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Module 202 Theme 1 > Stroke symposium > Flashcards

Stroke symposium Flashcards

1
Q

How many people have a stroke each year?

A

Over 100000 people in the UK

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2
Q

What is the lifetime risk for males of a stroke?

A

1 in 6

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3
Q

What is the lifetime risk for females of a stroke?

A

1 in 5

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4
Q

What is the cost of stroke to society?

A

£26billion

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5
Q

List some impacts of having a stoke

A 
Lack in confidence
Fear of another stroke 
Difficult to talk about the stroke 
Feel friends and family treat them differently
Unable to care for family
Considered breaking up with partner
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6
Q

What are the symptoms of stroke?

A

Face
Arms
Speech

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7
Q

How many neurons die a minute in stroke?

A

1.9 million neurons

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8
Q

What is found in the clinical assessment of stroke?

A

Sudden onset of focal neurological or monocular symptoms
Symptoms and signs should fit within a vascular territory
Negative symptoms rather than positive symptoms

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9
Q

What examination is used in stroke?

A

Quick assessment of systems

Standardised score

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10
Q

Describe the classic presentation of an ACA stroke

A

Colateral lower limb

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11
Q

Describe the classic presentation of a left MCA infarct

A

Dysphasia, right sided weakness/numbness

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12
Q

Describe the classic presentation of a right MCA infarct

A

Neglect, left sided weakness/numbness

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13
Q

Describe the classic presentation of a brainstem infarct

A

May involve diplopia, visual field defect, facial weakness, colateral limb weakness/numbness, incoordination

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14
Q

What are the causes of a hemorrhagic stroke?

A

Anomalies in vessel arrangement - aneurysm

Arteriovenous anomaly

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15
Q

What are the causes of an ischaemic stroke?

A

Thrombosis

Emboli

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16
Q

How is an ischaemic stroke diagnosed?

A

CT scan

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17
Q

If there is an infarct what is shown on CT?

A

Attenuation

Different colours of the brain matter

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18
Q

Where is the characteristic hypertensive haemorrhage found?

A

In the centre of the brain

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19
Q

Describe critical ischaemia

A

High metabolic demand of the brain - no glucose stores
Physiological blood flow 50ml/100g/min
<20ml/100g/min - electrical function stops - neurons still alive potentially salvageable - reversible ischemia - limited time
<10ml/100g/min - neuronal death within minutes, irreversible ischaemia - cerebral infarction

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20
Q

What is CT perfusion imaging used for?

A

Tells which areas are salvageable and determine the timing of the stroke

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21
Q

What does the length of the clot tell you?

A

Efficacy of thrombolysis

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22
Q

What is stent retrieval?

A

Way of regaining blood supply

Mechanical thrombectomy

23
Q

Why is an MRI useful?

A

Determines cerebral oedma and sites of infarction quicker

24
Q

What drug is used?

A

Clopidogrel

25
Q

What are the risk factors of stroke?

A 
Smoking
Diabetes
High blood pressure
Obesity
Stress
Hyperlipidemia
LDL
26
Q

What tests are done to determine what caused the clot?

A

Heart - echo (PFO), ECG (AF), ultrasound bifurcation (carotid stenosis)

27
Q

What is used to prevent the carotid stenosis causing more problems?

A

Stent and remove the atherosclerotic plaque

28
Q

Describe stroke pathophysiology

A

Endothelial injury - Increased vascular permeability, leukocyte adhesion

Accumulation of lipoproteins - Including LDL and its oxidised forms

Monocyte adhesion to the endothelium - Followed by migration into the intima and
transformation into macrophages and foam cells.

Platelet adhesion

Factor release - From activated platelets, macrophages inducing smooth muscle cell recruitment.

Smooth muscle cell proliferation

Lipid accumulation

29
Q

List the 5 types of ischaemic stroke

A 
●Large artery atherosclerosis
●Cardioembolism
●Small vessel occlusion
●Stroke of other determined etiology
●Stroke of undetermined etiology
30
Q

What is vital in care after a stroke?

A 
 Nursing and medical staff
 Functional and movement disability –
OT/physiotherapy
 Communication and swallowing function –
S&amp;LT
 Nutritional support – Dieticians
 Social service
31
Q

What is the role of the speech therapist in acute stroke management

A

Initial screen of swallow on admission - NG/NBM/PEG
Swallow therapy
Initial language/speech screen
Follow up language therapy
MDT working and support
Discharge planning and hand over to rehab or community teams

32
Q

What happens in the community by the speech therapist?

A 
Follow up on communication and swallow
Usually at patients home
Therapy
Link to community support
6 month review
Getting them back to hobbies
33
Q

What is dysphagia?

A

Difficulty swallowing
An impairment at any of the 4 stages of swallowing:
(pre-oral, oral, pharyngeal ,Oesophageal)
Can lead to aspiration pneumonia, malnutrition, dehydration, choking and death.
Assessed at bedside via observation and palpation and/or through instrumental techniques such as Videofluroscopy or Fiberoptic Endoscopic Evaluation of Swallow (FEES).
Can have a negative impact on mood and social participation

34
Q

What is aphasia?

