Stroke Flashcards
What are the benefits of admission to a specialist acute stroke unit for all suspected stroke?
Early recognition and treatment of complications.
MDT working
Co-ordinated and organised in-patient care with weekly MDT meetings
Involvement of carers in rehabilitation
Staff interest and expertise
Patients are more likely to receive measures to reduce aspiration, early nutrition, shorter length of stay, less likely to die and more likely to discharge independent
What is aphasia
inability to comprehend or formulate language. Comprehension and formulation of language is affected.
Generally with left hemisphere stroke. Traditionally Broca’s or Wernicke’s are the site of problem, bzut can also be right hemisphere.
Reading and writing is affected. Gestures and drawings as well
difficulties with communication affect how a person maintain and sustains their relationships, how they control their live through making choices and how they see themselves
The emphasis should be on us to provide help rather than relying on the person with aphasia to produce alternative ways of communicating. without this support someone with aphasia may not be able to participate in discussion or consent to treatment, but with it they may be enabled to reveal more ability than appears on the surface
What is dysphasia?
Expressive: understands language, but cannot find the right words. Recognises incorrect language. Reading and writing may be affected
Receptive (Wernicke’s):
inability to understand language. Does not recongize error in speech. Reading and writing unaffected
there is often a combination of expressive and receptive dysphasia, as the two areas are closely related anatomically
What is dysarthria?
know what they want to say, but cannot get the words out corretly (weakness of tongue or facial muscles).
Flat sounding voice. May sound slurred
Understanding, reading and writing not affected
What is apraxia
Difficulty in performing tasks, despite intact motor function
What is asterognosis
Inability to identify objects in both hands by touch alone, despite intact sensation
What is agnosia
Inability to recognize objects
Persons, sounds, shapes or smells
What is inattention
Inability to attend to stimuli bilaterally, despite intact sensation
What is dyspraxia
Dyspraxia affects the person’s ability to respond voluntarily in conversation, but they may be able to do things automatically
Can greet normally, but then unable to answer any questions
Generally, unable to repeat things
How is dysphagia recognized and managed?
Doctors and nurses are often the first member of a team to notice. Nurses can be trained to carry out intitial screening assessment.
Speech and Language therapist (SALT) does further assessment to check risks for oral intake.
Physiotherapist will assess appropriate positioning for swallowing (sitting balance, head control)
Occupational therapist (OT) will assess seating for eating and drinking to ensure optimum positioning. Look at hand-mouth coordination and adaptations to help
Dietician will assess and monitor intake to ensure nutritional requirements are met
The healthcare Assistants and nurses may feed/supervise the patient when eating/drinking.
The support team assistant needs to be aware whether the patient is on a modified diet or thickened fluids and give appropriate meals/drinks
What are the signs of dysphagia
coughing
choking
becoming very short of breath (aspiration)
however, some people can aspirate silently and there are no obvious clinical signs to indicate this
Silent aspiration can only be detected using videofluoroscopy (similar to a barium meal)
What measures can be taken to reduce the chance of aspiration in dysphagia
Modified diet and/or thickened fluids to minimise the risk
Risk may be considered too high: NBM
Non-oral feeding needs to be considered. eg. NG tube or PEG
Considering the risk of malnutrition is as important as considering the risk of aspiration. Taking oral drugs are also affected. Need to find a different way
Management of daysphagia..
Consistency of food
Quantity of food (small portions)
Strategies such as chin tuck, extra swallows
Positioning, alertness
Therapy
Advise re prognosis. Liaison re non-oral feeding
Other than dysphagia, what other dysfunction may arise from a parietal lesion?
Sensory neglect (when bilateral confrontation)
Agnosia
Astereognosis
Dyspraxia (problem with performing tasks)
What are the risk factors for stroke
HTN Hypercholesterolaemia DM Smoking Alcohol Dietary Low exercise Increased weight AF Drugs - illicit, Warfarin Increasing age - but young people can also have stroke Male Personal Hx of stroke, TIA or migraine FHx of stroke or clotting disorders
