Right-Side Cerebrovascular AccidentBY: CIERA JACKSON

DESCRIPTION AND DEFINITION

Cerebrovascular accident is the leading cause of serious long-term disability in the U.S..

Affects approximately 795,000 people each year

Sudden loss of blood supply to the brain that damages and kills brain cells, thus resulting in neurological deficits related to the involved areas of the brain

Stroke commonly results in hemiplegia or hemiparesis

A lesion on the right-side of the brain produces left-side hemiplegia

ETIOLOGY

A stroke generally occurs in either of two ways

Ischemic stroke, which cause 87% of total strokes

Hemorrhagic stroke which accounts for approximately 10%

WARNING SIGNS

Before stroke, may adults experience sudden warning signs, which include:

Sudden weakness or numbness of the face, arm, or leg

Confusion

Difficulty speaking

Blurred vision

Severe headache

SYMPTOMS

Weakness, paralysis of left side

Decreased attention span

Left hemianopsia

Decreased awareness & judgment

Left inattention

Emotional lability

Impulsive behaviors

Decreased spatial orientation

Memory deficits

COURSE AND PROGNOSIS

Recovery depends on the location, type and severity of a stroke

one month

one year

20-plus years

PRECAUTIONS

Practitioners working with Right CVA pts should be precautious of:

Warning signs of stroke

Deep vein thrombosis (DVT)

Subluxation

Muscle weakness

DEMOGRAPHICS OF DIAGNOSIS

AGE RANGE Right-side CVA can affect anyone but it increases with age, with 2/3 affecting

people older than 65.

PREMORBID

CONTRIBUTIN

G FACTORS

 

Hypertension

Cardiac diseases

Diabetes mellitus

Obesity

High cholesterol

GENDER Men have a slightly higher risk of stroke than women do.

TREATMENT TEAM

Occupational Therapists

Improving motor and sensory abilities, and ensuring patient safety in the post-stroke period

Help survivors relearn skills needed for performing ADL’s and iADL’s

Teach compensatory strategies and change elements of their environment that limit activities of daily living

Rehabilitation Nurses

Help survivors relearn how to carry out the basic activities of daily living

Educate survivors about routine health care

Reduce risk factors that may lead to a second stroke, and provide training for caregivers

Physical Therapists

Assess the stroke survivor's strength, endurance, range of motion, gait abnormalities, and sensory deficits

Aimed at regaining control over motor functions

Speech-Language Pathologists

Help stroke survivors with aphasia

Relearn how to use language or

Develop alternative means of communication

Improve ability to swallow, and they work with patients to develop problem-solving and social skills needed to cope with the after-effects of a stroke

Vocational Therapists

Identify vocational strengths and develop résumés that highlight those strengths

Identify potential employers, assist in specific job searches, and provide referrals to stroke vocational rehabilitation agencies

Educate disabled individuals about their rights and protections as defined by the Americans with disabilities act of 1990

FRAMES OF REFERENCES

Perceptual motor training

This FOR works with the client on improving memory, cognitive skills, safety awareness, and visual perception, because right CVA patients generally have problems in these areas this would be an ideal FOR for practitioners to implement

Neurodevelopment

Developmental

MODELS OF PRACTICE

Person Environment Occupation Performance (PEOP)

The main focus of OT is to promote maximal independent functioning in the patients natural environment. PEOP focus on the person, environment, occupation and those thing that interfere with the individual’s performance

Model of Human Occupation (MOHO)

Canadian Model of Occupational Therapy (CMOP)

EVALUATION METHODS

Standardized Functional Independence

Measure (FIM)

Measures the level of a patient’s disability and indicates how much assistance is required for the individual to carry of ADL’s

Clock Drawing Test

Assesses visuospatial and praxis abilities (may reflect both attention and executive dysfunction)

Non-Standarized Observation

Assesses patient performance in various areas of the OTPF

Manual Muscle testing

Manual muscle testing is a means of measuring the maximal contraction of a muscle or muscle group.

OCCUPATIONAL PERFORMANCE IMPACTOCCUPATIONAL PROFILE: JOANA

OCCUPATIONAL PROFILE

Joana is a 66 year old retired school teacher who has a master’s degree in early childhood education. She continues to educate through volunteer tutoring, and attends monthly educational classes. She lives alone but has constant gatherings and family visits. Joana enjoys cooking and working out in her free time. Although she suffered hypertension, it was controlled by diet and regular exercise. Joana now has weakness of her left side, which has impacted her mobility, strength and ROM, she also has decreased attention span which limits her ability to attend classes or tutor. Joana has found herself in a deep depression but is ready and determined to continue life at her prior level of functioning.

