Podcast
Questions and Answers
What is the primary cause of stroke?
What is the primary cause of stroke?
A failure to supply oxygen to brain cells, which are most susceptible to ischemic damage, leads to their death.
Which of the following are types of stroke?
Which of the following are types of stroke?
Hemorrhagic strokes account for 85% of stroke incidents.
Hemorrhagic strokes account for 85% of stroke incidents.
False
Transient ischemic attacks (TIAs) are irreversible.
Transient ischemic attacks (TIAs) are irreversible.
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What is the timeframe for TIAs to resolve?
What is the timeframe for TIAs to resolve?
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What percentage of TIA patients experience a stroke within 5 years?
What percentage of TIA patients experience a stroke within 5 years?
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What does a TIA stand for?
What does a TIA stand for?
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What percentage of strokes are thromboembolic?
What percentage of strokes are thromboembolic?
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What is the third most common cause of death in Malaysia?
What is the third most common cause of death in Malaysia?
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What are the two main types of cerebral circulation?
What are the two main types of cerebral circulation?
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Heavy alcohol use is linked to an increase in hemorrhagic strokes.
Heavy alcohol use is linked to an increase in hemorrhagic strokes.
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Which of the following is NOT a symptom of a left sided brain injury?
Which of the following is NOT a symptom of a left sided brain injury?
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Which of the following is NOT a modifiable risk factor for stroke?
Which of the following is NOT a modifiable risk factor for stroke?
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What is the most important modifiable risk factor for stroke?
What is the most important modifiable risk factor for stroke?
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A patient who has had a TIA is not at increased risk for a stroke.
A patient who has had a TIA is not at increased risk for a stroke.
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What is the most important intervention to promote independence after a stroke?
What is the most important intervention to promote independence after a stroke?
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What are the five frames of reference frequently used during treatment for stroke patients?
What are the five frames of reference frequently used during treatment for stroke patients?
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Which of the following is a typical treatment for spasticity?
Which of the following is a typical treatment for spasticity?
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A patient who has had a stroke is usually independent in ADL within a day or two of the stroke.
A patient who has had a stroke is usually independent in ADL within a day or two of the stroke.
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A patient who has had a stroke is likely to need some form of home-based therapy after discharge from the hospital.
A patient who has had a stroke is likely to need some form of home-based therapy after discharge from the hospital.
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Name three common ADL assessments that are used for stroke patients.
Name three common ADL assessments that are used for stroke patients.
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What are the seven stages of stroke recovery, based on the Brunnstrom stages?
What are the seven stages of stroke recovery, based on the Brunnstrom stages?
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Which of the following is NOT part of the neurological assessment typically performed for stroke patients?
Which of the following is NOT part of the neurological assessment typically performed for stroke patients?
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Which of the following is considered to be a negative sign associated with an upper motor neuron lesion?
Which of the following is considered to be a negative sign associated with an upper motor neuron lesion?
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Which of the following is a common intervention recommended for a patient with shoulder subluxation?
Which of the following is a common intervention recommended for a patient with shoulder subluxation?
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Which of following is a common intervention for oral facial weakness?
Which of following is a common intervention for oral facial weakness?
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It is not necessary to teach patients about their stroke condition, because they should already know about it.
It is not necessary to teach patients about their stroke condition, because they should already know about it.
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A patient who has recently had a stroke may have difficulty with any of the following, EXCEPT:
A patient who has recently had a stroke may have difficulty with any of the following, EXCEPT:
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Which of the following is not a common intervention during rehabilitation for a stroke patient?
Which of the following is not a common intervention during rehabilitation for a stroke patient?
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The NIHSS score is a valid method for assessing stroke severity.
The NIHSS score is a valid method for assessing stroke severity.
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Which of the following is not a common intervention for cognitive deficits post stroke?
Which of the following is not a common intervention for cognitive deficits post stroke?
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It is not possible to improve a patient's home environment for a patient with a stroke.
It is not possible to improve a patient's home environment for a patient with a stroke.
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What type of stroke is caused by a blockage in a blood vessel in the brain?
What type of stroke is caused by a blockage in a blood vessel in the brain?
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Which of the following is a good example of a common intervention activity for functional mobility training?
Which of the following is a good example of a common intervention activity for functional mobility training?
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What is the primary role of an Occupational Therapist in the treatment of stroke patients?
What is the primary role of an Occupational Therapist in the treatment of stroke patients?
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It is important to encourage patients to participate in activities that are enjoyable and/or personally meaningful to them during their rehabilitation.
It is important to encourage patients to participate in activities that are enjoyable and/or personally meaningful to them during their rehabilitation.
