Podcast
Questions and Answers
What is a significant risk associated with the use of low-dose unfractionated Heparin for prophylaxis?
What is a significant risk associated with the use of low-dose unfractionated Heparin for prophylaxis?
Which groups have an increased risk of developing hip fractures after a stroke?
Which groups have an increased risk of developing hip fractures after a stroke?
What is the approximate prevalence of depression among stroke patients?
What is the approximate prevalence of depression among stroke patients?
Which rehabilitation approach emphasizes training in the patient's own environment?
Which rehabilitation approach emphasizes training in the patient's own environment?
Signup and view all the answers
What is a key component of effective stroke rehabilitation?
What is a key component of effective stroke rehabilitation?
Signup and view all the answers
Which of the following is NOT a likely complication following a stroke?
Which of the following is NOT a likely complication following a stroke?
Signup and view all the answers
What type of care does a multidisciplinary team provide in stroke rehabilitation?
What type of care does a multidisciplinary team provide in stroke rehabilitation?
Signup and view all the answers
Which factor is associated with the development of fever in stroke patients?
Which factor is associated with the development of fever in stroke patients?
Signup and view all the answers
What is a documented benefit of having higher levels of social support for stroke patients?
What is a documented benefit of having higher levels of social support for stroke patients?
Signup and view all the answers
Which rehabilitation technique is part of contemporary treatment approaches for stroke patients?
Which rehabilitation technique is part of contemporary treatment approaches for stroke patients?
Signup and view all the answers
What is a significant challenge mentioned in integrating caregivers into rehabilitation?
What is a significant challenge mentioned in integrating caregivers into rehabilitation?
Signup and view all the answers
Which approach focuses on one-on-one training and tailored information for stroke patients?
Which approach focuses on one-on-one training and tailored information for stroke patients?
Signup and view all the answers
What outcome is associated with rehabilitation methods for patients with severe strokes?
What outcome is associated with rehabilitation methods for patients with severe strokes?
Signup and view all the answers
What did the authors find concerning caregivers' training during the rehabilitation phase?
What did the authors find concerning caregivers' training during the rehabilitation phase?
Signup and view all the answers
Which treatment approach is characterized by the use of robotic assisted training?
Which treatment approach is characterized by the use of robotic assisted training?
Signup and view all the answers
What is a factor that significantly influences a stroke patient's discharge destination?
What is a factor that significantly influences a stroke patient's discharge destination?
Signup and view all the answers
What characterizes the use of sensory stimuli in the Rood Approach?
What characterizes the use of sensory stimuli in the Rood Approach?
Signup and view all the answers
Which of the following is a key principle of Proprioceptive Neuromuscular Facilitation (PNF)?
Which of the following is a key principle of Proprioceptive Neuromuscular Facilitation (PNF)?
Signup and view all the answers
What does the 'use it or lose it' principle refer to in stroke rehabilitation?
What does the 'use it or lose it' principle refer to in stroke rehabilitation?
Signup and view all the answers
Which therapeutic approach emphasizes task-specific training in stroke rehabilitation?
Which therapeutic approach emphasizes task-specific training in stroke rehabilitation?
Signup and view all the answers
What role does neuroplasticity play in stroke rehabilitation?
What role does neuroplasticity play in stroke rehabilitation?
Signup and view all the answers
In the Rood Approach, which type of stimuli is considered inhibitory?
In the Rood Approach, which type of stimuli is considered inhibitory?
Signup and view all the answers
What is the primary focus of robotic-assisted therapy in stroke rehabilitation?
What is the primary focus of robotic-assisted therapy in stroke rehabilitation?
Signup and view all the answers
Which of the following techniques is included in facilitation according to the Rood Approach?
Which of the following techniques is included in facilitation according to the Rood Approach?
Signup and view all the answers
What is one mechanism by which neuroplasticity occurs?
What is one mechanism by which neuroplasticity occurs?
Signup and view all the answers
Which of the following factors can alter neuroplasticity?
Which of the following factors can alter neuroplasticity?
Signup and view all the answers
What does neuroplasticity primarily facilitate?
What does neuroplasticity primarily facilitate?
Signup and view all the answers
What alternative pathway might assume function if primary pathways are damaged?
