Long Term Management of Stroke (6) Flashcards
First few days - natural recovery
Resolution of oedema, reperfusion of ischemic penumbra
Weeks/months
Neuronal plasticity, cortical remodelling - dendrite sprouting, synaptic remodelling
Neglect occurs in which specific stroke?
Right parietal lobe
What is neglect?
Visual/somatosensory, failure to attend to/monitor your left side, can be confused with visual field defect/loss of sensation
Visual perception
Dorsal - where
Ventral - what
Agnosias
Inability to understand what an object is/other stimulus, can apply to any sensory modality, not just sensory
Visual agnosias
Unable to recognise common object by sight alone
Prosopoagnosia
Inability to recognise faces
Driving and DVLA
Absolute ban for 1 month, banned if seizure within past year, visual neglect, visual field defect, cognitive impairment, limb weakness - adapted vehicle
Dyspraxia
Loss of ability to conceptualise, plan and execute complex sequence of motor actions (loss of cortical pathways for initiating and performing skilled actions)
Where would lesions cause dyspraxia?
Left inferior parietal lobe/supplementary motor area
What difficulties would dyspraxia cause?
Identifying and knowing how to use objects, copying drawings, walking, dressing
Transfers
Hoist, standing hoist, ETAC turner, banana board
Apraxia
Inability to perform particular purposive actions
Environmental adaptions
Ramps, wet room, rocker knife (used one handed)
Spastic hemiparetic gait
Stiff legged (spasticity of ankle plantar flexors and knee flexors), short, slow steps, risk of falls (weak ankle, unable to dorsiflex), loss of righting reflexes
Management of gait
Split to correct foot drop, physiotherapy, manage spasticity, walking aides
Walking aides
Sticks, frames, improve stability by extending base of support
What is spasticity
Hyperexcitability of stretch reflex, co-existent tendon or soft tissue shortening
What does spasticity cause
Loss of function (impaired balance, manual dexterity), pain, unable to maintain skin hygiene in flexures
Treatment of spasticity
Physio, splinting (maintain joint range of movement)
Drug treatment of spasticity
Botulinum toxic injections (local) and baclofen (systemic)
WHO classification of disability
- Health condition
- Impairment of body structures and functions
- Limitations of activities
- Restriction of participation in society
- Environmental factors
- Personal factors