A

Difficulty talking

35
Q

List some motor speech disorders

A

Dysarthria

Apraxia of speech

36
Q

How can we help with complications of post stroke symptoms?

A
  • Adaptation of posture
  • Environmental changes e.g. reducing distractions
  • Modifying diet and fluids e.g. use of thickener in drinks
  • Educating family/carers e.g. feeding techniques
  • Compensatory strategies e.g. head turn, chin tuck- Swallow rehab exercises such as Massako manoeuvre for weak soft palate.
  • Adaptive equipment e.g. cutlery with large handles, plate guards, bolus limiting cups- Feeding at risk decisions
37
Q

What do you look out for in dysphagia?

A

Coughing whilst eating or drinking
Eyes watering, shortness of breath, choking episodes, reduced sats just after swallowing
New and/or recurrent chest infections (predominantly right sided consolidation, may indicate aspiration pneumonia)

38
Q

What are the risk factors for dysphagia?

A

dependent on feeding and oral care, poor positioning, reduced dentition, comorbidities e.g. COPD, frailty, alertness, cognition

39
Q

What is aphasia?

A

An acquired language impairment
Can affect any of the 4 modalities of language:
- speech/ auditory comprehension
- reading/ writing
Can have a devastating impact on the individual’s Quality of Life (QoL) and wellbeing

40
Q

Which part of the brain is involved in aphasia?

A

Usually associated with damage to the left cerebral hemisphere

41
Q

People with communication impairments may find it difficult to …

A 
take part in a conversation 
talk in a group or noisy environment 
read a book or magazine or road sign 
understand or tell jokes 
follow the television or radio 
write a letter or fill in a form 
use the telephone 
 use the internet
use numbers and money 
say their own name or the names of their family 
unable to express their immediate needs or ideas or words 
go out.
42
Q

Describe aphasia expressive difficulties

A 
word finding difficulties
non-fluent output 
short, staggered sentences
difficulty with past/present, 
he/she may miss words out
43
Q

Describe aphasia receptive difficulties

A

Long muddled sentences
Use of non-words e.g. ‘ploof’ for ‘dog’
Unable to understand what others are saying
May not be aware of impairment

44
Q

What does aphasia therapy focus on?

A

Specific impairments (usually 1:1) e.g. use of past tense

  • Functional communication e.g. practising how to order a coffee and then completing the task or learning compensatory strategies e.g. gesture and writing
  • Social participation e.g. developing communication techniques in group settings with family and friends or training carers to support communication.
45
Q

What is dysarthria?

A

Difficulty in speaking resulting from a weakness or loss of control
of the muscles used to make the sounds of speech, e.g. lips,
tongue, soft palate, larynx
Speech can sound slurred or unintelligible
Varies from individual to individual – some people may not be able
to form any words at all and other people may have only slightly
imprecise articulation

46
Q

What is apraxia of speech?

A

An inability to control the muscles used to form words. When themessages from the brain tothe mouth are disrupted, the person cannot move his or her lips or tongue in the correctmanner to make lettersounds.
Speech is uncoordinated and effortful.
Many sound and word errors e.g. ‘kitchen’ for ‘chicken’
Often very frustrating for the person

47
Q

What is cognitive communication disorder?

A

Result from damage to frontal regions of the brain (predominantly right-sided)
The frontal lobes are particularly important for cognitive communication skills because of their role in the brain’s ‘executive functions’, including planning, organisation, flexible thinking and social behaviour.
People with CCD may:
- talk too much or not enough
- interrupt conversation
- jump from topic to topic
- give too much or not enough eye contact
- Over or under-share
- Show impulsive behaviours such as spending lots of money online in one go
- Have reduced facial expression

48
Q

List some tips for communicating with people with communication difficulties

A 
Don’t pretend you understand 
Write down key words 
Say one thing at a time 
Relax – be natural 
Recap – check you both understand 
Don’t rush – slow down, be patient 
Draw diagrams or pictures 
Reduce background noise 
Ask what helps, e.g. some people would prefer that others don’t finish their sentences for them
Use pen and paper
49
Q

What is post stroke rehabilitation

A 
EARLY 
INDIVIDUALISED
FOCUSED and SPECIFIC
COMPLEX
ONGOING
50
Q

List some post stroke problems that impact of therapy

A 
Joint/muscle stiffness
Loss of muscle length
Contractures
Tissue Breakdown/Pressure Sores
Unstable Shoulder
Respiratory Complications
Urinary Problems
Pain
Circulatory Problems
Depression and Anxiety
Osteoporosis
CV Deconditioning
Hygiene difficulties
Oedema
Constipation
51
Q

What is hypertonia?

A

Made up of 1. Neural component
2. Biomechanical component

CNS Damage
- Direct result of blood alteration, ischaemia/haemorrhage, causing neuronal change and disordered information to be sent via corticospinal pathways.

  1. Biomechanical
    • Muscle shortening and lengthening for cross bridges in muscle fibres depending on direction of pull
52
Q

What is spasticity?

A

Resistance in 1 direction
Characteristic posture changes
Sensitive to sensory input

53
Q

What is rigidity?

A

Resistance in all directions
No static postural changes
Not Sensitive to sensory input
Cogwheel = rigidity plus tremor

Module 202 Theme 1 (28 decks)

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