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Management Neuropsychiatric Disorders > Neuropsychological Rehab of Stroke > Flashcards

Neuropsychological Rehab of Stroke Flashcards

1
Q

What is stroke?

A

Interruption/loss of blood suply to the brain leading to cell damage

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2
Q

What is an ischemic stroke?

A

Cerebral blood flow obstruction (plaque, blood clot) that can originate at the site of occlusion (thrombus) or at a distance from the occlusion (embolus)
Most common (88% of all cases)

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3
Q

What is a hemorrhagic stroke

A

Bleeding within the brain; most commonly caused by hypertension (50%) / in younger adults most commonly due to aneurysm or arteriovenous malformation (AVM)
12% of all cases

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4
Q

Name me 2 types of ischemic strokes

A
  • Left Middle Cerebral Artery Stroke
  • Right Middle Cerebral Artery Stroke
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5
Q

What are the symptoms of Left Middle Cerebral Artery stroke?

A
  • Right hemianopia/neglect
  • Right hemiplegia/paresis
  • Left right confusion
  • Apraxia
  • Impaired Verbal Memory
  • Impaired speech-aphasia
  • Slow performance
  • Awareness of deficits-depression/anxiety
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6
Q

Symptoms of Right Middle Cerebral Artery Stroke:

A
  • Impaired Judgement
  • Impulsive/safety problems
  • Left neglect
  • Left Hemianopia
  • Short attention span
  • Denies problems, insight difficulties
  • Spatial-perceptual deficits
  • Visual memory difficulties
  • Personality/ social cognition changes
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7
Q

What is the Hyper-acute stroke unit (HASU) for?

A

Immediate response to stroke

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8
Q

When can patient be transferred to local stroke unit (SU)?

A

When medically stable within 72h or earlier if appropriate.

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9
Q

What care does patient receive at the local stroke unit?

A

Multidisciplinary specialist rehabilitation & ongoing medical monitoring.

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10
Q

What happens after rehabilitation at the stroke unit?

A

1) discharged home with community rehabilitation and social care (as required)
2) transferred to post-acute rehab unit
3) transferred to residential or nursing home

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11
Q

Neuropsychological impairments of Attention and information processing speed post-stroke

A

1) Focused Attention
2) Divided Attention
3) Sustained Attention
4) Speed of processing information

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12
Q

Interventions for Attention and Speed of information processing:

A

1) Compensatory strategies, like time pressure management (setting timers/alarms, breaking tasks into smaller steps, using calendars, establishing routines & predictability, seeking assitance and deligating tasks)

2) Enivornmental modification (e.g. reduced distractions, have written plan, organised work area)

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13
Q

The cogntive strategy behind Time Pressure Management (TPM) - Main objectives

A

! To recognise time pressure in the task at hand
! To prevent as much time pressure as possible
! Dealing with time pressure as quicky and effectively as possible
! Urging the patient to monitor himself while using the TPM

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14
Q

Executive functions inpairment domains post-stroke:

A
  • Planning and executive tasks
  • Inhibition automatic impulses
  • Regulating emotional responses
  • Reasoning about risk and weighing up information
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15
Q

Which tests assess executive tasks?

A

Behavioural Assessment of Dysexecutive Syndrome (BADS)
Trail making tests
Delis-Kaplan Executive Functioning System (DKEFS)
Hayling & Brixton Tests

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16
Q

Interventions for executive functions

A
  • Compensatory techniques-Meta-cognitive strategies –Mental checklist
  • Stop-Think
  • Goal Management Training
  • Goal setting and feedback on functional tasks
  • External strategies (e.g. written checklists, electonic reminders)
17
Q

Goal Management Framework (GMF) for executive function

A
  1. What is my goal? (What am I trying to achieve?)
  2. Identify the possible solutions. (Think outside the box!)
  3. Weigh up the pro and cons.
  4. Make a decision and plan the steps.
  5. DO IT!
  6. Review it and evaluate.
18
Q

Domains of memory impairment post-stroke

A
  • Attention
  • Encoding, analysis/processing of information
  • Storage
  • Retrieval, searching/activating existing memory traces
19
Q

Types of memory:

A
  • Explicit
  • Implicit
  • Semantic
  • Episodic
  • Declarative
  • Procedural
20
Q

Assessement of Memory includes?

A

-Assess verbal and non-verbal memory

  • Possible test are Wechsler Memory scales, Rivermead behavioural memory test (RBMT)
21
Q

Interventions for memory impairment

A
  • Training and use of stragies (e.g.. spaced retrieval, deep encoding of material, errorless learning)
  • External aids (electronic reminders, written checklists)
22
Q

what is ideational apraxia?

A

the loss of concept of an action

23
Q

Which assessment tool is used for apraxia? And which rehab help to offer?

A

Test of Upper Limb Apraxia (TULIA)

Offer compensatory techniques

24
Q

Rehabilitation techniques for Spatial Neglect

A
  • Scanning training (e. g. Lighthouse strategy, Eye Search and Readright -UCL online therapy)
  • Alerting techniques (e.g. arm band, auditory alert)
  • Prism lenses
25
Q

Communiation aids for stroke survivors:

A
  • 1/3 stroke pateints have communication difficulties
  • cards stating “I have had a stroke…”
  • Careful assessement using Yes/No questions and technology/visual aids
26
Q

Help with NotFAST (Nottingham Fatigue After Stroke)

A

! Resting does not relief fatigue
- CBT
- Pharmacological approaches

27
Q

Pain post-stroke causes?

A
  • may be neuropathic
  • musculo-skeletal
  • shoulder pain
28
Q

Sleep disturbance post stroke interventions

A

! Assess if not part of a mood disorder
- sleep hygiene management
- pharmacological management

29
Q

Behavioural changes may require functional anaylsis of…

A
  • Disinhibition
  • Impulsivity
  • Agitation/Aggression
  • Not eating
  • Not sleeping
30
Q

How to address findings from functional anaylsis of behavioural changes?

A
  • environmental modification
  • reduction of triggers
  • support guidelines for the team
31
Q

Neuropsychological evaluation post-stroke:

A
  • Mood and cognitive functioning should be screened within 6 weeks of stroke = identify those with presenting emotional/ cognitive change or those vulnerable to mood disturbances
32
Q

What is a holistic rehab approach in stroke

A

-Functional, goal orientated treatment to release impact on daily life tasks
- goals are specific, relevant to patients, time limited, ambitious and incremental

  • include family and friends, voluntary agencies, social care and health care
33
Q

Stroke “Stepped Care Model” Levels

A

Level 3: Severe & Persistent mood/anx/behaviour = May need direct intervention from psychologist, RISK assessment, follow up

Level 2: Mild/Moderate anxiety or behaviour issue that interferes with rehab = May need specific recommendations from psychologist, support provided by specialist ward staff

Level 1: Emotional Distress - transitory worries, feeling low, frustrated = Support from peers and ward staff

34
Q

Interventions for Emontional functioning post-stroke (Depression, Anxiety, Distress)

A
  • Direct psychological interventions
  • Couple/Family work
  • Behavioural Activation - Increase social interaction, exercise, psychoeducation groups
  • Medication review after 4 months
  • Stepped/matched pathway approach
35
Q

Interventions for Emontional functioning post-stroke (emotionalism/pseudobulbar affect)

A
  • Psychoeducation for person and signficant others
  • Self-distraction strategies
    -Antidepressant medication and other medications now being trialled

Management Neuropsychiatric Disorders (16 decks)

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