stroke
TRANSCRIPT
Definition Of Stroke
• “Rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin and of more than 24 hours” WHO
• TIA (Transient Ischaemic Attack) recovery is complete within 24 hours. 10% of patients will go on to have a stroke.
Stroke
• Stroke is the third largest killer in the Western World.
• It accounts for up to 6% of in-patient hospital costs in Scotland.
• Stroke is one of the major causes of disability, particularly in the elderly.
• Stroke patients may present with a variety of physical, cognitive and psychosocial problems.
• Most stroke patients show signs of recovery over time.
Sub-types Of Stroke
• Ischaemic – obstruction to one of major cerebral arteries, brainstem strokes are less common.
• Haemorrhage – 9% are caused by haemorrhage to the deep parts of the brain. Patients are usually hypertensive.
Risk Factors
•OBESITY
•SMOKING
•DRUG ABUSE
•OLD AGE• Wee Betty lived a long and
fruitfull life, RIP Betty (1875-1997). That’s 122 years don’t you know!
•ALCOHOL
Stroke Classification
• TACI (Total Anterior Circulation Infarct)
• PACI (Partial Anterior Circulation Infarct)
• LACI (Lacunar Infarct)
• POCI (Posterior Circulation Infarct)
Adverse Prognostic Indicators
• Prior Stroke
• Older Age
• Persistent urinal and faecal incontinence
• Visuo-spatial deficits
• Additional Influences – Consciousness at onset, severity of paralysis, sitting balance,
admission ADL score, level of social support, metabolic rate of glucose outside the infarct area in hypertensive patient.
Physiotherapy Aims
• To normalise muscle tone• To restore muscle function• To control compensation strategies• To maintain muscle length• To re-educate balance• To retrain walking and restore mobility• To maximise functional ability while allowing on-
going neuromuscular recovery
Physiotherapy In Stroke
• Size Of BOS – Large to reduce tone– Small to increase tone
• Alignment– Flexor eg sitting/prone– Extensor eg standing/supine– Positioning Strategies
• Handling– Proximal/Distal/Anatomical
• Communication– Volitional/Automatic/Voice
Stroke Assessment
• Motor function• Muscle tone (high/low)• Sensation/Proprioception/Co-ordination• Alignment/Stability in various positions• Neuromuscular anatomy• Compensation Strategies• Balance• Mobility
Outcome Measures
• Mobility Milestones– 1minute sitting balance– 10 second standing balance– 10 independent steps– 10 metre walk
• Berg Balance Scale• 9 Hole Peg Test• Elderly Mobility Scale• Motor Assessment Scale
Treatment Strategies
• Approaches– Bobath, Motor Relearning etc.
• Hydrotherapy
• AFO/Calipers/Malleolar Locks
• Strapping
• Electrical Stimulation
• Positioning
Positioning
• Base Of Support• Alignment
– Flexor– Extensor– Combination
• Bed Type– Mattress– Pillows – how many?
• Chair Type– Cushion – soft, firm, intermediate
The Stroke Team
• Doctor• Nurse• Physiotherapist• Occupational
Therapist• Speech & Language
Therapist• Social Worker
• Dietician• Psychologist• Dentist • Podiatrist• Art Therapist• Volunteers• Carers
Other Problems To Consider
• Multipathologies– UTIs– RTIs– D & V
• Emotional Conditions– Lability– Depression
• Speech and Language Deficits– Dysphasia (expressive/receptive)– Dyspraxia– Dysarthria