Stroke❗️❗️❗️ Flashcards
Etiology of stroke
brain embolism from cardiac or arterial sources → Ischemia
Transient ischemic attacks (TIAs) = mini stroke
Functional outcome largely depends on which artery supplying the brain was involved
Information collected during Ax
- Upper-extremity function
- ROM
- MMT
- Sensorimotor
- muscle tone
- static&dynamic balance
- Functional Test for the Hemiplegic/Paretic Upper Extremity (FTHUE) - cognition
- Visual function
- Neglect (loss of awareness)
- hemianopia (loss of vision)
- Finger nose test (eye-hand coordination) - speech and language/communication
- Self-care and ADLs
- Home environment
- Reflex
Occupational performance issues
- Motor dysfunction (hemiplegia) (ranging from mild weakness to complete paralysis) on the side of the body opposite the lesion
- Decreased ADL independence
- Poor balance control
- Pressure sore
- communication difficulties
- cognitive and visual–perceptual impairment
- Shoulder subluxation
- Emotion/psychological issue
- transition to community
- Abnormal reflex
Tx goal and Tx plan (Decreased ADL independence)
Tx goal:
improving participation in occupations through early ADL training
Tx goal and Tx plan (Motor dysfunction)
- Include the affected upper extremity in functional tasks to promote awareness and use
e.g. weight bearing, moving objects across a work surface, and reaching and manipulating objects
e.g. facilitate active positioning of the affected upper extremity during all activities, including eating, grooming and hygiene, and wheelchair and bed positioning
Tx goal and Tx plan (Poor balance control)
Intervention strategies to facilitate postural stability while seated
a. Establish a neutral and active sitting alignment
b. Perform reaching activities while maintaining neutral sitting alignment
c. Perform activity to maintain trunk in midline
Intervention strategies to facilitate postural stability while standing
a. Kitchen activities (e.g., washing dishes at the sink) are particularly useful because they
allow for sturdy support with use of countertop if postural correction is needed.
b. Maintain center of mass over base of support with activity.
c. Maintain or restore equilibrium.
d. Use stepping strategies to widen the base of support.
Tx goal and Tx plan (Pressure sore)
Tx goal:
prevent pressure sore
Tx plan:
sit out/ positioning
Tx goal and Tx plan (Communication difficulties)
i. Encourage gestures and visual cues, such as having the client communicate through demonstration.
ii. Communicate in a quiet, calm area.
iii. Allow increased time for client response.
iv. Frame questions to allow yes-or-no responses.
v. Be concise.
vi. Do not be forceful.
vii. Encourage speech through routine or familiar ADL performance.
Tx goal and Tx plan (cognitive and visual–perceptual impairment)
- focus on the client’s participation in the task rather than on remediation of specific cognitive deficits such as attention and memory
- compensatory approaches for perceptual deficits, such as visual field scanning
- Visual scanning training: Prism glasses can be worn by people with hemispatial neglect during daily activities to expand the viewing area and help them attend to the neglected side.
Tx goal and Tx plan (shoulder subluxation)
Education to family, patient and caregivers about handling to avoid further subluxation/shoulder pain:
▪ Do not pull on shoulder
▪ Support shoulder during transfers (e.g. sling)
Shoulder positioning (bed, wheelchair)
▪ Gleno-humeral joint should always be supported
▪ Avoid positioning shoulder into internal rotation
- Perform passive and active ROM activities to maintain soft tissue length and promote function
Tx goal and Tx plan (emotional/psychological issue)
use positive coping strategies, including seeking social support systems, positive reframing, and acceptance of current abilities
Tx goal and Tx plan (transition to community)
address adaptations to the home environment, strategies for delivering home programs, and fall prevention
facilitate the client’s resumption of valued roles and areas of occupational performance, including work, leisure and recreation, sexual activity, and driving
Tx goal and Tx plan (Abnormal reflex)
Tx goal: normalise muscle tone
Bed positioning:
Side lying allows for normal postural positioning to minimize the effects of increased muscle tone. The use of a pillow under the top upper extremity allows the shoulder to be positioned in neutral.
Right CVA Characteristics
- Left sided weakness
- Visual agnosia: impairment in recognition of visually presented objects
- Prosopagnosia: inability to recognize faces or pictures of familiar people
- Anosognosia (denial): they may deny they had a stroke or that their paralyzed arm or leg belongs
to them. They look at the paralyzed arm or leg and believe it belongs to someone else. - Distorted awareness and impression of self
- Neglect: they may ignore the left side of their body or their environment
- Decreased/short attention span
o Perseveration: they may have difficulty following instructions or answering many questions asked one right after the other. They may repeat answers or movement even though a new instruction was given or a new question asked
- Visual/spatial problems
o They may have problems judging distance, size, position and rate of movement and how parts relate to a whole
Left CVA Characteristics
- Right sided weakness
- Decreased numerical and scientific skills
- Diminished functional speech: aphasias (Broca’s and Wernicke’s)
–> Aphasias affect: speaking, listening, reading, writing, sign language, dealing with numbers, understanding speech, thinking of words when talking or writing