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What are two common types of exercises for patients with limited upper or lower limb range of motion?
What are two common types of exercises for patients with limited upper or lower limb range of motion?
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Patient education programmes should only focus on the patient, and not involve family members.
Patient education programmes should only focus on the patient, and not involve family members.
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What type of environment encourages learning in patients with stroke?
What type of environment encourages learning in patients with stroke?
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Study Notes
Occupational Therapy Intervention for Stroke
- Stroke is a cerebral vasculature disease causing oxygen deprivation in brain cells, leading to cell death.
- Common stroke etiologies are thromboembolic (85%), lacunar (localized area), and hemorrhagic (15%).
- Hemorrhagic strokes account for 20% of incidents (Burkhardt, 2004).
- Transient ischemic attacks (TIAs) involve focal deficits but are reversible, as no cerebral infarction occurs.
- TIAs are caused by thrombotic or embolic events or cerebral vasospasm.
- Effects of TIAs must resolve within 24 hours.
- 33% of patients who experience TIAs will have a stroke within 5 years (Burkhardt, 2004).
- Treatment options for TIAs include anticoagulation therapy or surgery, depending on the cause.
Epidemiology of Stroke in Malaysia
- Non-communicable diseases (NCDs) such as diabetes, hypertension, high cholesterol, and obesity are a major factor in stroke incidents in Malaysia.
- 2.3 million adults (5.1%) in Malaysia have three NCDs.
- 35.9% (8.5 million) adults in Malaysia have metabolic syndrome.
- Cerebrovascular accident (CVA) is the 3rd most common cause of death in Malaysia.
- Hypertension is the most important modifiable risk factor.
- Locations of strokes include the anterior (carotid), 65%, and posterior (vertebrobasilar), 35%, circulations.
Modifiable Risk Factors
- Diabetes: Relative risk of 1.8-3.0 for stroke. Lower risk if statins are started.
- Dyslipidemia: Relative risk of 0.7 for stroke if statins are started.
- Cigarette smoking: Relative risk of 2.0. Reduced risk after 2-4 years of cessation.
- Alcohol: Increased hemorrhagic stroke risk with heavy use.
- Drugs: Cocaine, heroin, amphetamines, LSD, PCP, marijuana, phenylpropanolamine, ephedrine, pseudoephedrine, and some contraceptives (estrogen >50 µg) are linked to strokes.
Clinical presentation of stroke
- The location of the affected vascular territory determines the symptoms and clinical behavior of the stroke.
- Types of stroke based on affected circulation include anterior cerebral artery infarct, middle cerebral artery infarct, lacunar infarct, striatocapsular infarct, posterior cerebral artery infarct, cerebellar infarct, and brainstem infarct.
Left Cerebral Hemisphere
- Involved in analytical, logical thinking, and symbolic language functions.
- Left-sided brain injury results in right-side paralysis and problems in speech, language, caution, hesitation, anxiety and organization when faced with unfamiliar tasks.
- There is a need for frequent reassurance, immediate positive feedback, and breaking down tasks into steps for learning.
Left-Sided CVA: Left Brain Damage
- Different parts of the left side of the brain (frontal, parietal, temporal, and occipital lobes) control diverse functions.
- Possible deficits in left-sided CVA include impaired comprehension and memory, aphasias, awareness of deficits, depression, anxiety, hemiplegia or paresis, and impaired discrimination (R/L).
Right Cerebral Hemisphere
- Responsible for spatial sensation, perception, and judgment.
- Right-sided brain injury results in severe visual and spatial deficits (hemianopia, left neglect), deficits in figure-ground discrimination, and difficulties with spatial relationships and body scheme.
- Individuals often deny their disability and exhibit impulsivity.
- Potential difficulties include errors in judgment and an inability to abstract.
Right-Sided CVA: Right Brain Damage
- Different parts of the right side of the brain (frontal, parietal, temporal, and occipital lobes) control various functions.
- Right-sided stroke can cause impaired judgment, hemi-anopsia, impulsiveness (safety problems), rapid performance followed by rapid decreases, short attention span, left hemiplegia/paresis, denial of problems, difficulties in specific tasks, perceptual deficits, and left-sided neglect.
Spot a Stroke (BE FAST)
- Balance: Sudden loss of balance or coordination.
- Eyes: Double vision or inability to see out of one eye.
- Face: Drooping on one side of the face.
- Arm: One arm drifting downward.
- Speech: Slurring speech or difficulty communicating.
- Time: Call 9-1-1 immediately.
