Stroke Rehab Flashcards
What must be considered in stroke rehab
Re-ablement - maximised functional independence
Resettlement - provide safe transfer of care
Role fulfilment - establish personal autonomy
Readjustment - adapt to new lifestyle
Realisation of potential
Where can patients go after acute stroke unit?
Early supported discharge - hospital level of therapy at home
Stroke rehabilitation units
What is early supported discharge criteria?
Transfer independently or with one carer Suitable home environment Willing to participate in rehabilitation Identified rehabilitation goals Family carers happy Can be accepted from acute and rehabilitation and TIA clinic
What is rehabilitation unit transfer criteria?
Medically stable
Needing no more than 24% O2
NG feeding established - no risk of referring syndrome
Stroke consultant review 2ce a week
What are stroke symptoms that must be considered?
Aphasia/Dysarthria Impaired swallowing Malnourishment Balance and walking Fatigue Continence Spasticity Sensation Mouth care Cognitive Impairment Anxiety and depression Neuropathic pain Shoulder pain
What team for stroke rehabilitations?
Doctors - Stroke physician, GP, Psych
Nurse - bowel bladder complications
SALT - language, swallow, memory, thinking, communication
OT - hand and arm use for ADLs - bathing, dressing, home safety
PT- walking and balance
Dietician
Neuropsychology - cognitive skills
Therapeutic recreation specialists - hobbies and community participation
What is the doctors role in stroke rehabilitation?
Optimise medical care - risk factors - secondary prevention
Asses for depression
Assess cognitive unction
Medical review and treatment plan for bowel and bladder continence
Manage neuroapthic pain
Manage spasticity
Mx of aphasia/dysarthria?
SALT assessment and rehab
Communication methods
MX of dysphagia
Consider for alternative fluids
SALT assessment of swallowing
NG feeding
Dietician referral
Consider gastrostomy feed if:
Unable to tolerate NG
Unable to swallow adequate food/fluids by 4 weeks
Mx of hydration and nutrition
Refer to dietician for nutritional assessment, advice and monitoring
Consider NG feeding within 24h of admission
Mx of balance and walking
Assess and trained by Physiotherapy Mobility aids Balance training Orthotics Lumb strengthening Functional training
Mx of fatigue
Assess for mental and physical factors
Mx of Incontinence
Timed toileting Review of caffeine Medication review Bladder retraining Pelvic floor exercises Minimise use of constipating drugs Oral laxatives
Mx of spasticity and contractures
Positoining, passive movement, pain control
Focal spasticity - IM botox A
Generalised spasticity - muscle relaxant - baclofen
Mx of reduced sensation
Trained in how to avoid injury to affected body parts
OT home review
