Rehab

Question 1

What factors make the pt fit for rehab?

Answer 1

• Must have potential for gain from rehab
• Consider premorbid state (high functioning has better outcome)
• Consider medical stability (need to be able to participate in rehab)
• Consider cognition (need to be sufficient to learn and be engaged)
• Consider discharge destination (those going to high level care anyway may not be justified in extensive rehab)
• Consider quality of life (attaining assisted/independent transfers & lifts can let family members take patient out on weekends etc)

Question 2

Acute Mx of Ischaemic Stroke

Answer 2

• CT to exclude haemorrhage
• If definitely in 3 hour window and no CI → Thrombolyse
• If not, ASPIRIN (100-300mg daily)
• Do not lower blood pressure acutely

Question 3

Acute Mx of Haemorrhagic Stroke:

Intracerebral

Answer 3

• Lower blood pressure to

Question 4

Acute Mx of Haemorrhagic Stroke:

Sub-arachnoid

Answer 4

• Hypertension
• Hypervolaemia
• Haemodulition – Nimodipine (Ca channel blocker, vasodilate)

Question 5

RF for stroke and modifications

Answer 5

Risk Factor Prevention Strategy

1. Hypertension ACE-I (Aim

Question 6

Complications and preventative Mx

“People develop post stroke difficulties, a special team can decrease pain.”

Answer 6

Pneumonia Early mobilisation, physio

DVT & PE’s TED stockings ± low dose heparin

Pressure Sores Frequent rotation in bed

Dependent Oedema Ensure limbs don’t hang off bed

Aspiration Early swallowing assessment

Spasticity Physiotherapy

Oedema & Haemorrhagic Transformation Don’t give anticoagulation acutely

Continence Ensure adequate bowel function

Deconditioning Stroke Rehabilitation (multidiscipline)

Pain Adequate analgaesias