Occupations Impacted

ADLS

Bathing, Dressing, functional mobility, personal hygiene and grooming,

toilet hygiene

IADLSCommunity mobility, home management, Meal preparation and cleanup

WORK Volunteer participation

LEISURE Leisure participation

EDUCATION Informal personal education participation

PERFORMAN

CE SKILLS

MOTOR SKILLS Posture, Mobility, Coordination,

Strength

PROCESS SKILLS Energy (attend)

COMMUNICATION/

INTERACTION SKILLS

physicality

PERFORMAN

CE

PATTERNS

HABITS Healthy eating, organized, gets

adequate rest

ROUTINES Routines include, working out,

preparing meals , personal hygiene

ROLES Mother, teacher, friend, planner, cook,

head of house

CONTEXTS

CULTURAL Family, friends

PHYSICAL Ambulation in wheel chair

SOCIAL Decreased interaction due to limited

functional mobility

SPIRITUAL Promote education

TEMPORAL Pt is retired, is accustomed to being

active and independent

Client Factors

BODY

FUNCTION

S

SPECIFIC MENTAL Decreased attention

SENSORY Visual-motor coordination

HEARING/VESTIBULAR Balance

NEUROMUSCULAR/ MOVEMENT RELATED involuntary control of left side

decreased strength

CARDIOVASCULAR hypertension

ASSETS

Determination/Motivation

Full function of right side

Useful habits (eating healthy, regular exercise)

PROBLEMS REQUIRING OT

Weakness of left-side,

Limited ROM to complete ADL’s iADL’s

Decreased attention span

Adjustment to disability

TREATMENT PLAN

FUNCTIONAL PROBLEMInability to prepare full course meals due to left side paresis causing limited ROM and strength

STG Client will build the grip strength

and UE strength needed to prepare a meal (lift 10 pounds) with less than 50% assistance within 2 weeks.

Client will be able to complete full UE ROM required to prepare a meal independently by 3 weeks.

Intervention Client will participate in weight lifting

requiring both UE. Using different weight dumbbells. (Adjunctive)

Client will engage in enabling activities that require full UE ROM: stacking cones, block building, and shoulder abduction ladder. Client will demonstrate achievement of goal by completing simulated preparation of a meal.

LTG: Client will be able to complete a full course meal independently using both UE within 4 weeks.

FUNCTIONAL PROBLEMClient suffers from decreased attention span that limits her from being able to tutor.

STG Client will be able to complete 3

decorative baskets in 45 minutes with less than 2 verbal cues of redirection within 1 week.

Client will be able to complete 25 simple math problems in a classroom setting in 60 minutes with less than 1 verbal cue of redirection within 2 weeks.

Intervention Gradation is important so pt will

complete simple but meaningful crafts. Purposeful activity, ex. decorating baskets for a gathering.

Gradation is important so pt will complete math problems which would be a purposeful activity.

LTG: Client will be to substation attention during group session for 60 minutes without any redirection in 4 weeks.

DISCHARGE PLAN

Indications that client is ready for discharge Client is able to independently stand, balance and ambulate.

Client still shows weakness. in left UE, but is able to independently complete ADL’s and iADL’s using adaptive devices and more time

Client has adjusted to disability and participates in leisure activities

After Discharge Client will continue living at home alone

Minor modification will be made: ramp, grab rails throughout house

Client will attend post-stroke informative support groups

Client can be referred to Outpatient Services

REFERENCES

After Stroke. (n.d.). - National Stroke Association. Retrieved July 6, 2014, from http

://www.stroke.org/site/PageServer?pagename=afterstroke

Early, M. B. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd ed.). St. Louis, Mo.:

Elsevier/Mosby.

Post-Stroke Rehabilitation Fact Sheet. (n.d.). : National Institute of Neurological Disorders and Stroke (NINDS).

Retrieved July 6, 2014, from http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm#professionals

. (n.d.). The Rehabilitation Measures Database. Retrieved July 7, 2014, from

http://www.rehabmeasures.org/default.aspx

Watson, D. E., & Wilson, S. A. (2003). Task analysis: an individual and population approach (2nd ed.). Bethesda, MD:

AOTA Press (The American Occupational Therapy Association).