stroke rehab Flashcards
what is the stroke pathway?
A&E-> (hyper) acute stroke unit -> discharge (ESD, rehab ward, nursing home etc.)
therapist assessment timeline for stroke
dysphagia trained nurse swallow assessment - 4hrs;
SLT swallow and communication assessment - 72hrs;
physio assessment - 72hrs;
OT assessment -72hrs
role of physio in the MDT (stroke - 6)
initial assessment (objective/subjective); functional assessment; problem list; treatment plan; goal setting; discharge planning
(hyper) acute stroke management physios (5)
respiratory management (tracheostomy); early mobilisation and prompting neuro recover (plasticity); tone/spasticity management; assessment of further rehab potential/discharge planning; preventing negative complications
role of OT in (hyper) acute stroke (10)
social history/ neuro assessment; functional assessments (ADL); cognitive screen (ACE, mini ACE, object recognition etc.); mood screen; assessment of equipment needs; assessment of care needs; assessment of further rehab; family liaison + education; vision + perception assessment
cognition triangle (low to high)
sensory -> attention -> perception -> memory -> praxis -> executive
what can be checked with perception tests
distinction of objects from background; depth perception; visual neglect
what is assessed for in function
activities of daily living (eating, dressing, washing etc.); medically fit for discharge does not necessarily mean functionally fit
examples of acute complications post stroke (5)
malignant MCA; haemorrhage; allergic reactions (look for facial oedema); DVTs/PE; aspiration pneumonia
what is malignant MCA?
rapid neurological deterioration due to the effects of space occupying cerebral oedema following middle cerebral artery (MCA) territory stroke
what is aspiration pneumonia and how does it occur?
when food or liquid is breathed into the airways or lungs, instead of being swallowed; results due to dysphagia leading to inability to manage saliva, food + drink; poor mouth can can contribute to build up of bacteria within mouth
why does shoulder subluxation commonly occur post stroke
stroke may result in weakness around the shoulder girdle meaning that the weight of the upper limb can drag on the shoulder capsule + ligaments
should subluxation presentation and management
pain - but it may not be immediate, may develop weeks/month later due to poor moving/handling; management is good moving/handing, positioning, analgesia, orthotics
what should be considered for positioning (6)
type of chair; transfer technique; pressure management; positioning for feeding; tone management; engagement and interaction
what is spasticity
a condition where there is and abnormal increase of muscle tone/stiffness; It may affect movement or speech and cause pain
spasticity epi
younger patients; patients who have had a haemorrhagic stroke
examples of commonly seen spasticity
clenched fists, a bent arm held against the chest, scissoring of legs, foot drop and equinovarus foot.
why is spasticity bad?
affects activities of everyday living - patients become less independent; It can also result in things like: infections from not being able to wash, nails growing into palms (if hands are permanently clenched); psychosocial factor - may result in embarrassment and withdrawal from social activities
management of spasticity (6)
eliminating aggravating factors; antispasmodics/botulinum; analgesia; splinting/casting; positioning in bed and chair; passive stretches
4 things considered when assessing rehab potential
medical stability; cognitive ability to engage w therapy; able to demonstrate improvement from baseline neurology/function; motivated to engage in therapy program
considerations for discharge planning (8)
is the patient able to raise an alarm; how will the pt get out of bed etc.; stairs; can the pt independently prepare modified meals/drinks; what walking aids/equip r needed; can the pt initiate/remember ADLs; other support and access to help; returning to driving/arrange transport
stroke driving guideline
no driving for a month; must inform DVLA if: there are any visual/co-ordination/ memory problems after a month, there has been a seizure within 24hrs of the stroke/TIA, brain surgery was required, you hold a LGV or PCV licence
