Rehabilitation and Recovery Following a Stroke Flashcards
Physical impairments following a stroke
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
National Institute of Health Stroke Scale (NIHSS)
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
Barthel Index
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
Modified Ranking Scale (mRS)
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
Treatments for physical impairments following stroke
Physiotherapy
Fitness training
Walking therapies
Transcranial Magnetic Stimulation (TMS)
Robotics
Virtual Reality
Mirror Therapy
Physiotherapy
Strength training
Helps individuals rebuild their muscles
Improves muscle function and decreases the muscle weakness
Fitness training
For people who have small changes to their mobility to get them active and maintain their health
Walking therapies
Often use treadmills
Severe cases
Might have to hold them up on the treadmill
Useful for people with altered gait patterns
Transcranial Magnetic Stimulation (TMS)
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
Evidence for TMS in stroke patients
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
Robotics
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
Evidence for robotics in stroke therapy
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
Virtual reality in stroke patients
Combines robotics with virtual reality to engage individuals and make them more likely to continue the therapy
Evidence for virtual reality in stroke patients
Brewer et al. (2013)
Combined with robotics
Mixed results
Further studies required
Mirror therapy
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
How does mirror therapy work?
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
Evidence for mirror therapy in stroke patients
Brewer et al (2013)
MT daily combined with other rehabilitation has shown some benefits
Further research is required to determine practice intensity and duration
Occupational therapy
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
Multidisciplinary team involved in rehabilitation of a stroke patient
Speech and language therapist
Clinical psychologist
Doctors/nurses
Physiotherapists
Occupational therapists
Family and friends
Rehabilitation may involve
Cognitive therapy
Psychotherapy
Pharmacological treatment
Exercises
Adaptation/training
Social support
Factors that affect recovery
Age
Comorbidities
Stroke severity
Motivation
Family support
Level of dependency
Neurological recovery - early recovery
Local process - few days/weeks
Resolution of post stroke swelling
Re-perfusion of the ischaemic tissue
Recovery of partially damaged neurons
Neurological recovery - later recovery
Neuroplasticity
Training
Modification in structural and functional organisation
Functional recovery
Recovery in everyday functions
Adaptations
Training
Presence/absence of neurological recovery
Quality of therapy
Intensity of therapy
How early the therapy started
Motivation
