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Management of Disorders > Neuropsychological Rehab of Stroke > Flashcards

Neuropsychological Rehab of Stroke Flashcards

1
Q

What type of stroke may result in right sided neglect, right sided hemiplegia, or impaired verbal memory?

A

Left middle cerebral artery stroke

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2
Q

What type of stroke may lead to impaired judgement, left sided neglect, and visual memory difficulties?

A

Right middle cerebral artery stroke

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3
Q

A middle cerebral artery stroke on which hemisphere would lead to issues with insight?

A

Right

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4
Q

In which type of stroke might yoh see spatial-perceptual deficits, short attention span and social cognition changes?

A

Right middle cerebral artery stroke

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5
Q

A stroke in which artery might present with aphasia, slow performamce, and left-right confusion?

A

The left middle cerebral artery

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6
Q

What signs might indicate an anterior cerebral artery stroke?

A

Impaired judgement, personality change, contralateral weakness of lower extremities, apraxia

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7
Q

A stroke in which artery might lead to personality change, impaired judgement, and contralateral weakness of the lower limbs?

A

Anterior cerebral artery

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8
Q

Which type of stroke is most likely to result in aphasia and agnosia?

A

A middle cerebral artery stroke in the dominant hemisphere

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9
Q

What signs might indicate a middle cerebral artery stroke?

A

Upper extremities deficits, contralateral hemiparesis with sensory loss, and ipsilateral hemianopsia

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10
Q

A stroke in which artery might present with upper extremity deficits, contralateral hemiparesis with sensory loss, and ipsilateral hemianopsia

A

The middle cerebral artery

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11
Q

A stroke in which artery may lead to changes in vision, agnosia, memory deficits and altered mental status?

A

Posterior cerebral artery

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12
Q

What signs might indicate a vertebrobasilar artery stroke?

A

▪️ Vestibular effects
▪️ Visual effects
▪️ Motor defects
▪️ Loss of pain and temperatures on ipsilateral face and contralateral body

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13
Q

What type of stroke is typically associated with Wallenberg syndrome and Horner syndrome?

A

Posterior Inferior Cerebellar Artery (PICA)

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14
Q

What symptoms might be apparent with anterior inferior cerebellar artery stroke (AICA)?

A

▪️ Vertigo
▪️ Nystagmus
▪️ Nausea and vomiting
▪️ Ataxia of an extremity
▪️ Gaze palsy and ipsilateral face weakness
▪️ Deafness
▪️ Tinnitus

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15
Q

What are the main subtypes of lacunar infarcts?

A

▪️ Sensory stroke
▪️ Pure motor stroke
▪️ Combined motor and sensory resulting in ataxic hemiparesis

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16
Q

What neuropsychological interventions can be considered for impaired attention and speed of information processing?

A

▪️ Compensatory strategies (e.g., time pressure management)
▪️ Environmental modification (e.g., reduce distraction, organised work area)

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17
Q

What neuropsychological interventions can be offered for executive function deficits?

A

▪️ Compensatory techniques and meta-cognitive strategies (e.g., mental checklist)
▪️ Goal setting and feedback on functional tasks
▪️ External strategies (e.g., written lists, reminders)

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18
Q

What is neurological assessment used for in cases of memory impairment?

A

To understand where in the memory process is impaired
▪️ Attention
▪️ Encoding
▪️ Storage
▪️ Retrieval

19
Q

What neuropsychological interventions can be used for memory impairments post stroke?

A

▪️ Training and use of strategies (e.g., errorless learning, spaced retrieval)
▪️ External aids (e.g., reminders, checklists)

20
Q

What is ideomotor apraxia?

A

Inability to pantomime object use or to imitate a gesture

21
Q

What is ideational apraxia?

A

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

22
Q

How can we assess for apraxia?

A

Test of Upper Limb Apraxia (TULIA)

23
Q

What neuropsychological strategy can be used for apraxia?

A

Compensatory techniques

24
Q

What neuropsychological techniques can be used for the rehabilitation of neglect following stroke?

A

▪️ Scanning training (e.g., lighthouse strategy, Eye Search and Readright online therapy)
▪️ Alerting techniques (e.g., arm band)
▪️ Prism lenses

25
Q

What is homonymous hemianopia?

A

Loss of same part/half of the visual field in both eyes

(Quadrantanopia = a quarter)

26
Q

How many stroke patients experience communication difficulties?

A

~1/3

27
Q

What are the most common psychological effects of stroke?

A

▪️ Depression (33%)
▪️ Adjustment disorder
▪️ Anxiety (25%)
▪️ Pseudobulbar affect (20% in first 6 months)
▪️ Fatigue (43%)

28
Q

How many people experience fatigue post-stroke and what interventions are available?

A

▪️ 43% - very common!
▪️ CBT and pharmacological approaches

29
Q

What other disturbance are common following stroke?

A

▪️ Fatigue
▪️ Pain (neuropathic, musculo-skeletal, shoulder)
▪️ Sleep disturbance (may be part of mood disorder?)

30
Q

What behavioural difficulties are common following stroke?

A

▪️ Disinhibition
▪️ Impulsivity
▪️ Agitation/aggression
▪️ Not eating
▪️ Not sleeping

31
Q

What neuropsychological interventions can be offered for behavioural changes post-stroke?

A

▪️ Further assessment with functional analysis
▪️ Environmental modification
▪️ Reduction of identified triggers
▪️ Support guidelines for the tream

32
Q

When should neuropsychological evaluation/mood and cognition screening take place after stroke?

A

Within 6 weeks then at 6 and 12 months

33
Q

What is assessed during neuropsychological evaluation post-stroke?

A

Mood and cognitive functioning - identify both those presenting with changes and those vulnerable to mood disturbance

ASSESS BOTH DUE TO INTERACTION

34
Q

What can you use to screen for mood disturbance following a stroke?

A

▪️ 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

35
Q

What is the most common dementia following stroke?

A

Vascular dementia

36
Q

What screening tools can you used for cognitive impairment?

A

▪️ MoCA
▪️ AMT
▪️ MMSE
▪️ ACE-III

37
Q

What are the main challenges with cognitive screening?

A

▪️ 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

38
Q

How can neuropsychological rehabilitation post-stroke take a holistic approach?

A

Use functional and goal orientated treatments, specific and relevant to individual

39
Q

What is level 1 on the stepped care model?

A

▪️ Transitory emotional distress
▪️ Offer support from peers or ward staff

40
Q

What is level 2 on the stepped care model?

A

▪️ Mild/moderate mood, anxiety or behavioural issue interfering with rehabilitation
▪️ Specific recommendations from psychologist and support by specialist ward staff

41
Q

What is level 3 of the stepped care model?

A

▪️ Severe and persistent mood, anxiety, or behaviour
▪️ May need direct intervention from psychologist, risk assessment and follow up

42
Q

What neuropsychological interventions can be considered for depression, anxiety and distress following stroke?

A

▪️ 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

43
Q

What neuropsychological interventions may be considered for emotionalism/pseudobulbar affect?

A

▪️ Psychoeducation for person and significant others
▪️ Self-distraction strategies
▪️ Antidepressant medications and others people trialled

44
Q

When might a joint neuropsychiatry/neuropsychology approach be considered following stroke?

A

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

Management of Disorders (28 decks)

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