What alternative pathway might assume function if primary pathways are damaged?
Signup and view all the answers
What does the shift from strict localization to multiple circuits in stroke recovery suggest?
What does the shift from strict localization to multiple circuits in stroke recovery suggest?
Signup and view all the answers
What is indicated by the variability in FMRI studies of neuroplasticity?
What is indicated by the variability in FMRI studies of neuroplasticity?
Signup and view all the answers
Which area may be activated during recovery following a stroke affecting the motor function of one hemisphere?
Which area may be activated during recovery following a stroke affecting the motor function of one hemisphere?
Signup and view all the answers
What term describes the phenomenon where previously inactive pathways become functional?
What term describes the phenomenon where previously inactive pathways become functional?
Signup and view all the answers
What is the primary goal in normalizing muscle tone using NDT techniques?
What is the primary goal in normalizing muscle tone using NDT techniques?
Signup and view all the answers
Which statement best describes the interdependence of trunk and limb selective movements in NDT?
Which statement best describes the interdependence of trunk and limb selective movements in NDT?
Signup and view all the answers
What aspect of muscle tone normalization does NDT specifically address in hypertonic patients?
What aspect of muscle tone normalization does NDT specifically address in hypertonic patients?
Signup and view all the answers
How do therapists utilize manual cues in NDT?
How do therapists utilize manual cues in NDT?
Signup and view all the answers
What are the implications of abnormal muscle tone in the context of NDT?
What are the implications of abnormal muscle tone in the context of NDT?
Signup and view all the answers
What is the effect of practicing functional activities according to NDT principles?
What is the effect of practicing functional activities according to NDT principles?
Signup and view all the answers
Which handling technique is emphasized in NDT for reducing increased muscle tone?
Which handling technique is emphasized in NDT for reducing increased muscle tone?
Signup and view all the answers
What is the rationale behind the use of contemporary NDT handling techniques?
What is the rationale behind the use of contemporary NDT handling techniques?
Signup and view all the answers
What is a key principle of motor learning that facilitates motor control?
What is a key principle of motor learning that facilitates motor control?
Signup and view all the answers
What outcome is associated with early admission to a specialized rehabilitation program?
What outcome is associated with early admission to a specialized rehabilitation program?
Signup and view all the answers
What role does the environment play in motor relearning?
What role does the environment play in motor relearning?
Signup and view all the answers
Which therapy aims to stop the reliance on unaffected limbs to improve motor ability in affected limbs?
Which therapy aims to stop the reliance on unaffected limbs to improve motor ability in affected limbs?
Signup and view all the answers
What is essential for a patient’s active participation in motor learning?
What is essential for a patient’s active participation in motor learning?
Signup and view all the answers
What can lead to a decline in cortical representation during recovery?
What can lead to a decline in cortical representation during recovery?
Signup and view all the answers
What aspect of rehabilitation can enhance functional recovery according to animal studies?
What aspect of rehabilitation can enhance functional recovery according to animal studies?
Signup and view all the answers
What is emphasized in task-oriented practice for motor learning?
What is emphasized in task-oriented practice for motor learning?
Signup and view all the answers
Study Notes
Clinical Sciences: Medical and Neurological Conditions
- Cerebral Vascular Accident (CVA)/Stroke B
Stroke Team
- Stroke Physician
- Neurologist
- Nurses
- Physiotherapist
- Occupational therapist
- Speech therapist
- Pharmacist
- Dietitian
- Social worker
- Clinical psychologist
Learning Outcomes
- Understand medical treatments for different types of CVA
- Familiar with stroke rehabilitation phases and process
- Identify stroke rehabilitation approaches (both conventional and updated)
Outline
- Medical Treatments
- Stroke Complications
- Overview of stroke rehabilitation
- Stroke rehabilitation process
- Acute care
- Rehabilitation phase
- Community phase & integration
- Various treatment approaches
- Resources for practice knowledge and service information
Medical Treatment to Acute Stroke
- Keep close neuro-observation
- Close monitoring of vital signs (body temp, BP, HR, SpO2)
- Stroke Service
- TIA clinic
- ASU
- FTPA
- ESD
Stroke Care Pathway (Examples for Day 0-6)
- Activities in first 24 hours:
- Health & neurological assessment
- Specific assessments & interventions
- Prevention of risks & complications
- Examples for Day 2+:
- Monitoring vital signs, GCS, level of consciousness
- Additional information: Barthel Index, and specific assessment and interventions for specific conditions (swallowing, bladder, bowel, etc)
- Discharge planning, family meeting, MO, etc.
