stroke & stroke rehab

Question 1

How soon after a stroke can you start rehab?

Answer 1

as soon as patient is stable

Question 2

what team can come in to mobilize the patient as soon as they are stable?

Answer 2

acute rehab team

Question 3

list 4 components of acute care

Answer 3

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

Question 4

what three things do you assess when determining rehab candidacy?

Answer 4

level of consciousness
cognitive status
level of communication

Question 5

What is NIHSS? and what does a score of 16+ mean?

Answer 5

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

Question 6

Inpatient vs Outpatient rehab

Answer 6

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

Question 7

what are some motor functioning training for rehab?

Answer 7

constraint-induced movement therapy (UE weakness)
functional electrical stimulation for foot drop, gait training (eg. BioNess, WalkAid)
also treadmills and rails

Question 8

what are factors that impact type & amount of disability w/ strokes?

Answer 8

site and size of lesion– impacts amount and type
degree of recovery– patient’s premorbid status, rehab plan, environmental support system

Question 9

Neurological vs functional recovery

Answer 9

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

Question 10

what influences neurological recovery?

Answer 10

the adjacent cortex’s plasticity to compensate

Question 11

what influences functional recovery?

Answer 11

age and lesion size

Question 12

what is the focus of post acute stroke care?

Answer 12

assessment and recovery of deficits (includes looking at risks and type of rehab)
compensation for residual impairment

Question 13

what are the signs of a stroke?

Answer 13

BE FAST
Balance
Eyes
Face uneven
Arms hanging down
Speech slurred
Time is essential

Question 14

name 3 middle cerebral artery (MCA) occlusions.

Answer 14

R MCA
L MCA
Lacunar stroke

Question 15

what side of the body do you see symptoms of Left MCA stroke? what are 3 symptoms?

Answer 15

R side
weakness, sensory disturbance, APHASIA

Question 16

what are the two types of aphasia? what part of the brain do aphasias affect?

Answer 16

Receptive/Wernicke’s
Expressive/brocas
the left side of the brain is typically affected

Question 17

Compare expressive and receptive aphasias

Answer 17

expressive– halting speech, lost fluency, can’t write; aka broca’s
receptive— can’t understand, speaking gibberish, can’t read; aka wernicke’s

Question 18

how could you test for one-sided UE weakness?

Answer 18

pronator drift

Question 19

what side of the body do you see symptoms of Right MCA stroke? what are 3 symptoms?

Answer 19

Left side
weakness, sensory disturbance, NEGLECT

Question 20

what type of function is affected w/ lacunar strokes? what exactly is a lacunar stroke?

Answer 20

motor functions!
lacunar stroke is an occlusion in a v. small deep penetrating vessel of the MCA that supplies the internal capsule

Question 21

what are the two types of posterior cerebral artery (PCA) occlusions?

Answer 21

peripheral/cortical strokes
central/penetrating strokes

Question 22

what are two symptoms of peripheral/cortical strokes?

Answer 22

homonymous hemianopsia
memory deficits

Question 23

what is homonymous hemianopsia

Answer 23

when each eye only sees one side of the visual field- R eye would only see in front and to the right

Question 24

what kind of memory deficits could someone who had a peripheral/cortical stroke experience?

Answer 24

it can be transient amnesia where they can’t form new memories
they recover

Question 25

what are signs of central/penetrating strokes?

Answer 25

sensory loss (thalamus)
CN III palsy w/ contralateral hemiplegia

Question 26

what are some signs of anterior cerebral artery (ACA) strokes?

Answer 26

paralysis/sensory loss of leg/foot
urinary incontinence
paresis of proximal ARM— hand would be ok
flat affect
akinetic mutism

Question 27

how can homunculus help us decipher which artery is occluded?

Answer 27

ACA is typically trunk down
MCA is typically arms and up
PCA is typically vision

Question 28

how to differentiate between R & L MCA?

Answer 28

look at which side of body symptoms are showing
neglect vs aphasia– aphasia is L side, neglect is R side

Question 29

what is a TIA stroke

Answer 29

having neurologic sx that lasts 3-4 mins
it is a medical emergency and a real stroke could happen a week later