Stroke Rehabilitation

Question 1

When does neurological recovery peak post-stroke?

Answer 1

• Begins immediately post–ischaemic stroke, peaks in 3 months
• Later recovery in haemorrhagic stroke

Question 2

In neuro-recovery from stroke, what processes occur?

Answer 2

• Local
  
  • Resolution of ischaemic penumbra (hours to weeks)
  • Resolution of oedema and mass effect (weeks to 2 months)
  • Resolution of remote functional depression - diaschisis (days to months)
• Neuroplastic
  
  • Unmasking (immediate to months)
    
    • Utilisation of “collateral” circuits
  • Synaptogenesis (weeks to months)
    
    • More given more stimulation and complex environments
  • Neurotransmitter alterations (weeks to years)

Question 3

In the acute phase of stroke rehabilitation, what broad considerations are appropriate?

Answer 3

• Prevention and management of pressure injuries
  
  • Movement, nursing, nutrition, air mattresses, loose clothing
• Prevention of DVT
  
  • Mobilisation, anticoagulants (ischaemic) antiplatelet agents (haemorrhagic)
  • No evidence for compression stockings in stroke - possible harms include pressure injuries
• Assessment and management of dysphagia
• Bladder management
• Bowel management
• Prevent complications associated with immobility
• Early mobilisation

Question 4

In MCA and ACA strokes, which motor function tends to be recovered first? What is a good prognostic indicator?

Answer 4

• MCA strokes - leg involved more than arm and is slower to recover
• ACA strokes - arm involved more than limb and is slower to recover
• Predictors of upper limb recovery - recovery or improvement of finger thumb movements by 3 months

Question 5

Post-stroke, how many people will have identifiable aphasia at 6 months?

Answer 5

• 12-18%
• Slower to recover than motor function

Question 6

What are some cognitive deficits that might be present in a person post-stroke?

Answer 6

• Delirium - common, usually reversible
• Drowsiness
• Neglect - line bisection test, shaving, eating, bruises on one side
  
  • May be sensory, visual etc.
  • Increase stimulation to the affected side
• Constructional ability
• Anosagnosia
• Apraxia - planning disorders
• Apathy
• Attention, concentration and executive function
• Dementia
• Emotional lability - R-sided strokes

Question 7

What are some signs that a person post-stroke may be having problems with dysphagia? How might they be managed?

Answer 7

• Coughing after swallowing, moist cough, drooling, inability to initiate, occasional mild temperatures (aspirations)
• Modify diet, teach physical manoeuvres (chin tuck, small bolus sizes, pacing). Consider NGT if needed initially