- Skin assessment, IV removal, swallow assessment.
Ischemic Stroke (IV) rtPA
- Intravenous (IV) recombinant tissue-type Plasminogen Activator (rtPA)
- Improve proportion of patients with complete neurological recovery when given within 4.5 hours (but commonly suggest 180 minutes) of symptom onset.
- Some cases may receive rtPA even > 4.5 hours, depending on doctor's decision
Special Care in ASU
- Enhance personal hygiene
- Prevention of pressure sores
- Prevention of Deep Vein Thrombosis (DVT)
- Caring of patients (frequent medical officer visits)
Service Model
- Acute Stroke Unit (ASU)
- 24 hours IV rtPA (Tissue Plasminogen Activator) service
- Early supported discharge program
- TIA fast-track clinic
Features of Stroke Unit
- Care coordinated by multidisciplinary team.
- Team consists of professionals interested and specializing in stroke.
- Team meeting at least weekly.
- Involvement of caregivers in patient care.
rtPA Therapy Candidates (NOT fit for r-tPA therapy)
- Brain CT scan to confirm no bleeding.
- More than 3-4.5 hours from first symptom onset.
- Diabetes Mellitus (DM) or kidney diseases.
- Recent head injury.
- Bleeding problems/ulcers.
- Pregnancy.
- Recent surgery.
- Taken blood-thinning medications (e.g., Warfarin).
- Trauma.
- Uncontrolled high blood pressure.
IV-tPA Treatment
- Shows before vs. after images.
Medical Treatments (cont')
- Stroke Care Units reduce death and dependence.
- Multidisciplinary team involvement.
- Swallowing assessments.
- Early mobilization.
- Management protocols correct physiological derangements
- Anti-coagulants, prevent blood clots, oral medication.
- Aspirin started within 48 hours, reduces death, or dependence; secondary prevention (for those not suitable for rtPA cases).
Medical Treatment
- Antiplatelet treatment (Aspirin + dipyridamole, Plavix).
- Blood pressure lowering treatment
- Cholesterol control by statins.
Anticoagulation
- Warfarin to prevent stroke in atrial fibrillation (AF).
- Carotid endarterectomy (surgical removal of atherosclerotic material from carotid arteries in recent carotid stenosis symptoms).
Summary of Secondary Prevention
- Aspirin in 1978.
- Aspirin + Dipyridamole (prevents blood clots) in 1987.
- Carotid endarterectomy for symptomatic carotid artery stenosis ≥ 70% in 1991.
- Warfarin for patients with AF in 1993.
- Plavix (Clopidogrel) in 1996.
- Aspirin + Plavix for minor stroke & TIA in 2013.
- BP reduction with perindopril and indapamide or Ramipril in 2001.
- Cholesterol reduction with Statin in 2006.
Surgical Intervention
- Craniotomy
- Drainage via burr hole
- External ventricular drainage (EVD) of intraventricular blood
Burr Hole and Craniotomy
- For aneurysm clipping.
Craniotomy and Craniectomy
- Video link.
Stroke Complications
- Cardiac complications.
- Pulmonary complications.
- Gastrointestinal complications.
- Genitourinary complications.
- Venous thromboembolism.
- Musculoskeletal complications.
- Other complications
Cardiac Complications
- High occurrence of serious cardiac events and non-stroke vascular death in patients with stroke.
- Myocardial infarction.
- High risk factors: established coronary artery disease, diabetes, peripheral vascular disease, and severe strokes.
- Cardiac arrhythmias.
- Congestive heart failure & cardiomyopathy
- Associated with sudden death, congestive heart failure, and recurrent thromboembolism.
Pulmonary Complications
- Pneumonia (one of the most frequent medical complications) & most common cause of fever within first 48 hours; 3x increased risk of death.
