stroke rehab

Question 1

what is the stroke pathway?

Answer 1

A&E-> (hyper) acute stroke unit -> discharge (ESD, rehab ward, nursing home etc.)

Question 2

therapist assessment timeline for stroke

Answer 2

dysphagia trained nurse swallow assessment - 4hrs;
SLT swallow and communication assessment - 72hrs;
physio assessment - 72hrs;
OT assessment -72hrs

Question 3

role of physio in the MDT (stroke - 6)

Answer 3

initial assessment (objective/subjective); functional assessment; problem list; treatment plan; goal setting; discharge planning

Question 4

(hyper) acute stroke management physios (5)

Answer 4

respiratory management (tracheostomy); early mobilisation and prompting neuro recover (plasticity); tone/spasticity management; assessment of further rehab potential/discharge planning; preventing negative complications

Question 5

role of OT in (hyper) acute stroke (10)

Answer 5

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

Question 6

cognition triangle (low to high)

Answer 6

sensory -> attention -> perception -> memory -> praxis -> executive

Question 7

what can be checked with perception tests

Answer 7

distinction of objects from background; depth perception; visual neglect

Question 8

what is assessed for in function

Answer 8

activities of daily living (eating, dressing, washing etc.); medically fit for discharge does not necessarily mean functionally fit

Question 9

examples of acute complications post stroke (5)

Answer 9

malignant MCA; haemorrhage; allergic reactions (look for facial oedema); DVTs/PE; aspiration pneumonia

Question 10

what is malignant MCA?

Answer 10

rapid neurological deterioration due to the effects of space occupying cerebral oedema following middle cerebral artery (MCA) territory stroke

Question 11

what is aspiration pneumonia and how does it occur?

Answer 11

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

Question 12

why does shoulder subluxation commonly occur post stroke

Answer 12

stroke may result in weakness around the shoulder girdle meaning that the weight of the upper limb can drag on the shoulder capsule + ligaments

Question 13

should subluxation presentation and management

Answer 13

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

Question 14

what should be considered for positioning (6)

Answer 14

type of chair; transfer technique; pressure management; positioning for feeding; tone management; engagement and interaction

Question 15

what is spasticity

Answer 15

a condition where there is and abnormal increase of muscle tone/stiffness; It may affect movement or speech and cause pain

Question 16

spasticity epi

Answer 16

younger patients; patients who have had a haemorrhagic stroke

Question 17

examples of commonly seen spasticity

Answer 17

clenched fists, a bent arm held against the chest, scissoring of legs, foot drop and equinovarus foot.

Question 18

why is spasticity bad?

Answer 18

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

Question 19

management of spasticity (6)

Answer 19

eliminating aggravating factors; antispasmodics/botulinum; analgesia; splinting/casting; positioning in bed and chair; passive stretches

Question 20

4 things considered when assessing rehab potential

Answer 20

medical stability; cognitive ability to engage w therapy; able to demonstrate improvement from baseline neurology/function; motivated to engage in therapy program

Question 21

considerations for discharge planning (8)

Answer 21

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

Question 22

stroke driving guideline

Answer 22

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