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Medicine - Year 2 > The vascular system and stroke - Stroke rehabilitation > Flashcards

The vascular system and stroke - Stroke rehabilitation Flashcards

1
Q

What are the long term effects of stroke?

A
  • Spasticity, stiffness in muscles, painful muscle spasms
  • Problems with balance and/or coordination
  • Aphasia
  • Bodily neglect or inattention
  • Pain, numbness or odd sensations
  • Problems with memory, thinking, attention or learning
  • Being unaware of the effects of a stroke
  • Dysphagia
  • Problems with bowel or bladder control
  • Fatigue
  • Difficulty controlling emotions (emotional liability)
  • Fatigue
  • Difficulty controlling emotions (emotional lability)
  • Depression
  • Difficulties with daily tasks
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2
Q

List the members of the multidisciplinary team for stroke patients

A

Doctors
Nurses
Speech and language (SALT)
Dieticians
Physiotherapy
Occupational therapy
Social services
Optometry and ophthalmology
Psychologist
Orthotics
Rehabilitation specialist

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3
Q

Describe the physiotherapy role of the MDT

A
  • Social history + neuronal assessment
  • Vison + perception
  • Functional assessments
  • Cognitive screen
  • Mood screen
  • Upper limb management
  • Assessment of equipment and needs
  • Assessment of care needs
  • Assessment of further “rehab potential”
  • Family liaison and education
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4
Q

a) How soon should early mobilisation occur?

b) What are the benefits of early mobilisation?

A

a) Within 24 to 48 hours of admission

b)
- It reduces the risk of complication
- it has strong positive psychological benefit for the patient

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5
Q

What factors in stroke require rehabilitation management?

A
  • Mobility
  • Activity of daily living
  • Communication
  • Swallowing
  • Orthosis
  • Shoulder pain
  • Spasticity
  • Cognitive and perception
  • Mood
  • Bowel and bladder continence
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6
Q

List therapeutic exercises and traditional functional retraining involved in the rehabilitation of stroke patients

A
  • ROM exercises
  • Muscle strengthening exercises
  • Mobilisation activities
  • Fitness training
  • Compensatory techniques
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7
Q

List neurophysiological approaches

A
  • Muscle re-education approach
  • Neurodevelopmental approaches - sensorimotor approach, movement therapy approach,
  • Motor relearning program for stroke
  • Contemporary task orientated approach
  • Proprioceptive Neuromusclar facilitation
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8
Q

Positioning should be assessed over a 24-hour period including in a bed and chair. What areas should be considered for positioning?

A
  • Type of chair/equipment
  • Transfer technique
  • Pressure management
  • Positioning for feeding
  • Tone management
  • Engagement and interaction
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9
Q

Describe the treatment options for dysphagia

A
  • Posture change
  • Heightening sensory input
  • Swallowing manoeuvres
  • Active exercise
  • Diet modification
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10
Q

Describe the treatment of aspiration pneumonia

A
  • Antibiotic treatment
  • Chest physiotherapy for positioning, suctioning and percussion as indicated
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11
Q

What are some examples of orthosis used in

A
  • Shoulder slings for subluxation
  • Hand splint - for spasticity, stiffness, positioning and ROM
  • Foot slings - to prevent/correct foot problems w.g., foot dram and helps ROM
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12
Q

What are the management options for shoulder pain?

A
  • TENS
  • Shoulder strapping
  • Mobilisation
  • Medical (pharmacological) - analgesia
  • Intraarticular injections
  • Modalities: ice, heat, massage
  • Strengthenings
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13
Q

a) What is shoulder subluxation in stroke a consequence of? and how does it cause pain?

b) What are the management options for shoulder subluxation?

A

a) It is a consequence of weakness around the shoulder girl that occurs as a result of stoke. The weight of the upper limb can drag on the shoulder capsule and ligament causing pain

b) Management is good moving and handling, positioning, analgesia and orthotics

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14
Q

What is spasticity?

