recovery after stroke Flashcards
what are the two important questions during the assessment of a stroke patient?
- do you know where you are?
- can you hear me?
how many times does stroke approximately occur in the UK a year?
- approximately 152,000 times a year
how many first time incidence occurs in a year?
-17 million
how many stroke survivors are there in the UK?
- 1.2 million stroke survivors in the UK
how many per 10 stroke survivors go onto having recurrent strokes or TIA?
- 3 in 10 stroke survivors
how many strokes are fatal within the first 30 days compared to within a year?
- 1 in 8 strokes are fatal within the first 30 days
- 1 in 4 strokes are fatal within a year
what number is stroke the cause of death in the UK and in the world?
- fourth single largest cause of death in the UK
- second in the world
by the age of 75, how many women and men will have a stroke?
- by 75, 1 in 5 women and 1 in 6 men will have a stroke
what race are more likely to have a stroke? how much by?
- black people are twice as likely to have a stroke compared to white people
how does race affect stroke onset?
- black and south asian people have strokes at a younger age compared to white people
what is stroke one of the largest of?
- largest causes of disability
how much stroke survivors in the UK depend on others? how many of these are family/ friends?
- over a third of stroke survivors in the UK are dependent on others
- of those 1 in 5 are cared for by family and/ or friends
how much is spent on medical research each year for stroke patients?
- £48 a year for every stroke patient
what percentage of first stroke survivors regain independence?
- 58% of first stroke survivors regain independence
what percentage of first stroke survivors can walk?
- 82% walk independently
- with or without an aid
what time frame is most recovery? when is least recovery?
- most recovery in first 2 months
- less recovery at 4-5 months
- at 6 months, little further recovery expected
what are needed for stroke management and heterogeneity?
- reliable predictors needed
what do we need to know to assess stroke intervention?
- need to know about recovery patterns
what needs to be set in stroke management?
- set realistic/ attainable goals (inform communication with patient)
what should stroke management and heterogeneity facilitate?
- should facilitate proper discharge planning
- anticipate home adjustments/ community support
what are prognostic indicators of stroke? (9)
- disability on admission
- urinary continence
- degree of motor paresis
- sitting balance
- age
- comorbidity
- level of consciousness in first 48 hours
- orientation in time and place (cognitive status)
- depression
what percentage of stroke patients walk at 6 months?
- 60-80% of stroke patients are walking at 6 months
what occurs in the affected lower limb at 2-4 weeks? what is this associated with?
- sitting balance and strength in the affected lower limb at 2-4 weeks associated with achieving independent gait
what percentage of stroke patients do not show any recovery in upper limb function at 6 months?
- 33-66% of stroke patients do not show any recovery in upper limb function at 6months
what percentage of stroke patients show full recovery in upper limb function?
- 5 to 20% show full recovery
what do those who make functional gains later show?
- those who make functional gains later show some improvement in impairment within first 4 weeks
when do greatest gains occur in treatment?
- greatest gains occur within the first three months after stroke
what should be kept in mind when using predictors?
- keep in mind that exceptions to the prediction rules exist
what is the main classification system used for ischaemic stroke?
- Bamford classification
what are the 4 classifications of stroke?
- total anterior circulation stroke
- partial anterior circulation stroke
- lacunar syndrome
- posterior circulation syndrome
what is TACS?
- total anterior circulation stroke
- large cortical stroke affecting the area of the brain supplied by both the middle and anterior cerebral arteries
what three things need to be present for a diagnosis of TACS?
- unilateral weakness (and/ or sensory deficit) of the face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
what is PACS?
- partial anterior circulation stroke
- only part of the anterior circulation has been compromised
what two of the three need to be present for a PACS diagnosis?
- unilateral weakness (and/ or sensory deficit) of the face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
what is POCS?
- posterior circulation syndrome
- damage to the area of the brain supplied by the posterior circulation e.g., cerebellum
what one of the five need to be present for a POCS diagnosis?
- Cranial nerve palsy and a contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder (e.g. horizontal gaze palsy)
- Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
- Isolated homonymous hemianopia
what is LACS?
- lacunar stroke
- subcortical stroke that occurs secondary to small vessel disease
is there loss of higher cerebral function in LAS?
- no loss of higher cerebral functions e.g., dysphasia
which one of the four following need to be present for a diagnosis of LACS?
- pure sensory stroke
- pure motor stroke
- sensori- motor stroke
- ataxic hemiparesis
what are the 4 physiotherapy approaches for stroke?
- restorative vs compensatory
- bobath; brunstrom, PNF, motor learning programme
- controversies
- guidelines e.g., arm re-education
what are you likely to need help with after a stroke? what is this known as?
- need help to regain old abilities, learn new skills an cope with any remaining disabilities
- known as rehabilitation
what do physiotherapists use for stroke patients? why?
- use specific exercises, techniques and massage to keep muscles and joints in working order
what is neural plasticity?
- process that involves adaptive structural and functional changes to the brain
what are the three evidence- based therapies used in stroke management?
- constraint- induced movement therapy (CIMT)
- upper limb robotics
- functional electro- stimulation of the arm
what are early supported discharge policies by a stroke team dependent on?
- dependent on appropriate selection of stroke patients that may benefit most from a particular intervention
what is constraint induced movement therapy based on?
- based on scientific principles
what are the three factors that constraint- induced movement therapy depends on?
- commitment of patients
- service users
- willingness of therapists to deliver
