Stroke Prognosis

Question 1

What is the most important treatable risk factor that prevents strokes?

Answer 1

untreated HTN

- 80% stroke are preventable!

Question 2

What is the breakdown of function recovery following stroke?

Answer 2

10% = almost completely
25% = minor impairments
40% = moderate to severe impairments
10% require LT care facility
15% die shortly after the stroke

Question 3

Does ischemic or hemorrhagic stroke have a better chance of survival? what is the primary predictor of survival?

Answer 3

Ischemic (60%, more common) better than hemorrhagic (38%)

State of consciousness
- coma after stroke = poor prognosis for survival

Question 4

What type of stroke has better functional recovery?

Answer 4

hemorrhagic (debatable though)

Question 5

What are major prognostic variables?

Answer 5

1. Age
2. Degree of neurological impairment - Altered cognition, language impairments, behavioral impairment, visual field deficit, motor deficits
3. Size of stroke on imaging
4. Location of stroke on imaging
5. Presence of comorbidities - ↑ BP, ↑ cholesterol, smoking, CAD, afib, CHF, MI, diabetes, dementia, cancer

Others:

• Therapy interventions - rehab makes positive diff in ST and LT outcomes, but type of intervention doesn’t matter
• Psychosocial aspects - motivation, family support, financial resources
• Pusher syndrome - poorer outcome, slows progress in beginning of tx

Question 6

What are prognostic variables associated with good functional outcomes?

Answer 6

1. No h/o prior stroke
2. Younger age < 70 years
3. Minimal or no cognitive impairments
4. Minimal or no communication impairments
5. Mild hemiparesis
6. Rapid return of reflexes
7. Retain bladder control
8. Minimal or no visual/sensory/perceptual problems
9. No dysphagia
10. Healthy weight prior to stroke (lower BMI)
11. FIM > 60 at admission (out of 126)

Question 7

Degree of ambulation recovery is related to both the degree of initial impairment of ______ and to severity of ______. What is the timeframe of when ambulation recovery is most likely to happen?

Answer 7

walking function; LE paresis

• 11 weeks! stresses need to push patients during the first 11 weeks following stroke to regain function

Question 8

What allows for recovery following stroke?

Answer 8

neuroplasticity

Question 9

What is the timeline for recovery?

Answer 9

Greatest recovery occurs in first 3-6 months

recovery continues up to 18 mo’s after

Question 10

What are goals for chroni stroke?

Answer 10

1. Maintenance/Prevent Regression
2. Patient-Caregiver Education
3. Safety
4. Can still make functional gains – won’t be huge, and likely won’t get back to baseline, but can still make some

Question 11

What are the 10 principles of experience-dependent plasticity?

Answer 11

1. Use it or lose it
2. Use it and improve it
3. Specificity
4. Repetition matters
5. Intensity matters
6. Time matters
7. Salience matters
8. Age matters
9. Transference
10. interference