- Risk factors: old age (65+), speech impairment, stroke disability, cognitive impairment, dysphagia
- Oxygen desaturation & apnoea (risk factors: severe strokes, age, swallowing impairment, pre-existing cardiac & pulmonary disease, obstructive sleep apnoea, & central periodic breathing)
- Rx: evaluation of swallowing function, & dietary modifications; frequent suction, prophylactic antibiotics
Gastrointestinal (GI) Complications
- Dysphagia (major risk factor for stroke).
- Risk factors: 37%-78%, stroke-associated pneumonia.
- Nasal Gastric (NG) tube at early stage, or Percutaneous Endoscopic Gastrostomy (PEG) at chronic stages; protection against aspiration pneumonia.
- Gastrointestinal bleeding (Risk factors: recurrent strokes, venous thromboembolism, myocardial infarction, peptic ulcer disease, cancer, sepsis, renal failure, abnormal liver function).
- Faecal incontinence (Risk factors: 30%-56%).
Genitourinary (GU) Complications
- Urinary tract infections (UTIs): Increased age, use of urinary catheters, stroke severity, female sex.
- Rx: Avoid unnecessary catheterization and meticulous catheter care.
- Urinary incontinence: Risk factors: advanced age, lesion size, diabetes, hypertension, premorbid disabilities, initial stroke severity.
Venous Thromboembolism
- Deep Vein Thrombosis (DVT): develops if immobile for a long time (bed-bound after stroke/hemiparesis); blood clots can travel to lungs (pulmonary embolism).
- Pulmonary embolism: Most fatal occur between weeks 2 & 4 after stroke.
- Prophylaxis: Low-dose unfractionated heparin to prevent DVT and pulmonary embolism and reduce death risk but increase major bleeding risk.
Musculoskeletal Complications
- Hip fractures (7x higher risk first year after stroke; risk factors: women, advanced age, moderate disabilities).
- Pain (central post-stroke pain syndrome; mostly inappropriate handling; shoulder pain).
Other Complications
- Fatigue.
- Depression (33%; risk factors: women, younger patients, those with greater disabilities).
- Fever (5%; risk factors: among patients hospitalized within a few hours; 60% of patients with ischemic stroke developed fever within 72 hours; infection, systemic stress, impairment of central thermoregulation).
- Pressure injuries (prolonged bed rest or immobilization by patient).
Overview of Stroke Rehabilitation
- Acute treatment to rehabilitation (after management in Acute Emergency Department (AED))
- Acute Stroke Unit (ASU)
- Early supported discharge teams
- Therapy-based rehabilitation at home.
Stroke Rehabilitation
- General Principles
- Multidisciplinary team care
- Goal setting (specific, measurable, and time-dependent), guide management.
- Good rehab outcome associated with high patient motivation & engagement.
- Training should target goals relevant to patients' needs (task specific training).
- Training preferably in patient's own environment.
- High-intensity practice
- High complex treatments
- Intervention is provided by more than one individual/professional, a complex package of treatment.
- E.g., cognitive rehabilitation , early support discharge service, integrated care pathway, occupational therapy (OT), physical therapy (PT), speech therapy (ST), & therapy-based rehabilitation services, etc.
- Target specific stroke-related impairments: e.g., ankle foot orthosis (AFO), Bilateral arm training, EMG Biofeedback, constraint-induced movement therapy (CIMT), robotic training,
Acute Stroke Unit (ASU)
- Stroke unit vs. General medical unit.
- Reduction in mortality rates.
- Shorter length of inpatient stay (LOS).
- Improved independence in activities of daily living (ADLs).
- Cochrane Library (2000): reviewing stroke unit care + early discharge + community support care reduced cost by 15% while influencing clinical outcomes, and shorter patients' stay in rehab hospitals
Acute Stroke Unit (ASU) (cont')
- Integrated approach
- Early mobilization & rehabilitation
- Prevention of post-stroke medical complications: pneumonia, deep vein thrombosis, etc.
- Rehabilitation plans involving carers.
- Early assessment & discharge planning needs
Stroke Acute Care (Besides Medical Care)
- Assessment & Triaging.
- Positioning (in bed, in wheelchair).
