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Care Home Training

Care Home Training. A workshop on Stroke. To be clear about what a stroke & TIA are, what causes them and the range of effects. Learning Objectives To be clear what a stroke and TIA are To know about the physical effects of stroke

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Care Home Training

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  1. Care Home Training A workshop on Stroke

  2. To be clear about what a stroke & TIA are, what causes them and the range of effects • Learning Objectives • To be clear what a stroke and TIA are • To know about the physical effects of stroke • To know how stroke affects swallowing and the importance of oral care • To have an understanding of the effects on communication and vision following a stroke • To have an awareness of the cognitive and psychological impact

  3. A guide to stroke

  4. What is a stroke? • Damage to part of the brain • Caused by a problem with its blood supply • Blood is supplied through arteries • There is a ‘blockage’ or ‘burst’ • Usually happens quickly and strikes suddenly- brain attack

  5. How does this happen? Ischaemic (69% - 80%) Death of tissue (infarction) because of blockage by: Thrombosis – a solid clot of blood in artery supplying brain or Embolism – a clot or other substance (fat, cholesterol, blood platelets) carried from elsewhere in circulation

  6. How does this happen? Haemorrhage (15% - 20%) Bleeding in the brain Burst blood vessel e.g. artery High blood pressure can weaken artery Bursts and damages tissue Brain damage is the result

  7. Transient Ischaemic Attack • Occurs when the brain’s blood supply is briefly interrupted • Classification: effects last no longer than 24hours from onset or the symptoms start to resolve within 1–20 minutes • Very rarely, symptoms of a TIA are due to bleeding (haemorrhage) in the brain • The FAST test helps people to quickly recognise the key symptoms of a TIA or stroke

  8. Act FAST .Facial weakness C Armweakness Can the person raise Speech problems Can the person speak say Time to call 999 Stroke is a medical emergency. If you see any one of these signs, seek immediate medical attention • Other symptoms include: • Sudden weakness or numbness on one side of the body • Sudden confusion • Sudden dizziness or unsteadiness • Sudden visual problem • Severe headache

  9. Hypertension Hormonal Contraception & HRT Smoking Obesity Heart Disease Family History or Ethnicity Inactivity Binge Drinking & Substance Misuse Diabetes Age Previous Stroke & TIA

  10. Stroke Facts Every year, approximately 152,000 people have a stroke in the United Kingdom That is more than one every five minutes In 2008, stroke was the fourth largest cause of death in the UK after heart disease, cancer and respiratory disease Stroke is the largest cause of complex disability in adults

  11. Body talk

  12. Parietal Lobe • Taste, temperature, pain • Understanding language • Auditory & visual memory • Calculations • Reading & writing • Spatial awareness The brain • Frontal Lobe • Planning actions • Learning New tasks • Motivation • Behaviour regulation • Occipital Lobe • Visual Perception • Colour • recognition • Temporal Lobe • Memory functions • Word based memory • (dominant) • Visual Memory • (non-domination) • Brain Stem • Breathing • Blood Pressure • Digestion • Heart Rate • Other Autonomic Functions • Cerebellum • Coordination • Balance • Equilibrium • Muscle tone

  13. What happens in the brain? • RIGHT BRAIN controls: • Left side of body • Movement • Vision • Hearing • Memory • Art • Music • Spatial awareness LEFT BRAIN controls: • Right side of body • Movement • Vision • Hearing • Memory • Reading • Writing • Speaking • Understanding • Mathematics ! !

  14. Exercise:

  15. Neuroplasticity Neuroplasticity: The brain's ability to reorganise itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment

  16. Normal muscle tone? The amount of contraction in a group of muscles which enables smooth voluntary movement to take place

  17. How stroke affects tone Low tone – muscles tend to be loose and weak, hanging limply. Flaccidity High tone – tightening of muscles, tendons and ligaments that prevents normal movement. Spasticity

  18. What can help Good positioning Support and stabilise limbs Symmetrical Medication Baclofen Botox Encourage use Move in normal patterns

  19. Down the wrong way

  20. The swallow process There are four stages to a swallow: Preparation/anticipation Mouth Throat Throat to stomach Stroke can affect any stage - Dysphagia

  21. Aspiration Epiglottis fails to close off windpipe Fluid/food goes into the lungs Chest infection/pneumonia Life and death matter

  22. Warning signs of Dysphagia Recurrent chest infections Weight loss Inability to maintain posture Poor dentition Aphonic / weak voice Weak, ineffective cough reflex Coughing / choking pre/post swallow Wet, gargly voice quality Change in respiratory status Change in colour

  23. Speech and Language Therapists may advise: Thickening drinks and soups Food supplements Soft diet Pureed diet Enteral feeding (NG / PEG)

  24. Tips for safe swallowing

  25. Tips for safe swallowing

  26. Tips for safe swallowing Ensure carers and family members understand the stroke survivors swallowing problems

  27. Daily Mouth Care

  28. Making sense of the world

  29. What did you have for breakfast?

  30. How do we communicate?

  31. When we talk... • 55% is communicated via body language • 38% is communicated via tone of voice • 7% is communicated by actual words

  32. Types of aphasia Receptive aphasia Unable to understand words Expressive aphasia Unable to find words or sentences

  33. She shells sea shells on the she shore Stroke and communication DYSARTHRIA Weak muscular activity Difficulty articulating speech Slurred, unclear speech DYSPRAXIA Difficulties sequencing speech Co-ordinating movements “jumbled-up” unintelligible speech, can be repetitive I was a rangahoo

  34. body language & facial expression Writing & using keywords gesture Supported Conversation pointing drawing communication ramps talking

  35. Visual problems after stroke High proportion of people who have had a stroke have some form of visual dysfunction as a result - 62% - 71% Visual Field loss Visual Inattention & Neglect Eye movement problems Perception problems Focussing and reading problems

  36. http://www.undergrad.ahs.uwaterloo.ca/~aktse/drawing.gif

  37. Cognitive effects Memory Language Attention Concentration Vision and perception Reasoning and problem solving

  38. How are you feeling?

  39. Psychological effects Anxiety/fear Frustration Anger Apathy Depression Emotional lability

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