Recovering from stroke Flashcards
What are the 2 facets to rehabilitation?
1) Restoration of function - as much as possible
2) Adaptation to disability if recovering function isnt possible
When does rehabilitation post stroke begin?
As soon as the patient is admitted to hospital
What 2 parts of physiological recovery happen within the first few days post stroke?
Natural recovery
1) Resolution of oedema
2) Reperfusion of ischaemic penumbra
What physiological recovery occurs weeks/months post stroke?
Neuronal plasticity = cortical remodelling
Includes dendrite sprouting, synaptic remodelling
What is neglect?
Problem of attention - failure to monitor/ attend to the LEFT side
Which is not explicable by visual field defect or loss or sensation
What are the 2 types of neglect?
1) Visual
2) Somatosensory
Neglect occurs in a stroke in what part of the brain?
Right parietal lobe stroke
Only in the RIGHT hemisphere, NOT in the L hemisphere
What may visual neglect be confused with?
A visual defect
What is agnosia?
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
What is visual agnosia?
Unable to recognise a common abject by sight alone. May be able to do when allowed to use other modalities eg. touch
What is prosopoagnosia?
Inability to recognise faces
What are the DVLA regulations for driving immediately post stroke?
Absolute ban for 1 month post stroke - patient has a legal responsability to inform the DVLA - rules are much stricter for HGVs
If a patient fails to inform the DVLA post stroke a doctor can breach confidentiality and do so - is this true?
Yes
What are the 4 reasons post stroke that a patient can have an absolute ban on driving from the DVLA?
1) Seizure within past year
2) Visual neglect
3) Visual field defect
4) Cognitive impairment
What is dyspraxia?
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
What 2 anatomical lesions can commonly lead to dyspraxia?
1) Left inferior parietal lobe
2) Supplementary motor area
Give 3 tasks that a patient suffering from dyspraxia may struggle with?
1) Identifying and knowing how to use objects
2) Copying drawings
3) Tasks such as walking and dressing
Give 4 options for patient transfers, what 2 factors would determine the method of choice?
Options: 1) Hoist 2) Standing hoist 3) ETAC turner 4) Banana board Method chose depends on: 1) Balance 2) Alertness and cognition
What process is key in discharge planning to determine whether it is feasible for a patient to live in their home?
Environmental visit examining the exterior, the interior and considering what environmental changes will need to be made
What is meant by spasticity?
Hyperexcitability of the stretch reflex - get increased muscle tone - may also be consequent tendon or soft tissue shortening
What are the 3 main consequences of spasticity?
1) Loss of function: impaired balance, manual dexterity
2) Unable to maintain skin hygiene in flexures
3) Pain
What are the 2 types of management for spasticity?
1) Physiotherapy and splinting to maintain joint range of movement
2) Drugs
What are the 2 drugs which can be used to manage spasticity?
1) Botulinum toxin injections - local
2) Baclofen - systemic
What percentage of younger patients want to return to work post stroke?
75%
What are the 5 common limiting factors for returning to work following stroke?
1) Fatigue
2) Depression
3) Cognition
4) Visual field defects
5) Communication problems (dysphasia)
What is the WHO classification of disability?
Health condition, environmental factors and personal factors leading to impairment of body structures and functions, limitation of activities and restriction of participation in society
Depression and anxiety in the family is common following stroke, give 5 ways this can be managed?
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
