Recovering from stroke

Question 1

What are the 2 facets to rehabilitation?

Answer 1

1) Restoration of function - as much as possible

2) Adaptation to disability if recovering function isnt possible

Question 2

When does rehabilitation post stroke begin?

Answer 2

As soon as the patient is admitted to hospital

Question 3

What 2 parts of physiological recovery happen within the first few days post stroke?

Answer 3

Natural recovery

1) Resolution of oedema
2) Reperfusion of ischaemic penumbra

Question 4

What physiological recovery occurs weeks/months post stroke?

Answer 4

Neuronal plasticity = cortical remodelling

Includes dendrite sprouting, synaptic remodelling

Question 5

What is neglect?

Answer 5

Problem of attention - failure to monitor/ attend to the LEFT side
Which is not explicable by visual field defect or loss or sensation

Question 6

What are the 2 types of neglect?

Answer 6

1) Visual

2) Somatosensory

Question 7

Neglect occurs in a stroke in what part of the brain?

Answer 7

Right parietal lobe stroke

Only in the RIGHT hemisphere, NOT in the L hemisphere

Question 8

What may visual neglect be confused with?

Answer 8

A visual defect

Question 9

What is agnosia?

Answer 9

Modality specific inability to access semantic (ability to name) knowledge of an object (or other stimulus) - can apply to any sensory modality but is not attributable to sensory impairment alone

Question 10

What is visual agnosia?

Answer 10

Unable to recognise a common abject by sight alone. May be able to do when allowed to use other modalities eg. touch

Question 11

What is prosopoagnosia?

Answer 11

Inability to recognise faces

Question 12

What are the DVLA regulations for driving immediately post stroke?

Answer 12

Absolute ban for 1 month post stroke - patient has a legal responsability to inform the DVLA - rules are much stricter for HGVs

Question 13

If a patient fails to inform the DVLA post stroke a doctor can breach confidentiality and do so - is this true?

Answer 13

Yes

Question 14

What are the 4 reasons post stroke that a patient can have an absolute ban on driving from the DVLA?

Answer 14

1) Seizure within past year
2) Visual neglect
3) Visual field defect
4) Cognitive impairment

Question 15

What is dyspraxia?

Answer 15

Loss of ability to conceptualise, plan and execute complex sequences of motor actions (Eg. brushing teeth, using tools) which is not explained by weakness or lack of comprehension of the task but is due to loss of cortical pathways for initiating and performing skilled actions

Question 16

What 2 anatomical lesions can commonly lead to dyspraxia?

Answer 16

1) Left inferior parietal lobe

2) Supplementary motor area

Question 17

Give 3 tasks that a patient suffering from dyspraxia may struggle with?

Answer 17

1) Identifying and knowing how to use objects
2) Copying drawings
3) Tasks such as walking and dressing

Question 18

Give 4 options for patient transfers, what 2 factors would determine the method of choice?

Answer 18

Options:
1) Hoist
2) Standing hoist
3) ETAC turner
4) Banana board
Method chose depends on:
1) Balance
2) Alertness and cognition

Question 19

What process is key in discharge planning to determine whether it is feasible for a patient to live in their home?

Answer 19

Environmental visit examining the exterior, the interior and considering what environmental changes will need to be made

Question 20

What is meant by spasticity?

Answer 20

Hyperexcitability of the stretch reflex - get increased muscle tone - may also be consequent tendon or soft tissue shortening

Question 21

What are the 3 main consequences of spasticity?

Answer 21

1) Loss of function: impaired balance, manual dexterity
2) Unable to maintain skin hygiene in flexures
3) Pain

Question 22

What are the 2 types of management for spasticity?

Answer 22

1) Physiotherapy and splinting to maintain joint range of movement
2) Drugs

Question 23

What are the 2 drugs which can be used to manage spasticity?

Answer 23

1) Botulinum toxin injections - local

2) Baclofen - systemic

Question 24

What percentage of younger patients want to return to work post stroke?

Answer 24

75%

Question 25

What are the 5 common limiting factors for returning to work following stroke?

Answer 25

1) Fatigue
2) Depression
3) Cognition
4) Visual field defects
5) Communication problems (dysphasia)

Question 26

What is the WHO classification of disability?

Answer 26

Health condition, environmental factors and personal factors leading to impairment of body structures and functions, limitation of activities and restriction of participation in society

Question 27

Depression and anxiety in the family is common following stroke, give 5 ways this can be managed?

Answer 27

1) Specifically ask about carer strain
2) Provide information about diagnosis and plan
3) Ask about rearrangements for respite care
4) Refer for benefits advice: many carers do not claim the benefits they are entitled to
5) Voluntary organisations eg. stroke association