- Early mobilization & functional training.
- Fall prevention.
- Patient/family/staff education (effects of therapy).
- Swallowing assessment
Early Supported Discharge Teams
- Provided by skilled multidisciplinary teams with regular meetings.
- Patient return home earlier with reduced need for institutional care.
- Increase likelihood of regaining independence in activities of daily living (ADL).
- Most effective for patients with mild-to-moderate disabilities
Therapy-based Rehabilitation at Home
- Therapy from multidisciplinary team (OT, PT, community nurse) in patients' homes.
- Prevent deterioration in activities of daily living (ADL).
- Meta-analysis: OT services at home delivered during first year increased both ADL & IADL.
Rehabilitation Phase
- Rehabilitation is the cornerstone of stroke management.
- Process of assisting disabled persons due to stroke, to return to optimal level of health, activity & participation within limits of persisting stroke impairment (ICF concept).
- Rehabilitation aids in facilitating reorganization of residual brain function (remediation approach).
- Rehabilitation aims at facilitating reorganization of residual brain function.
Priorities in Stroke Rehabilitation
- Prevention of complications.
- Interventions to minimize disability, including remedial therapy.
- Adaptations to minimize handicap and enhance function, including home modifications and use of adaptive aids.
- Counseling, education on mood, monitoring, and empowerment.
- Empowering patients/caregivers, to improve quality of life (QOL).
- Organised multidisciplinary care for efficiency.
Community Phase & Reintegration
- Discharge planning:
- Home modification and prescription of assistive devices.
- Carer/patient education
- Carer's education
- Educational class (sharing, and mutual support)
- Involvement in patients' treatment sessions (enhance communication with patients and family members).
- Information pamphlets (information to keep).
- Information provision content and strategies (related to recovery; practical caring tasks, transfer; use of assistive devices etc).
- Planning social activities & support.
- Intro of resources available in the community & make referral.
Community Reintegration
- RCT (300 patients and caregivers in UK): formal (educational) training of caregivers during patient's rehabilitation associated with less caregiving burden, better psychological outcomes in patients & caregivers, higher quality of life (QOL) in patients & caregivers, and reduced overall costs of health & social care.
Conclusions on Community Supports
- Scope of social support: Day Care center; community support-services (home care service, meals on wheels, home-help, volunteer visits); family's support: a key factor in discharge destination.
- Higher levels of social support associated with greater functional gain, less depression/improved mood, more social activity/interaction.
- Evidence of benefit of one-on-one training/counseling with tailored information vs. written information; more effective.
- Patients with severe stroke + rehabilitation (on prevention of complications, equipment needs, and arrangement of social support); shortened hospital LOS and reduced mortality rates.
Challenges in Community Integration
- Integrating caregivers into rehabilitation programs: Community facilities, manpower; caregivers illness/burnout issues.
Treatment Approaches in Stroke Rehabilitation
- Traditional
- Bobath/Neurodevelopmental Therapy (NDT).
- Rood Approach.
- PNF (Proprioceptive Neuromuscular Facilitation).
- Brunnstrom Movement Therapy Approach
- Contemporary
- Motor Re-learning
- Motor Re-learning program by Carr & Sheppard
- Constraint Induced Therapy (CIMT) by E. Taub
- Task specific training
- Functional Electrical Stimulation (FES)
- Robotic assisted training
- (Contemporary) NDT (NEURAL-IFRAH)
- Mental Imagery
- Motor Re-learning
Bobath/Neurodevelopmental Therapy (NDT)
- Developed by Dr. Karel & Berta Bobath in 1940s in UK, established in 1960s in North America.
- Major treatment aims: focus on progression of movement (developmental sequence), inhibition of primitive reflexes/spasticity, and facilitation of higher-level control.
- Focus on: Physical problems in stroke; abnormal coordination of movement patterns, poor balance, sensory deficits, and abnormal tone.
Brunnstrom Movement Therapy
- 6 stages recovery; examples on upper limb (UL) with flexor synergy.
Rood Approach
- Uses sensory stimuli to facilitate or inhibit movement through progressive stages of movement control (Characteristic).
