National Stroke Foundation Guidelines

Question 1

What do the levels of evidence mean (A, B, C, GPP)?

Answer 1

A - Can be trusted to guide practice
B- Can be trusted to guide practice in most situations
C- Some support for recommendation, but take care in application
GPP - Best practice based on clinical expertise and expert opinion

Question 2

What does the NSF recommend for spasticity? (3 points, Week 2, p. 5)

Answer 2

• For mild to moderate spasticity, just follow regular, early, comprehensive therapy program - GPP
• For moderate to severe, Botox A can be trialled along with rehabilation which sets clear goals - B.
• For moderate to severe, ES and biofeedback - B.

Question 3

NSF Guidelines for strength (3 points, week 2, p. 8)

Answer 3

–Progressive resistance exercises - B
-Electrical stimulation - B
Electromyographic biofeedback + conventional therapy - C

Question 4

NSF guidelines for co-ordination training (1 point, week 2, p. 17)

Answer 4

-Grade A or B recommendation for task specific training

Question 5

NSF Guidelines for sensation training (2 points, week 2, p. 18)

Answer 5

• Sensory specific training for sensory loss - C

- Sensory training designed to facilitate transfer - C

Question 6

NSF Guidelines for fitness training (2 points, week 3, p. 2)

Answer 6

• Rehab should include interventions to increase cardiovascular fitness, once there is sufficient strength in the LL - A
• Patients should undertake regular, ongoing fitness training - GPP

Question 7

NSF Guidelines for contracture (4 points, week 3, p. 3)

Answer 7

• Conventional therapy (a.k.a. early, tailored interventions) - GPP
• Routine use of splints, and prolonged positioning of muscles in lengthened position is NOT recommended - B
• Overhead pulleys should not be used routinely for shoulder ROM - C
• Serial casting can be used to reduce severe, persistent contracture when conventional therapy has failed - GPP

Question 8

NSF guidelines for people who are immobile, to PREVENT swelling (3 points, week 3. p. 6)

Answer 8

• Dynamic pressure garments - C
• ES - C
• Elevation of the limb when resting - GPP

Question 9

NSF guidelines for people who are immobile, to REDUCE swelling in the hand and foot (4 points, week 3. p. 6)

Answer 9

• Dynamic pressure garments - C
• ES - C
• Continuous passive motion with elevation - D
• Elevation of the limb when resting - GPP

Question 10

NSF guidelines for shoulder subluxation prevention (4 points, week 3, p. 7)

Answer 10

For those with severe weakness who are AT RISK:

• ES - B
• firm support devices - GPP
• Education and training for the patient, family, carers and staff on how to handle the limb - GPP

For those who HAVE DEVELOPED a subluxed shoulder:
-Firm support devices to prevent further subluxation - GPP

Question 11

NSF Guidelines for shoulder pain prevention (5 points, week 3, p. 9)

Answer 11

For people with severe weakness who are AT RISK of developing shoulder pain:

• Shoulder strapping - B
• Education of staff, carers etc. - GPP

For people who DEVELOP shoulder pain:
-Evidence based interventions for acute shoulder pain - GPP

NOT RECOMMENDED as routine interventions:

• Corticosteriod injections - C
• Ultrasound - C

Question 12

What is the NSF evidence for STS training? (1 point, week 4, p. 7)

Answer 12

Practice standing up - A

Question 13

What is the NSF evidence for sitting training? (1 point, week 4, p. 2)

Answer 13

Practice reaching beyond arm’s length (in sitting, with supervision). - B

Question 14

What is the NSF evidence for training standing (still, not STS). (1 point, week 4, p.5)

Answer 14

Task specific standing training with feedback - B