stroke & stroke rehab Flashcards
How soon after a stroke can you start rehab?
as soon as patient is stable
what team can come in to mobilize the patient as soon as they are stable?
acute rehab team
list 4 components of acute care
secondary prevention of stroke and complications
assess candidacy for rehab and what kind
swallow studies and nutritional status
skin assessment and risk for pressure ulcers
what three things do you assess when determining rehab candidacy?
level of consciousness
cognitive status
level of communication
What is NIHSS? and what does a score of 16+ mean?
NIHSS is a evaluation tool used to screen for deficits and depression 24 hrs after a stroke and can be used to keep track of recovery
16+ means severe impairment or death
Inpatient vs Outpatient rehab
inpatient rehab is more aggressive, runs 7 days a week for 3-5 hrs each
outpatient rehab involves individual therapists and typically runs 3 days a week for 1 hr each
what are some motor functioning training for rehab?
constraint-induced movement therapy (UE weakness)
functional electrical stimulation for foot drop, gait training (eg. BioNess, WalkAid)
also treadmills and rails
what are factors that impact type & amount of disability w/ strokes?
site and size of lesion– impacts amount and type
degree of recovery– patient’s premorbid status, rehab plan, environmental support system
Neurological vs functional recovery
Neurological recovery– intrinsic recovery (includes brain compensation)– peaks in first 3 months; divided into early local process and later reorganization
Functional recovery– compensation allowing for regained independence– goal is ADL & IADL; can continue 6 months-3yrs
what influences neurological recovery?
the adjacent cortex’s plasticity to compensate
what influences functional recovery?
age and lesion size
what is the focus of post acute stroke care?
assessment and recovery of deficits (includes looking at risks and type of rehab)
compensation for residual impairment
what are the signs of a stroke?
BE FAST
Balance
Eyes
Face uneven
Arms hanging down
Speech slurred
Time is essential
name 3 middle cerebral artery (MCA) occlusions.
R MCA
L MCA
Lacunar stroke
what side of the body do you see symptoms of Left MCA stroke? what are 3 symptoms?
R side
weakness, sensory disturbance, APHASIA
what are the two types of aphasia? what part of the brain do aphasias affect?
Receptive/Wernicke’s
Expressive/brocas
the left side of the brain is typically affected
Compare expressive and receptive aphasias
expressive– halting speech, lost fluency, can’t write; aka broca’s
receptive— can’t understand, speaking gibberish, can’t read; aka wernicke’s
how could you test for one-sided UE weakness?
pronator drift
what side of the body do you see symptoms of Right MCA stroke? what are 3 symptoms?
Left side
weakness, sensory disturbance, NEGLECT
what type of function is affected w/ lacunar strokes? what exactly is a lacunar stroke?
motor functions!
lacunar stroke is an occlusion in a v. small deep penetrating vessel of the MCA that supplies the internal capsule
what are the two types of posterior cerebral artery (PCA) occlusions?
peripheral/cortical strokes
central/penetrating strokes
what are two symptoms of peripheral/cortical strokes?
homonymous hemianopsia
memory deficits
what is homonymous hemianopsia
when each eye only sees one side of the visual field- R eye would only see in front and to the right
what kind of memory deficits could someone who had a peripheral/cortical stroke experience?
it can be transient amnesia where they can’t form new memories
they recover
