stroke physio, MDT services Flashcards
what are the roles of the medical team with stroke patients?
-identify stroke through FAST protocol
-assess severity of stroke NIHSS
-scan - CT,MRI etc
-medical intervention
-surgical intervention
-identify cause eg BP, Afib etc
what are the 2 treatments for stroke?
-thrombolysis - clot busting IV drug
-thrombectomy in Beaumont or CUH
what are the surgical treatments for haemorrhage?
-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
what are the different scans / procedures that can be done with a stroke patient initially?
-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
what are the roles of OT with stroke patients?
-help with cognition
-help with visual / visuospatial problems
-helps with function / vocation
-help with sensory problems
-UL and hand function
what are the roles of SLT with stroke patients?
-speech
-swallow
-communication
-SLT will set the diet etc
what is the role of the CN / dietician w/ stroke patients?
-to ensure adequate hydration / nutrition
-alternative feeding routes
-modified diet
-healthy eating
what is the role of the MSW with stroke patients?
social and emotional support
what is the role of the clinical psychologist with stroke patients?
-neuropsychology input
describe physiotherapy in the acute stage of stroke care?
-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
according to the national guidelines for stroke, what are the recommendations?
-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
what are the national clinical guidelines for early mob in stroke patients?
-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
what is the role of physio in the sub-acute stage of stroke?
-re-assessment
-positioning
-mobility
-rehab
-tone management
-hemiplegic shoulder care
-goal setting
equipment eg aids, e-stim
how many hours of therapy should stroke patients be given?
a minimum of 3 hours of MDT therapy - physio, OT, SLT etc
what is the role of physio in the long term management of stroke patients?
-outpatient services
-LTC
-exercise prescription
-equipment provision
-self management
-community services
-onward referrals
what are examples of secondary prevention of stroke?
-exercise
-eat healthy
-control cholesterol
-manage diabetes
-quit smoking
-treat HTN
-reduce alcohol intake
what are the exercise recs after stroke?
-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
where could stroke patients be referred to post acute stage?
-rehab site eg peamount, st josephs, NRH
-early supported discharge
-community services
-outpatient rehab services eg peamount, NRH, clonskeagh
what is ESD?
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
what are the general criteria for ESD?
-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
what is a carer?
a carer is someone who looks after a relative or friend with a disability, a chronic illness or a frail /aged person
what is the role of the carer?
-provide 24 hr support for the person
what kind of skills would the physio teach the carer?
–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