Neuropsychological Rehab of Stroke Flashcards
What type of stroke may result in right sided neglect, right sided hemiplegia, or impaired verbal memory?
Left middle cerebral artery stroke
What type of stroke may lead to impaired judgement, left sided neglect, and visual memory difficulties?
Right middle cerebral artery stroke
A middle cerebral artery stroke on which hemisphere would lead to issues with insight?
Right
In which type of stroke might yoh see spatial-perceptual deficits, short attention span and social cognition changes?
Right middle cerebral artery stroke
A stroke in which artery might present with aphasia, slow performamce, and left-right confusion?
The left middle cerebral artery
What signs might indicate an anterior cerebral artery stroke?
Impaired judgement, personality change, contralateral weakness of lower extremities, apraxia
A stroke in which artery might lead to personality change, impaired judgement, and contralateral weakness of the lower limbs?
Anterior cerebral artery
Which type of stroke is most likely to result in aphasia and agnosia?
A middle cerebral artery stroke in the dominant hemisphere
What signs might indicate a middle cerebral artery stroke?
Upper extremities deficits, contralateral hemiparesis with sensory loss, and ipsilateral hemianopsia
A stroke in which artery might present with upper extremity deficits, contralateral hemiparesis with sensory loss, and ipsilateral hemianopsia
The middle cerebral artery
A stroke in which artery may lead to changes in vision, agnosia, memory deficits and altered mental status?
Posterior cerebral artery
What signs might indicate a vertebrobasilar artery stroke?
▪️ Vestibular effects
▪️ Visual effects
▪️ Motor defects
▪️ Loss of pain and temperatures on ipsilateral face and contralateral body
What type of stroke is typically associated with Wallenberg syndrome and Horner syndrome?
Posterior Inferior Cerebellar Artery (PICA)
What symptoms might be apparent with anterior inferior cerebellar artery stroke (AICA)?
▪️ Vertigo
▪️ Nystagmus
▪️ Nausea and vomiting
▪️ Ataxia of an extremity
▪️ Gaze palsy and ipsilateral face weakness
▪️ Deafness
▪️ Tinnitus
What are the main subtypes of lacunar infarcts?
▪️ Sensory stroke
▪️ Pure motor stroke
▪️ Combined motor and sensory resulting in ataxic hemiparesis
What neuropsychological interventions can be considered for impaired attention and speed of information processing?
▪️ Compensatory strategies (e.g., time pressure management)
▪️ Environmental modification (e.g., reduce distraction, organised work area)
What neuropsychological interventions can be offered for executive function deficits?
▪️ Compensatory techniques and meta-cognitive strategies (e.g., mental checklist)
▪️ Goal setting and feedback on functional tasks
▪️ External strategies (e.g., written lists, reminders)
What is neurological assessment used for in cases of memory impairment?
To understand where in the memory process is impaired
▪️ Attention
▪️ Encoding
▪️ Storage
▪️ Retrieval
What neuropsychological interventions can be used for memory impairments post stroke?
▪️ Training and use of strategies (e.g., errorless learning, spaced retrieval)
▪️ External aids (e.g., reminders, checklists)
What is ideomotor apraxia?
Inability to pantomime object use or to imitate a gesture
What is ideational apraxia?
The loss of the concept of action
I.e., inability to plan movements related to interaction with an object due to loss of perception of its purpose
How can we assess for apraxia?
Test of Upper Limb Apraxia (TULIA)
What neuropsychological strategy can be used for apraxia?
Compensatory techniques
What neuropsychological techniques can be used for the rehabilitation of neglect following stroke?
▪️ Scanning training (e.g., lighthouse strategy, Eye Search and Readright online therapy)
▪️ Alerting techniques (e.g., arm band)
▪️ Prism lenses
What is homonymous hemianopia?
Loss of same part/half of the visual field in both eyes
(Quadrantanopia = a quarter)
How many stroke patients experience communication difficulties?
~1/3
What are the most common psychological effects of stroke?
▪️ Depression (33%)
▪️ Adjustment disorder
▪️ Anxiety (25%)
▪️ Pseudobulbar affect (20% in first 6 months)
▪️ Fatigue (43%)
How many people experience fatigue post-stroke and what interventions are available?
▪️ 43% - very common!
▪️ CBT and pharmacological approaches
What other disturbance are common following stroke?
▪️ Fatigue
▪️ Pain (neuropathic, musculo-skeletal, shoulder)
▪️ Sleep disturbance (may be part of mood disorder?)
What behavioural difficulties are common following stroke?
▪️ Disinhibition
▪️ Impulsivity
▪️ Agitation/aggression
▪️ Not eating
▪️ Not sleeping
What neuropsychological interventions can be offered for behavioural changes post-stroke?
▪️ Further assessment with functional analysis
▪️ Environmental modification
▪️ Reduction of identified triggers
▪️ Support guidelines for the tream
When should neuropsychological evaluation/mood and cognition screening take place after stroke?
Within 6 weeks then at 6 and 12 months
What is assessed during neuropsychological evaluation post-stroke?
Mood and cognitive functioning - identify both those presenting with changes and those vulnerable to mood disturbance
ASSESS BOTH DUE TO INTERACTION
What can you use to screen for mood disturbance following a stroke?
▪️ Observation
▪️ Self-report (e.g., HADS)
▪️ SODS and SADQ H10 are validated for use with stroke patients
▪️ Consider other factors than scores
▪️ Ensure measures are short and practical
What is the most common dementia following stroke?
Vascular dementia
What screening tools can you used for cognitive impairment?
▪️ MoCA
▪️ AMT
▪️ MMSE
▪️ ACE-III
What are the main challenges with cognitive screening?
▪️ Emphasis on memory
▪️ Not all can be assessed due to language or physical impairments
▪️ Need more than score alone - ecological validity?
▪️ No specific test of mental capacity
How can neuropsychological rehabilitation post-stroke take a holistic approach?
Use functional and goal orientated treatments, specific and relevant to individual
What is level 1 on the stepped care model?
▪️ Transitory emotional distress
▪️ Offer support from peers or ward staff
What is level 2 on the stepped care model?
▪️ Mild/moderate mood, anxiety or behavioural issue interfering with rehabilitation
▪️ Specific recommendations from psychologist and support by specialist ward staff
What is level 3 of the stepped care model?
▪️ Severe and persistent mood, anxiety, or behaviour
▪️ May need direct intervention from psychologist, risk assessment and follow up
What neuropsychological interventions can be considered for depression, anxiety and distress following stroke?
▪️ Direct psychological interventions (e.g., CBT)
▪️ Couple/family work
▪️ Behavioural activation - increase social interaction, exercise and psychoeducation
▪️ Medication review after 4 months
▪️ Stepped/matched pathway approach
What neuropsychological interventions may be considered for emotionalism/pseudobulbar affect?
▪️ Psychoeducation for person and significant others
▪️ Self-distraction strategies
▪️ Antidepressant medications and others people trialled
When might a joint neuropsychiatry/neuropsychology approach be considered following stroke?
In those with severe and persistent emotional problems, cognitive impairment, and/or communication difficulties
▪️ Moderate to severe
▪️ Unresponsive to high-intensity psychological interventions or pharmacological treatments