Upper Motor Neuron Lesion (UMNL)
- Positive signs: Increased response to rapid stretch (flexor, extensor, and spasms), co-contraction of antagonist muscles, hyperactive deep tendon reflexes, and clonus (abnormal rhythmic contractions).
- Negative signs: Loss of coordination, reduced speed of movement, increased weakness, and easy fatigability.
Flexor and Extensor Synergies
- Describes stereotypical patterns of movement in affected limbs.
Medical Stroke Management
- Treatment varies based on lesion location and severity.
- Diagnostic tools include computer axial tomography (CAT) scanning, and magnetic resonance imaging (MRI) to determine the lesion location and extent.
- Other tests may be performed, such as urinalysis, blood tests, and electrocardiograms.
Prognosis
- Depends on the recovery stage when therapy begins, the site and severity of the brain lesion, associated medical conditions, age, and support systems.
- History of multiple CVAs and incontinence are poor prognostic indicators.
- Younger patients tend to have better functional outcomes.
Occupational Therapy Intervention to Promote Independence After Stroke
- Interventions focus on improving daily living activities, motor function, sensory-motor function, cognitive and perceptual function, psychosocial function, and psychological function.
Occupational Therapy Objectives
- General: Independent activities of daily living, and meaningful quality of life (work, leisure, socialization).
- Specific: Minimizing the negative effects of CVA, reducing impairment, addressing motor weakness, depression, cognitive regression, optimizing affected limb function, addressing spasticity, improving communication, ensuring consistent home management post-discharge, and supporting adjustment to disability.
Occupational Therapist Role
- Rehabilitation to maximum well-being via chosen functions to enable independence and community re-integration.
- Improves functions and planning in daily life, safely and effectively.
- Maintains and increases the patient's level of functional independence.
Frames of Reference in Occupational Therapy
- Neurodevelopmental: Neurosciences-normalization and integration of biological processes.
- Biomechanical: Physical sciences (kinetics, kinematics, and medicine).
- Cognitive: Biological psychiatric and neurosciences; cognitive underlying behaviors.
- Sensory Integration: Neurosciences, relationship between sensory input, and neural integration
- Rehabilitation: Medicine and physical sciences relating to individual capabilities.
- Behavioral: Psychology, learning through reinforcing environment.
Specific Theoretical Bases and Evaluations
- Detailed descriptions of different assessment tools, theoretical bases, and evaluation procedures for neurodevelopmental, biomechanical, cognitive, sensory integration, rehabilitation, and behavioral frames of reference are provided.
Occupational Therapy Evaluation
- Assessment of the areas of daily living activities (ADL), motor function, sensory-motor function, cognitive and perceptual function, psychosocial function, psychological function using various tools and assessments.
- Details of evaluation tools and competency areas in assessment and interpreting results.
Specific Problem Areas in Motor Function, Sensory-Motor Function, and Cognitive and Perceptual Function Descriptions of various problem areas in stroke patients.
- Including assessments, evaluations processes, intervention goals, and treatment strategies to address such issues as abnormal muscle tone, limited active ROM, upper and lower limb weakness, spasticity, poor hand function, shoulder subluxation, edema, oral facial weakness (hemiparesis), visual perception deficits, perceptual deficits, and pain management.
Problems Associated with Activities of Daily Living (ADL) & Instrumental Activities of Daily Living (IADL)
- Methods to address problems with home management, money management, lack of community resources, mobility, safety procedures, and medication routines.
- Addressing difficulties in performing daily activities by teaching adaptive coping skills, basic ADL & IADL skills, and providing adaptive equipment.
Problems in Psychosocial Function
- Goals and interventions addressing emotional lability, depression, behavioural problems, lack of knowledge of stroke condition, inaccessibility and inadequate home environments using techniques such as psychological support, stress management, patient education, carer education, family conferences, support groups, and home visits for support.
Problem Areas in Community Mobility
- Interventions to restore independence and safety in driving and public transportation, focusing on pre-driving training and modification.
Patient Education Programmes
- Objectives and components (sessions) of patient and family education programmes for effective stroke rehabilitation.
- Programmes include stroke cause explanation, risk factors, prevention, complication prevention, motor retraining, daily life activities, psychological adjustment, and coping skills.
Patient Home Programme
- Components and considerations in enabling ongoing treatment continuity following in-patient rehabilitation – patient/family adherence, consistent activities, regular evaluation, and adaptation to recovery stages.
- Various stages of recovery for correct positioning, mobility, and functional training.
Tutorial/Assessments
- Description of the Modified Rankin Scale (MRS) and the National Institutes of Health Stroke Scale (NIHSS) used to assess stroke severity and for assessing patient progress.
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