Stroke Rehab

Question 1

What is the commonest cause of disability in the western world?

Answer 1

Stroke

Question 2

Number of strokes in australia per year?

Answer 2

50 000

Question 3

Outcomes of patients post stroke acutely?

Answer 3

• 25% die
• 40% require IP rehab
• 35% go straight home (follow up for driving / work clearance etc; home rehab etc)

Question 4

Outcomes post stroke at 1y?

Answer 4

• 1/3 dead
• 1/3 complete recovery
• 1/3 persistent disability

Question 5

What signs are associated with infarcts of ICA distribution (i.e. MCA / ACA)

Answer 5

Cortical signs e.g. dysphasia, dyspraxia, neglect

Question 6

What are lacunar infarcts?

Answer 6

• Occur in territory or small perforating arteries

- usually

Question 7

What are signs associated with infarcts of the vertebrobasilar artier (e.g. PCA)

Answer 7

• Ataxia
• CN palsies
• Nystagmus
• motor and sensory signs

Question 8

Where does hemorrhagic stroke occur?

Answer 8

• Putamen
• Thalamus
• Pons
• Cerebellum
• Cerebral lobes

Question 9

What are the management needs to be addressed in acute stroke?

Answer 9

• Secondary prevention
• Nutrition and swallowing, aspiration
• Continence
• Pressure management
• Spasticity
• Contracture
• Pain - shoulder, central
• Visual loss
• Swelling of affected limb or dependent oedema
• DVT/ PE
• Seizures
• Sleep apnoea
• Infections
• Falls

Question 10

Secondary prevention of stroke (infarct)?

Answer 10

• RFx: smoking, lipids, BP 70%)
• Cause specific (i.e. AF, hormone therapy, PFO surgery)
• Physical activity / exercise
• SNAP, diabetes

Question 11

Secondary prevention of stroke (haemorrhage)?

Answer 11

-BP control

Question 12

What are the aims of inpatient stroke rehab?

Answer 12

1. Prevent complications (e.g. nutrition and swallowing - Drs, nursing, SP, dietitian)
2. Increase independence in personal care (OT, nursing, PT)
3. Increase independence in mobility (PT, OT)
4. Communication, cognitive and behavioural deficits assessment and education (SP, OT, neuropsych, clin psych)
5. Home assessment (OT)
6. Application for home services (SW, OT)
7. Education and supportive counselling

Question 13

What accounts for the improvement in function following a stroke?

Answer 13

• Recovery within ischaemic penumbra
• Resolution of cerebral oedema
• Neuroplasticity and compensation

Question 14

What factors predict outcome post stroke?

Answer 14

• Stroke severity
• Age
• Social supports
• Co morbidities
• Pre stroke mobility
• Motivation

Question 15

What are indicators of stroke severity used to assess likely outcome?

Answer 15

• Arm motor deficit at 2 weeks
• Poor sitting balance
• Neglect
• Incontinence
• Cognitive impairment
• Lesion site and size
• LOC at onset