stroke physio, MDT services

Question 1

what are the roles of the medical team with stroke patients?

Answer 1

-identify stroke through FAST protocol
-assess severity of stroke NIHSS
-scan - CT,MRI etc
-medical intervention
-surgical intervention
-identify cause eg BP, Afib etc

Question 2

what are the 2 treatments for stroke?

Answer 2

-thrombolysis - clot busting IV drug
-thrombectomy in Beaumont or CUH

Question 3

what are the surgical treatments for haemorrhage?

Answer 3

-burrholes - holes drilled into the skull over the clot and removed
-craniotomy - a piece of skull is removed to access the clot
-craniectomy - flap not replaced after surgery - to allow the brain to swell (bone is stored in abdomen)
-cranioplasty - bone flap is frozen and replaced months after surgery

Question 4

what are the different scans / procedures that can be done with a stroke patient initially?

Answer 4

-CT brain - first choice in acute stroke because of quick scan and availability
MRI -more sensitive for ischemic stroke, longer scan and more expensive
-CT angiogram - blood vessel imaging - shows blockages

Question 5

what are the roles of OT with stroke patients?

Answer 5

-help with cognition
-help with visual / visuospatial problems
-helps with function / vocation
-help with sensory problems
-UL and hand function

Question 6

what are the roles of SLT with stroke patients?

Answer 6

-speech
-swallow
-communication
-SLT will set the diet etc

Question 7

what is the role of the CN / dietician w/ stroke patients?

Answer 7

-to ensure adequate hydration / nutrition
-alternative feeding routes
-modified diet
-healthy eating

Question 8

what is the role of the MSW with stroke patients?

Answer 8

social and emotional support

Question 9

what is the role of the clinical psychologist with stroke patients?

Answer 9

-neuropsychology input

Question 10

describe physiotherapy in the acute stage of stroke care?

Answer 10

-initial assessment
-positioning
-early mobility
-begin rehab
-early tone management
-hemiplegic shoulder care
-respiratory care
-medications precautions eg bed rest post thrombylysis etc and BP precautions

Question 11

according to the national guidelines for stroke, what are the recommendations?

Answer 11

-patients should be seen ASAP for positioning within 4 hrs of hosp
-patients admitted to hospital with acute stroke should be allowed to adopt either a sitting up or lying flat head position in first 24 hours
-NB positioning to minimise the risk of aspiration and other resp complications, shoulder pain and subluxation, pressure sores etc

Question 12

what are the national clinical guidelines for early mob in stroke patients?

Answer 12

-should be assessed ASAP within the first 24 hours
-patients should be offered frequent daily short mobs eg sitting out of bed, standing or walking with staff

Question 13

what is the role of physio in the sub-acute stage of stroke?

Answer 13

-re-assessment
-positioning
-mobility
-rehab
-tone management
-hemiplegic shoulder care
-goal setting
equipment eg aids, e-stim

Question 14

how many hours of therapy should stroke patients be given?

Answer 14

a minimum of 3 hours of MDT therapy - physio, OT, SLT etc

Question 15

what is the role of physio in the long term management of stroke patients?

Answer 15

-outpatient services
-LTC
-exercise prescription
-equipment provision
-self management
-community services
-onward referrals

Question 16

what are examples of secondary prevention of stroke?

Answer 16

-exercise
-eat healthy
-control cholesterol
-manage diabetes
-quit smoking
-treat HTN
-reduce alcohol intake

Question 17

what are the exercise recs after stroke?

Answer 17

-minimise bed rest after your stroke
-try to sit to stand intermittently with assistance if necessary
-your daily exercise activities should be based on your stage of recovery, environment, social support etc
-engage in rehab exercise programmes that involve aerobic, strength training, flexibility and balance

Question 18

where could stroke patients be referred to post acute stage?

Answer 18

-rehab site eg peamount, st josephs, NRH
-early supported discharge
-community services
-outpatient rehab services eg peamount, NRH, clonskeagh

Question 19

what is ESD?

Answer 19

early supported discharge
- the aim of this is to accelerate discharge home from hospital and provide stroke specialist rehab and support in the home setting

Question 20

what are the general criteria for ESD?

Answer 20

-if the patient has rehab potential
-if they need no overnight assistance that their family / carers cannot support
-adequate cognitive ability to manage at home
-able to transfer with assistance of one, +/- equipment
-household able to manage continence needs

Question 21

what is a carer?

Answer 21

a carer is someone who looks after a relative or friend with a disability, a chronic illness or a frail /aged person

Question 22

what is the role of the carer?

Answer 22

-provide 24 hr support for the person

Question 23

what kind of skills would the physio teach the carer?

Answer 23

–advice on walking aids
-home exercise programme
-contracture prevention
-falls prevention/ getting up after a fall
-application of splints
-home visits
-how to handle a painful shoulder
-sitting to standing - technique and safety
-transfers / handling - use of handling belt, sliding board