Transcript Document

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 (18751997). That’s 122 years don’t
you know!
•ALCOHOL
Stroke Classification
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TACI (Total Anterior Circulation Infarct)
PACI (Partial Anterior Circulation Infarct)
LACI (Lacunar Infarct)
POCI (Posterior Circulation Infarct)
Adverse Prognostic Indicators
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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
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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 ongoing 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
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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
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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.
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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
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Doctor
Nurse
Physiotherapist
Occupational
Therapist
• Speech & Language
Therapist
• Social Worker
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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