Stroke Flashcards
3 main goals for stroke rehab
- Restoration - retrain to regain lost functions
- Compensation - adapt behaviour to loss of function
- Modification - alter environment to promote function and ADLs
11 risk factors for post stroke pain
- Older age
- Female
Pre stroke - Alcohol use
- Statin use
- Depression
- PVD
Stroke - Ischemic
- Thalamic/brainstem
Clinical - Spasticity
- Sensory deficits
- Reduced upper extremity movement
List 2 clinical outcomes of preoperative covert stroke after non cardiac surgery
- Perioperative delirium
- Cognitive decline
OR - Overt stroke 1 year post op
What DOAC is considered FORTA A? Why was it classified as such?
Apixaban
1. As effective in stroke prevention as warfarin
2. Reduction in ICH
3. Reduction in major bleed
4. No close monitoring needed
5. No age interaction
6. Less drug-drug intereactions
7. Safe in patients with falls
List 5 complications/adverse outcomes following stroke that need preventative planning
- Spasticity/contractures
- Pressure injuries
- Falls
- VTE
- Dysphagia –> aspiration
- Incontinence
4 interventions to prevent post stroke shoulder pain and 4 interventions to treat it
Prevention
1. Position and support arm during rest
2. Protect and support arm during functional mobility
3. Protect and support arm during wheelchair use
4. Avoid slings and overhead pulleys
Treatment
1. Gentle stretching and mobilization
2. Positioning with sling
3. Analgesics (NSAID, Tylenol, opioid)
4. Consider prednisone
5. Injections: subacromial steroid, botox
4 specific rehab interventions for upper extremity motor and sensory stroke
- ROM exercises
- Stretching
- Strength training
- Functional electrical stimulation
Modifications to bed and bathroom if having difficulty with transfers post stroke
- Shower bench
- Transfer bench
- Shower/bath grab bars
- Floor mat
- Raised toilet seat
- Wheeled commode
- Hand held shower head
- Adjustable bed
- Transfer pole
- Wide doorways
- Gait aid
Patient with L frontal stroke, list 4 behaviours, 4 cognitive features and 4 neurological signs
Behaviours
1. Disinhibition
2. Lack of sympathy/empathy
3. Perseverative behaviours
4. Apathy
5. Hyperorality
Cognitive features
1. Difficulty planning/multitasking
2. Broca’s aphasia
3. Inattention
4. Poor judgement/insight
Neurologic signs
1. R arm weakness
2. R leg weakness
3. R side hyperreflexia
4. R side spasticity
3 recommendations for delivery of post stroke rehab
- Not recommended to do early mobilization in first few days
- Pre transition needs assessment conducted to ensure smooth transition home
- 3 hr/d of direct therapy, 5 d/week
3 tx options for central post stroke pain
- Gabapentin or pregabalin
- TCA or SNRI like duloxetine
- Opioids or tramadol
Management of dysphagia post stroke
Screen all patients before oral intake
Educate patients and family
Patients should feed themselves
Nutrition recommendations post stroke
If suspected concerns refer to RD
Enteral feeding may be required, should decide this early into admission
Replace NG with GJ if prolonged
Screen for malnutrition within 48 hrs
Management of upper limb spasticity post stroke
- Anti spastic pattern positions
- ROM exercises
- Stretching
- Botox
- Baclofen or tizanidine
- Avoid benzodiazepines
Management of lower limb spasticity post stroke
Same as upper limb but can consider intrathecal baclofen for severe/intractable
Avoid botox <6 mos post stroke
