Rehabilitation

Question 1

List 7 consequences of stroke

Answer 1

Dysphagia
Gait disturbance
Post-stroke seizure
Post-stroke depression
Spasticity
Pain
Dysphasia

Question 2

What bladder changes are seen in UMN lesions? (2)

Answer 2

1. Detrusor overactivity - reflexive bladder emptying
2. Detrusor sphincter dyssynergia (increased pressures, VUR) i.e. detrusor contracting against closed sphincter - urine can reflux

Question 3

What bladder changes are seen in LMN lesions?

Answer 3

Flaccid bladder +/- flaccid sphincter (chronic retention with overflow incontinence, incomplete emptying)

Question 4

What bowel changes are seen in UMN lesions?

Answer 4

Hyperreflexic pelvic muscles, inability to relax sphincter

Constipation

Question 5

What bowel changes are seen in LMN lesions?

Answer 5

Slower transit, reduced sphincter tone

Constipation with frequent incontinence

Question 6

How is a reflexic bowel managed? (UMN lesion)

Answer 6

Rectum may fill normally and then empty completed using sacral reflex arc

Rectal filling can be facilitated with stimulant (Senna) and faecal softener (docusate)

Rectal emptying can be stimulated by post-prandial gastro-colic eflex, digital anal stimulation, or per rectal suppositories or enema (microlax)

Question 7

How is an arreflexic bowel managed? (LMN lesion)

Answer 7

Rectum can be slow to fill and evacuation commonly incomplete

Bulking agent (metamucil) useful to achieve soft formed BA

Anal stimulation unhelpful (no reflex to rely on), use manual removal and stimulating suppositories or enema

More likely to choose colostomy or try irrigation programs

Question 8

What is spasticity?

Answer 8

Velocity dependent increase in muscle tone

Question 9

How is spasticity managed?

Answer 9

Non-pharmacological: positioning, stretching program, serial casting

Pharmacological: systemic (baclofen, dantrolene), focal (botox injections)

Question 10

List some intervention strategies in dealing with fallers. (6)

Answer 10

1. Medication review and management
2. Footwear modification
3. Physio: education on improving transfers and gait, Strength, balance and gait re-training +/- gait aid
4. Vision testing
5. Fall alert cards and bracelets
6. Home hazard assessment and modification