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STROKE. By Us. 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.

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STROKE

By Us


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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.


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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.


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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.


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Risk Factors





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  • OLD AGE

  • Wee Betty lived a long and fruitfull life, RIP Betty (1875-1997). That’s 122 years don’t you know!



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Stroke Classification

  • TACI (Total Anterior Circulation Infarct)

  • PACI (Partial Anterior Circulation Infarct)

  • LACI (Lacunar Infarct)

  • POCI (Posterior Circulation Infarct)


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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.


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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


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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


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Stroke Assessment

  • Motor function

  • Muscle tone (high/low)

  • Sensation/Proprioception/Co-ordination

  • Alignment/Stability in various positions

  • Neuromuscular anatomy

  • Compensation Strategies

  • Balance

  • Mobility


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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


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Treatment Strategies

  • Approaches

    • Bobath, Motor Relearning etc.

  • Hydrotherapy

  • AFO/Calipers/Malleolar Locks

  • Strapping

  • Electrical Stimulation

  • Positioning


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Positioning

  • Base Of Support

  • Alignment

    • Flexor

    • Extensor

    • Combination

  • Bed Type

    • Mattress

    • Pillows – how many?

  • Chair Type

    • Cushion – soft, firm, intermediate


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Doctor

Nurse

Physiotherapist

Occupational Therapist

Speech & Language Therapist

Social Worker

Dietician

Psychologist

Dentist

Podiatrist

Art Therapist

Volunteers

Carers

The Stroke Team


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Other Problems To Consider

  • Multipathologies

    • UTIs

    • RTIs

    • D & V

  • Emotional Conditions

    • Lability

    • Depression

  • Speech and Language Deficits

    • Dysphasia (expressive/receptive)

    • Dyspraxia

    • Dysarthria


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