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functional impairments of stroke

Functional Impairments Of Stroke

Information was produced and/or compiled by the Alberta Provincial Stroke Strategy and written permission is required before reprinting any information contained in this document. 12/07:12/08[R]

purpose
Purpose

The purpose of this presentation is to provide a general overview of common functional impairments of stroke, the basic anatomy and physiology related to these impairments and to provide the learner with tips on how to deal with each functional impairment.

target audience
Target Audience

Health care providers who require basic knowledge of the functional impairments of stroke

learning objectives
Learning Objectives
  • Identify 10 common functional impairments of stroke
  • Identify the basic anatomy and physiology related to each functional impairment
  • Identify tips to assist stroke survivors to manage the functional impairments
common effects by hemisphere
Common Effects By Hemisphere

Figure 1, HSFO, 2002

common functional impairments
Common Functional Impairments
  • Mobility
  • Arm/hand function
  • Speech and language
  • Cognition
  • Vision
  • Visual perception
  • Motor planning
  • Urinary continence
  • Swallowing and aspiration
  • Nutrition

Figure 2, adapted from WHO, 2001

mobility
Mobility
  • Hemiplegia and mobility
  • Mobility after stroke may be affected by a number of factors:
    • Loss of motor control
    • Sensation
    • Fatigue
    • Muscle tone
    • Balance
    • Posture
    • Perception
tips for assisting with mobility
Tips For Assisting With Mobility
  • Stroke survivors should be mobilized as early as possible
  • Ensure safety and comfort while promoting independence
  • Avoid over-tiring the survivor
  • Each person is unique
  • Move slowly and gently
  • Talk with the survivor
  • Encourage participation
  • Use good body mechanics
  • Position the affected arm
hand and arm function
Hand And Arm Function
  • Stroke may affect a survivor’s hand and arm function
  • Hand and arm recovery may be slower than the lower extremity
  • Most recovery occurs in the first 3 months but improvement can occur even months and years in the future
painful hemiplegic shoulder
Painful Hemiplegic Shoulder
  • Painful shoulder occurs in 40% to 60%
  • Major impact on ADLs and rehab
  • Etiology is complex:
        • Glenohumeral subluxation
        • Spasticity of the shoulder muscles
        • Impingement
        • Soft tissue trauma
        • Rotator cuff tears
        • Reflex sympathetic dystrophy
        • Myofascial pain
        • Referred pain from the neck
  • Take home message: HANDLE WITH CARE
painful hemiplegic shoulder11
Painful Hemiplegic Shoulder

Subluxation

Figure 3 – Normal and subluxed shoulder

Figure 4

tips for assisting with hand and arm function
Tips For Assisting With Hand And Arm Function
  • Never pull on the survivor’s affected arm
  • Positioning
  • Reposition the “forgotten arm”
  • Support the affected arm during transfers
  • Sling use
speech and language
Speech And Language
  • Difficulty in using or understanding language, which results from damage to the brain
  • Aphasia or dysphasia
  • Dysarthria
  • Dyspraxia of speech
tips for communication
Tips For Communication

Strategies to help you get your message across

  • Look at the person
  • Appropriate tone of voice
  • One idea at a time
  • Write down key words
  • Use gestures and facial expressions
  • Use objects
  • Use YES/NO questions
  • Draw simple pictures
tips for communication15
Tips For Communication

Strategies to help the person with communication problems get their message across

  • Encourage writing or drawing
  • Encourage pointing
  • Identify the general topic and then move to the details
  • Ask YES/NO questions
  • Use words that you have written down
cognition
Cognition
  • Two-thirds may experience cognitive impairment
  • Most recovery occurs in the first three months, but may continue for at least the first year
  • Cognitive changes may include:
    • Attention
    • Executive functioning
    • Processing speed
    • Memory
    • Orientation
tips to assist with cognition
Tips To Assist With Cognition

Depends on the nature of cognitive impairment

  • Orientation
  • Attention
  • Memory
  • Impulsivity
  • Planning and starting a task
  • Decreased information processing speed
vision
Vision
  • Vision problems are common following stroke
  • Double vision (diplopia)
  • Changes in clarity of vision (visual acuity)
  • Visual field impairment (hemianopia)
tips to assist with vision
Tips To Assist With Vision
  • Visual acuity
    • Bring glasses to hospital or rehabilitation
    • Optometrist referral if glasses are in poor condition
  • Double vision
    • Patching
    • Consider the use of prisms
  • Hemianopia
    • Compensate through scanning
    • Consider the use of prisms
visual perception
Visual Perception
  • Unilateral spatial neglect (USN) is inability to respond to sensory stimuli presented on the survivor’s affected side
  • USN is more common in individuals who have right-sided lesions than left.
tips to assist with unilateral spatial neglect
Tips To Assist With Unilateral Spatial Neglect
  • Arrange the environment
  • Approach the survivor from the unaffected side
  • Use a positive approach
  • Use visual cues to assist the survivor
motor planning
Motor Planning

The inability to perform purposeful movements even though the survivor has the physical ability and understands the task

Figure 5

tips to assist with motor planning
Tips To Assist With Motor Planning
  • Use physical cues
  • Use short and simple instructions
  • Use verbal cues and instructions
  • Break the task down into small steps
  • Maintain a consistent routine
  • Provide support and encouragement
  • Provide hand-over-hand guidance
  • Refer to rehab
urinary continence
Urinary Continence
  • The loss of control of urine or inability to hold urine until the bathroom is reached
  • Stroke may impact normal bladder function
  • Indirect impact of stroke
  • Environmental considerations
tips for assisting with urinary continence
Tips For Assisting With Urinary Continence
  • Urinary incontinence can be treated
  • Timed voiding
  • Prompted voiding
  • Bladder retraining with urge suppression
  • Pelvic muscle exercises
  • Compensatory rehabilitation
  • Remove catheter ASAP
swallowing and aspiration
Swallowing And Aspiration
  • Dysphagia is difficulty swallowing
  • 29 to 65% of stroke survivors
  • Common in brainstem or bilateral stroke
  • Frequent in unilateral stroke
  • Aspiration
tips for swallowing and aspiration
Tips For Swallowing And Aspiration
  • NPO until screened by a trained individual
  • Referral to an expert in swallowing
  • Referral to a dietician
  • Individuals with dysphagia should feed themselves
  • Low risk feeding strategies
nutrition
Nutrition
  • Malnutrition is common problem after stroke
  • Patients consume fewer calories and protein following stroke
tips for nutrition
Tips For Nutrition
  • Nasogastric tubes
  • Intragastric feeding tubes
  • Oral supplementation improves energy and protein intake
discussion
Discussion

Discussion and questions

functional impairments of stroke31
Prepared by:

Margaret Grant, BScOT

Rehabilitation Education Coordinator

Alberta Provincial Stroke Strategy

Reviewed by:

Dr. Carmen Tuchak, BSc(Hons), MD, FRCP(C)

Clinical Director

Glenrose Hospital Stroke Program

Edmonton , Alberta

Luchie Swinton, BScOT

Rehabilitation Facilitator

Calgary Stroke Program

Calgary, Alberta

Functional Impairments of Stroke

Gayle Thompson RN(NP), MN

Education Project Manager

Alberta Provincial Stroke Strategy