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Atypical Brain Development and Degeneration > Rehabilitation and Recovery Following a Stroke > Flashcards

Rehabilitation and Recovery Following a Stroke Flashcards

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The Brain flashcards
1
Q

Physical impairments following a stroke

A

Reduced muscle strength

Altered sensation
- May not process if something is too hot/cold

Coordination problems

Balance impairment

Hemiparesis
- Paralysis on one side of the body

Altered gait pattern

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2
Q

National Institute of Health Stroke Scale (NIHSS)

A

Stroke deficit scale

Brief

Good reliability

Doesn’t have practice effects and so is good for long-term monitoring

Isn’t very sensitive and so can’t pick up some deficits due to being very brief

Doesn’t identify the cause of the deficits

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3
Q

Barthel Index

A

Assessment of activities of daily living

High reliability

Not suitable for people who are bedbound as they won’t have the same daily activities

Easy to administer

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4
Q

Modified Ranking Scale (mRS)

A

Global Disability Scale

Easy to administer

Broad measure so assess a range of deficits

Good reliability and validity

Might not be able to pick up specific deficits as it is quite broad

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5
Q

Treatments for physical impairments following stroke

A

Physiotherapy

Fitness training

Walking therapies

Transcranial Magnetic Stimulation (TMS)

Robotics

Virtual Reality

Mirror Therapy

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6
Q

Physiotherapy

A

Strength training

Helps individuals rebuild their muscles

Improves muscle function and decreases the muscle weakness

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7
Q

Fitness training

A

For people who have small changes to their mobility to get them active and maintain their health

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8
Q

Walking therapies

A

Often use treadmills

Severe cases

Might have to hold them up on the treadmill

Useful for people with altered gait patterns

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9
Q

Transcranial Magnetic Stimulation (TMS)

A

Promotes neuroplasticity

Electrical current induced into the cortex which increases electrical activity in the area

Can’t target areas deep in the brain

Safe, painless and non-invasive

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10
Q

Evidence for TMS in stroke patients

A

Ganguly et al. (2013)

Repeated TMS paired with task can improve motor function

Short and long-term trial found an overall benefit

Dependent on lesion location

Further research required

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11
Q

Robotics

A

Program a robot to give assistance to patient’s movements

Robot gives less and less assistance as the patient gets better at moving their own body

Allows the brain and body connections to be used again

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12
Q

Evidence for robotics in stroke therapy

A

Branin & Zorowitz (2012)

Improves activities of daily living

Improves arm functioning

No improvement in muscle strength

Need to combine with physiotherapy to get the best results

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13
Q

Virtual reality in stroke patients

A

Combines robotics with virtual reality to engage individuals and make them more likely to continue the therapy

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14
Q

Evidence for virtual reality in stroke patients

A

Brewer et al. (2013)

Combined with robotics

Mixed results

Further studies required

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15
Q

Mirror therapy

A

Individual is asked to use their unaffected limb to perform a task such as writing

A mirror is placed next to them to mimic the affected limb

Tricks the brain into thinking that the affected limb is working

Brain regions of the affected limb fire even though it is not being used

Improves sensation in the affected limb

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16
Q

How does mirror therapy work?

A

In a healthy brain, the sensory information from the skin is sent to the primary somatosensory cortex to tell the brain that you are experiencing a sensation

The SSC the communicates with the motor cortex and responds accordingly

In MT, the visual feedback that they are receiving from viewing the hand in the mirror can make it possible to perceive sensation in the affected limb by reactivating the pathways between the SSC and the MC

17
Q

Evidence for mirror therapy in stroke patients

A

Brewer et al (2013)

MT daily combined with other rehabilitation has shown some benefits

Further research is required to determine practice intensity and duration

18
Q

Occupational therapy

A

Help with relearning daily activities

  • Getting out of bed
  • Making breakfast

Physical and emotional support

Initial assessment to see what activities are difficult

Then put together a plan to train the patient to be able to do these again

Can be multiple times a day

Retraining the brain like training a child

19
Q

Multidisciplinary team involved in rehabilitation of a stroke patient

A

Speech and language therapist

Clinical psychologist

Doctors/nurses

Physiotherapists

Occupational therapists

Family and friends

20
Q

Rehabilitation may involve

A

Cognitive therapy

Psychotherapy

Pharmacological treatment

Exercises

Adaptation/training

Social support

21
Q

Factors that affect recovery

A

Age

Comorbidities

Stroke severity

Motivation

Family support

Level of dependency

22
Q

Neurological recovery - early recovery

A

Local process - few days/weeks

Resolution of post stroke swelling

Re-perfusion of the ischaemic tissue

Recovery of partially damaged neurons

23
Q

Neurological recovery - later recovery

A

Neuroplasticity

Training

Modification in structural and functional organisation

24
Q

Functional recovery

A

Recovery in everyday functions

Adaptations

Training

Presence/absence of neurological recovery

Quality of therapy

Intensity of therapy

How early the therapy started

Motivation

25
Q

Road to recovery (Langhorne, Bernhardt & Kwakkel, 2011)

A

Hours
- Medical

Hours to days
- Early mobilisation

Days to weeks
- Restoring impairments in order to regain activities

Days to months

  • Task-orientated practice
  • Rehabilitation to improve activities of daily living and social interaction

Weeks to months
- Environmental adaptations and services at home

Months to years
- Maintenance of physical condition and monitoring quality of life

26
Q

Family functions in rehabilitation of stroke patients

A

Can change the family dynamic
- May be role reversal

More flexible and supportive the family, the better the outcome

Family therapy may be required
- Knock on effect on everyone in the family

Atypical Brain Development and Degeneration (10 decks)

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