Stroke Guidelines

Question 1

Australian Stroke Guidelines mild to moderate spasticity

Answer 1

GPP:

Interventions to decrease spasticity other than an early comprehensive therapy program should NOT be routinely provided for people who have mild to moderate spasticity (ie does noit interfere with activity or personal care)

Question 2

Australian Stroke Guidelines moderate to severe spasticity

Answer 2

Grade B recommendation:
botulimum toxin A should be trialled in conjuction with rehabilitation therapy which includes setting clear goals

Grade C recommendation:
E stim and/or EMG biofeedback

Question 3

Australian Stroke Guidelines weakness

Answer 3

One or more of the following interventions should be used for people with reduced strength:

Grade B:
progressive resistance exercises

Grade B:
E stim

Grade C:
electromyographic biofeedback in conjunction with conventional therapy

Question 4

Australian Stroke Guidelines co-ordination after stroke

Answer 4

Grade A recommendation for task specific

training

Question 5

Australian Stroke Guidelines sensation training

Answer 5

Grade C:
Sensory-specific training can be providing to stroke survivors who have sensory loss

Grade C:
Sensory training designed to facilitate transfer can also be provided to stroke survivors who have sensory loss

Question 6

Australian Stroke Guidelines fitness training

Answer 6

GPP:
Patients should be encouraged to undertake regular, ongoing fitness training (40-70% heart rate reserve)

Grade A:
Rehab should include interventions aimed at increasing cardiorespiratory fitness once patients have sufficient strength in the larger lower limb muscle groups

Question 7

Australian Stroke Guidelines contracture

Answer 7

GPP:

Early tailored interventions (positiong 30 min, active practice) should be provided for people at risk or who have developed contracture

Grade B:
For those at risk or have developed contracture and are undergoing comprehensive rehab, routine use of splints or prolonged positioning of muscles in a lengthened position not recommended

Grade C:
Overhead pulley should not be used routinely to maintain end of range motion of shoulder

Question 8

Australian Stroke Guidelines severe, persistent contracture

Answer 8

GPP:

Serial casting can be used to reduce severe, persistent contracture when conventional therapy has failed

Question 9

Australian Stroke Guidelines swelling

Answer 9

GPP:
elevation of the limb when resting

Grade C:
E stim

Grade C:
dynamic pressure garments

Grade D:
continuous passive motion with elevation

Question 10

Australian Stroke Guidelines people with severe weakness who are at risk of developing a subluxed shoulder

Answer 10

Management should include one or more of

GPP:
Firm support devices
Education and training for the patient, carer, and clinical staff on how to correctly handle and position the affected upper limb

Grade B:
E stim

Question 11

Australian Stroke Guidelines people who have developed subluxation

Answer 11

Grade C:

Firm support devices to prevent further subluxation

Question 12

Australian Stroke Guidelines shoulder pain prevention

Answer 12

Grade B:
Shoulder strapping

Grade GPP:
educate staff, carers and people with stroke about preventing stroke

Question 13

Australian Stroke Guidelines people who have already developed shoulder pain

Answer 13

Grade GPP
Management based on evidence-based interventions for acute MSK pain

Grade C:
Routine use of following is NOT recommended for routine use

• Corticosteroid injections
• Ultrasound

Question 14

Australian Stroke Guidelines evidence for training standing up

Answer 14

Grade A

Practising standing up from a chair

Question 15

Australian Stroke Guidelines evidence for training sitting

Answer 15

Grade B:
Practice reaching beyond arms length with supervision/assistance
(3000 reaches in 2 weeks)

Question 16

Australian Stroke Guideline training strategies for walking

Answer 16

Grade A
“As much as possible”
Essential to find training strategies that allow high intensity of practice
Semi/supervised independent practice