A

A condition in which there is abnormal tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain

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15
Q

Describe the harmful effects of spasticity according to the different ICF levels

A
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16
Q

Describe the management of spasticity

A

Physical
- Eliminating aggravating factors
- Splinting and casting
- Positioning in bed and chair
- Passive stretches

Pharmacological
- Generalised spasticity –> oral agents
- Regional spasticity –> Intrathecal baclofen (muscle relaxant)
- Focal and multi-focal spasticity –> Botulinum toxin, phenol blockade
- Avoid diazepam

Surgical management
- Neurosurgical procedure (selective dorsal rhizotomy)

17
Q

a) What problems with cognition and perception can stroke patients have?

b) What is the treatment for cognitive and perception problems?

A
18
Q

a) What problems with cognition and perception can stroke patients have?

b) What is the treatment for cognitive and perception problems?

A

a) - Attention deficits
- Visual neglect
- Unilateral neglect
- Memory deficits
- Problem solving difficulties

b) - Orientation - time, place, person
- Memory
- Repetitive
- Environment
- Problem solving

19
Q

How is mood impacted in stroke?

A
  • Post stroke depression (PSD)
  • Anxiety
  • Emotionalism (emotional ability improves with time)
20
Q

50% of stroke patients have urinary incontinence during the acute phase. This improves with time

a) What are the risk factors

b) Describe the management of bladder incontinence

A

a) Age, increased stroke severity, diabetes

b) Indwelling urinary catheter (Foley catheter) - aids in management of fluid, prevents urinary retention

21
Q

Describe the management of bowel incontinence is stroke patients

A
  • Adequate intake of fluid
  • Bulk and fibre food
  • Bowel training
22
Q

a) What are the communication problems that stroke patients suffer with?

b) What is the goal of treatment when it comes to treatment of communication problems?

A

a) Aphasia and Dysarthria

b) Facilitate recovery of communication and develop strategies to compensate e.g., gesture, picture, communication board, computer

23
Q

What anatomical areas in the brain are affected in stroke patients with aphasia

A

Broca’s area (frontal lobe of left hemisphere)

Wernicke’s area (superior temporal gyrus in the dominant (usually left) cerebral hemisphere

24
Q

Describe the location and role of Broca’s area and Wernicke’s area

A

Broca’s area
- Left frontal lobe
- Motor speech (speech production and articulation)

Wernicke’s area
- Superior temporal lobe
- Receives information from auditory cortex (comprehension of speech)

25
Q

Broca’s and Wernick’s area of the brain can be involved during a stroke which can cause aphasia. Which area is associated with receptive aphasia and which are is associated with expressive aphasia?

A

Broca’s area - receptive aphasia

Wernick’s area - expressive aphasia

26
Q

a) What is receptive aphasia?

b) What are the clinical representation?

c) What strategies can we use with patients with receptive aphasia?

A

a) Difficulties understanding and processing information (verbal and/or written)

b) - Difficulties following commands
- Yes/no response may be unreliable
- May have ‘jargon’ - speech is fluent but off topic
- Usually able to recognise (and use) social phrases e.g., greetings/goodbye etc
- May have poor insight into difficulties

c) Use of facial expressions/gestures/visual gifs/physical prompts can help support their understanding, so they are not fully reliant on verbal communication

27
Q

a) What is expressive aphasia?

b) What is the clinical presentation?

A

a) Difficulties with producing language (verbal and/or written)

b)
- May have word finding difficulties
- May repeat what you’ve said
- May perseverate
- May be frustrated
- Can be variable - unable to speak to occasional difficulties
- Writing may be impaired
- May be able to use drawing/gesttres/pointing

28
Q

a) What is dysarthria?

b) What is the clinical presentation?

c) What are the strategies to use with dysarthic patients?

