Transcript stroke bridging the gap - Spalding Rehabilitation Hospital

ACUTE CARE
REHABILITATION COMMUNITY
STROKE IS A NEUROVASCULAR
CONDITION AFFECTING BLOOD
VESSELS IN THE BRAIN
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ISCHEMIC STROKE – occlusion of a cerebral
artery causing damage to that portion of the
brain dependent on the blood supply from
the affected vessel.
HEMORRHAGIC STROKE – blood leakage
from a cerebral artery that damages
adjacent brain tissue.
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CAROTID ARTERIES – supply the anterior
portion of the brain – including most of the
cerebrum.
VERTEBRAL ARTERIES – housed in the cervical
vertebral column – they merge to form the
basilar artery – supply the posterior portion
of the brain – the cerebellum and brain stem.
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MID CEREBRAL ARTERY – the largest vessel
branching off the internal carotid artery – the
most common site of cerebral occlusion. The
MCA feeds:
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Frontal Lobes
Temporal Lobes
Parietal Lobes
Basal Ganglia
Internal Capsule
The MCA has a main stem and several
branches. Occlusion of the main stem
affects the entire area of the brain
supplied by the MCA. This distribution
of the MCA is so large that a stroke of
the main stem puts the victim at risk
of death or severe disability.
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Hemiplegia (paralysis) of the contral lateral
(opposite) side affecting the lower side of the
face, the arm, the hand, less affecting the leg
Contra lateral sensory loss in the same area
Contra lateral homonymous hemaniopsia –
visual field defects affecting the same half of
the visual fields of both eyes
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Aphasia – partial or total loss of the ability to
communicate through language
Expression – difficulty converting thoughts
into language
Reception – difficulty understanding verbal
and written language
Both – global aphasia
Paralysis on the right side of the body
Dysphagia
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Impaired thought process – information
processing delays
Impaired voluntary motion – apraxia
Confusion between left and right – poor
discrimination
Loss of right visual field – right hemaniopsia
Easily frustrated
Compulsiveness or slowness
Do not underestimate his ability to learn and
communicate
 Use other forms of communication if he cannot
speak
 Do not overestimate his understanding of speech
and overload him with “static”
 Do not shout – keep the message short and simple
 Do not use special voices
 Divide tasks into simple steps
 Give much feedback and point out every indication
of progress. It is better to give too much
encouragement than too little.
Unilateral neglect
Decreased awareness or failure to attend to
the left side
 Lack of awareness or concerns about deficits
 Paralysis on the left side of the body
(hemiplegia or hemiparesis)
 Excessive talking
 Short attention span
 Memory problems
 Poor judgment
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Time disorientation
Loss of left field of vision (left hemaniopsia)
Unconscious of neglect – person and
environment
Impaired abstract thinking – concrete
thinking predominates – doesn’t get the joke
Emotional lability
Lack of interest and motivation – lethurgy
Acts without thinking - impulsivity
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Do not overestimate his abilities. Spatial
deficits are difficult to spot.
Use verbal clues
Break tasks into small steps with much
feedback
Watch to see what he can do safely, rather
than taking his word for it
Minimize clutter around him
Anticipate falls
Anterior Cerebral Artery (ACA) branches off the
Internal Carotid Artery and supplies the
frontal and parietal lobes
Least commonly affected by strokes
Contral lateral leg weakness
Sensory loss
Posterior Cerebral Artery arises from the top of
the Basilar Artery and supplies the medial
occipital lobe and inferior and medial
temporal lobes
Vision is the primary function of the occipital lobe
Visual defects – contra lateral hemaniopsia
Vertebal Artery – basilar stroke affect the
cerebellum, brain stem or both
 Cerebellar strokes impair balance and
coordination – ataxia
 Brain stem stroke – rare, with devastating
symptoms
Hemiparesis or Tetraplegia
Sensory loss affecting either one or both sides of
the body
Double vision – diplopia
Dysconjugate gaze
Slurred speech
Dysphagia
Decrease level of consciousness
HTN
 Rupture Aneurysm
 Arteriovenous Malformation
 Cause same focal symptoms as ischemic
stroke
 Results in more pronounced neck pain
 Headache- “The worst headache of my life”
 Light intolerance
 Nausea and vomiting
 Impaired level of consciousness
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Medical necessity to be in an acute setting
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Would benefit from daily doctor’s visit
Requires 24 hour nursing care
Capable of doing 3 hours of therapy a day
Has a rehab diagnosis that prevents them
from returning to community living
Has a reasonable chance of returning to
community living
We can reasonably document a significant
change in function
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Change from max to min assist transfers
Incontinent to continent
De-cannulize trach
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Daily Program That Includes:
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3 hours of therapy with OP therapist
RN supervision of program
Group therapy with peers and psychologist
5-6 hours per day
Facilitates transition to community