Neuropsychological Rehabilitation of Stroke Flashcards
What might be evaluated in attention?
Focused attention
Divided attention (multitasking and cognitive flexibility)
Speed of processing
What are the types of apraxia?
Ideational apraxia - loss of concept of an action
Ideomotor apraxia - inability to imitate a gesture
What side of space does the left hemisphere attend to?
Right
What side of space does the right hemisphere attend to?
Left and right
A lesion in which hemisphere is the most likely to cause neglect?
Right hemisphere
(A lesion to the left hemisphere will be compensated for by the right)
What problems may exist with speech?
Aphasia - impairment of language
Dysarthria - speech impairment - slow, weak movements cause slurred speech
Apraxia - oral motor planning dysfunction - difficulty articulating words
According to the RCP, when should people be screened for mood and cognitive function after stroke?
Within 6 weeks
How prevalent is emotional lability after stroke.
20% if people in first 6 months
What areas of damage are related to emotional lability?
Frontal lobes, brain stem, thalamus, cerebellum
How prevalent is post stroke anxiety?
25%
What area of damage to the brain is related to apathy?
Medial prefrontal cortex and basal ganglia
What’s another name for emotional lability?
Pseudobulbar affect
How might one screen for mood?
Observation - Signs of depression scale
Self report
What are the levels of the stepped care model?
Level 1 - emotional distress - support from peers or ward staff
Level 2 - mild/moderate mood, anxiety or behavioural issue - specialist staff or psychologist recommendations
Level 3 - severe mood, anxiety or behavioural issue - psychological intervention and risk assessment
What interventions are there for pseudobulbar affect?
Psychoeducation
Self distraction strategies
Antidepressants are being trialled
What interventions are there for depression and anxiety?
Psychological interventions
Family work
Behavioural activation
Medication
What is the frontal lobe paradox?
Patients perform well in test settings but have impairments in everyday life (eg impulsivity even though they know what they should do)
It’s important to get collateral information and do observation
What areas would be affected by an occlusion in the right internal carotid artery?
Right frontal lobe
What symptoms would you see I. Someone with a right internal carotid artery stroke?
Cognitive inflexibility
Emotional lability
Disinhibition
Distractibility
Hemispatial neglect
What percentage of strokes are ICH?
~10%
What percentage of strokes are SAH?
5%
What deficits would left side MCA stroke result in?
Speech - aphasia
Performance (slow)
Muscle movement - hemiplegia/paresis
Vision - hemianopia
Verbal memory
Orientation - Gerstmann (L-R)
Apraxia
What deficits would right side MCA stroke result in?
Judgement
Impulse control
Vision - left hemianopia
Attention span
Attention to left side - hemispatial neglect
Insight - anosagnosia
Visual memory
Personality
How many HASUs are there in London?
6
<45 mins away from anywhere in London
Once medically stable, how soon are people repatriated to their local stroke unit?
Within 72 hours
Outside of their local SU, where else might a patient be repatriated to?
End of life care
Home (maybe with referral to community rehabilitation)
After rehab at SU, where are patients discharged to?
Home with community rehabilitation
Post acute rehabilitation
Residential/nursing home
What types of attention might be evaluated?
Focused attention
Divided attention
Sustained attention
Speed of processing
What interventions might be put in place for attention?
Compensatory - time pressure management
Environmental - reducing distractions, organising work area, writing a plan
What are the main elements of time pressure management?
Recognise time pressure in the task at hand
Prevent as much time pressure as possible
Dealing with time pressure quickly and effectively
Urging the patient to monitor themselves while using the strategy
What tests are specific to executive function?
Behavioural assessment of dysexecutive syndrome
Trail making tests
Dells Kaplan Executive Functioning Systems
Hayling & Brixton Tests
Damage to what area is typically responsible for hemispatial neglect?
Right parietal lobe
(Right covers both sides of the body, so left damage would be compensated for)
What strategies are used to rehabilitate hemispatial neglect?
Scanning training - Eye Search, Readright
Alerting techniques - wrist band, auditory alert
Prism lenses