A

a) Difficult or unclear articulation of speech that is otherwise linguistically normal

b)
- Speech can sound slurred/unintelligible
- Language is intact
- Can affect respiratory, phonatory, articulatory and/or resonators components of speech
- May be able to write/use an alphabet or communication chart
- Brainstem stroke - anarthria or ‘locked in syndrome’

c)
- Encouraging the person to speak slowly and deliberately
- Emphasising initial sounds of words
- Letting the person know if you do not understand
- Asking the person to repeat what was said if it was unclear
- Use of communication charts/alphabet charts if speech is unintelligible

29
Q

a) What is apraxia of speech (AOS)

b) What is the clinical presentation of apraxia of speech (AOS)

c) What are the strategies used to help these patients?

A

a) A speech sound disorder affecting an individual’s ability to translate conscious speech plans into motor plans, which results in limited and difficult speech ability.

b)

  • Reduced speech intelligibility
  • Articulation errors (substitution, distortions)
  • Initiation difficulties, articulatory groping (visible, audible), speech slowed
  • Inconsistent errors
  • Pure apraxia of speech means that language is fully intact - comprehension is good and there are no word difficulties

c)
- Showing patience and understanding
- Reducing distractions and background noise
- Giving the person plenty of time to speak
- Encouraging the person to use other forms of communication to support their needs e.g., gesture, writing, drawing

30
Q

Sometimes stroke can result in weakness in the laryngeal muscles, what is this known as?

A

Dysphonia

31
Q

a) What is dysphonia

b) What is the clinical representation?

A

a) Dysphonia is a disorder of the voice

b)
- Voice may sound rough/strained/hoarse
- Sometimes it can result in complete loss of voice: aphonia

32
Q

a) What are the implications of dysphagia?

b) What are the consequences of dysphagia?

A

a)
- Dependent on being fed
- Dribbling/drooling, residue in weak side of mouth
- Residue in pharynx
- Poor airway protection

b)
- Aspiration
- Aspiration pneumonia

33
Q

a) What are the implications of dysphagia?

b) What are the consequences of dysphagia?

c) How is dysphagia assessed?

A

a)
- Dependent on being fed
- Dribbling/drooling, residue in weak side of mouth
- Residue in pharynx
- Poor airway protection

b)
- Aspiration
- Aspiration pneumonia
- Choking
- Dehydration
- Malnutrition
- Silent aspiration
- Missing key medications
- Negative impact on social interactions and QoL

c) - Clinical bedside assessment
- Videofluoroscopy (VFSS) aka modified barium swallow (MBa)

34
Q

Describe the role of videofloroscopy in swallowing

A
  • Radiological dynamic study of the swallow - with contrast to barium
  • Allows visualisation of both the oral and pharyngeal stages of the swallow (+/- oesophageal sage if indicated)
  • Used to determine severity and nature of dysphagia and guide management
35
Q

Describe the role of the fibreoptic endoscopic evaluation of swallowing (FEES)

A
  • Trans-nasal endoscopy
  • Can view the larynx/pharynx
  • Can view secretions
  • Useful to test laryngeal sensation
  • Can be carried out at bedside so great for patients who cannot transfer to radiology
36
Q

Describe the role of the international dysphagia diet standardisation initiative (IDDSI)

A
  • Came into place 2019
  • All SLTs across the world now use the same diet and fluid descriptors for modified oral intake
37
Q

What are the alternative methods of feeding?

A
  • Nasogastric tube (NGT) / Bridle NGT (temporary)
  • Percutaneous endoscopy gastrostomy (PEG) / radiologically inserted percutaneous gastronomy
38
Q

Which cranial nerves are involved with swallowing

A

V (5th) - Trigeminal maxillary/mandibular divisions
VII (7th) - Facial
IX (9th) - Glosso-pharyngeal
X (10th) - Vagus
XI (11th) - Accessory
XII (12th) - Hypoglossal

39
Q

Name the 4 stages of swallow

A
  1. Pre-oral
  2. Oral
  3. Pharyngeal
  4. Oesophageal

Medicine - Year 2 (27 decks)

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