles of neurorehab for neural plasticity

Answer 31

- Use it or lose it - Use it and improve it - Specificity - Repetition matters - Intensity matters - Time matters - Salience matters - Age matters - Transference - Interference

Question 32

Use it or lose it & use it and improve it

Answer 32

- Brain functions will start to degrade if not actively engaged - Training will protect and enhance brain function

Question 33

Specificity

Answer 33

The nature of the training dictates the nature of the plasticity - training is specific to each person and their needs

Question 34

Repetition matters

Answer 34

- Neurological reorganisation requires repetition - Also induces lasting neural changes - MUST occur outside of therapy (not just in)

Question 35

Intensity matters

Answer 35

- Training must be intense enough to stimulate experience-dependent neural plasticity - Also must be progressively modified to match the changing level of skill

Question 36

Time matters

Answer 36

- 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

Question 37

Salience matters

Answer 37

Neural plasticity is maximised by training that the individual wants to do - Sparks motivation and thus increased likelihood for neural adaptation

Question 38

Age matters

Answer 38

Brain processes reduce with ageing | - changes occur with ageing but may be less prominent and slower

Question 39

Transference

Answer 39

- Plasticity in response to a training experience may help to enhance the person's ability to do similar behaviours

Question 40

Interference

Answer 40

- Plasticity in response to a training experience can interfere with the person's ability to do other behaviours