- Facilitation (heavy work): tactile stimuli (light touch, brushing); thermal stimuli (icing); proprioceptive stimuli (quick stretch of muscle, vibration, & stretch to finger intrinsic, heavy joint compression, & resistance).
- Inhibition (light work): tactile stimuli (rhythmical moving touch); thermal stimuli (neutral warmth, prolonged cooling); proprioceptive stimuli (prolonged stretch, joint approximation, & tendon pressure); vestibular stimuli (slow rolling/rocking)
Proprioceptive Neuromuscular Facilitation (PNF)
- Principles: stimulation of proprioceptors to facilitate/inhibit movement.
- Characteristic: PNF diagonal patterns(all parts of the body, head & neck, trunk, limbs, & facial muscles to perform two diagonal patterns, based on normal motor activity), and techniques (diagonal movement patterns, relaxation techniques to increase range of motion, and emphasis on breathing).
Contemporary Basis of Stroke Rehabilitation
- Neuro re-organization & neuroplasticity.
- Contemporary NDT.
- Motor re-learning theory.
- Use it or lose it principle & CIMT.
- Task-specific therapy.
- Robotic Assisted Therapy.
Neuroplasticity
- Assumption: brain has intrinsic ability to modify structural & functional organization.
- 4 possible mechanisms: collateral sprouting of new synaptic connections, unmasking of previously latent functional pathways, assuming function from undamaged redundant neural pathways, and regenerative proximal sprouting.
- Experimental evidence indicates plasticity can be altered by several external factors (pharmacological agents, electrical stimulation, and environmental stimulation)
Neuroplasticity (cont')
- Plasticity underlies all skill learning and is a part of CNS function.
- The CNS and neuromuscular system can adapt and change their structural organization in response to intrinsic and extrinsic information.
- Changes in the CNS structure can be organized through therapy or disorganized by stroke, producing adaptive or maladaptive sensorimotor behavior.
- Manipulation of information can directly affect structural organization of the CNS.
fMRI Studies of Neuroplasticity
- New & functionally related areas take over damaged brain function.
- Other distant areas of the brain are involved in relearning and recovery.
- Different strokes have different recovery patterns.
- Shift from strict localization to multiple circuits (however, great variability between studies and lack of longitudinal data).
fMRI Studies of Neuroplasticity (cont')
- Reorganization activity in contralateral side of the brain.
- Activation of adjacent, undamaged areas on the ipsilateral side.
- Example: Patient with severe stroke with right UL dysfunction, right hemisphere may take over control.
Current Concepts in Bobath/NDT
- Therapy aims at relearning normal movement through experience with active participation.
- To regain more effective & efficient postural & selective movement strategies.
- To reeducate patient's internal referencing system (accurate afferent input, efficient, specific, and movement choices).
Current Concepts in Bobath/NDT (cont')
- Assumption: balance and selective movement are a basis for functional activity.
- Selective movement of trunk and limbs is interdependent and interactive with a postural control mechanism.
- Functional activity is practiced to improve efficiency and promote generalization
- Abnormal tone & mass movement patterns can be interpreted as plastic responses of CNS, brought about by patient's compensatory efforts to move.
Current Concepts in Bobath/NDT (cont')
- Contemporary NDT approaches are heavily influenced by motor learning theories (Ryerson & Levit, 1997; Runyan, 2006).
- Use of manual cues to recover functional use of components of movement (ie. accessing missing components of movement).
- Muscle tone management isn't just about spasticity, related to changes in motor recruitment patterns and joint alignment and reeducate new movement patterns
Principles in Normalizing Tone in NDT
- Abnormal muscle tone: hypertonic/spasticity, hypotonic/flaccidity, rigid
- Aims of tone normalization: hypertonic to create appropriate motor control, hypotonic/flaccidity to access optimal muscle activation.
- Techniques: Therapists emphasize reduced movement, cutaneous, proprioceptive, and handling techniques to change muscle tone and facilitate movement.
Motor Re-learning Theory
- Principles of motor learning
- Patient's active participation.
- Opportunities for practice; identify movement components, repetition important for motor control consolidation (may not be the same way), supervised practice, provide feedback.
- Meaningful goals, goal-oriented, & task-specific
- Human motor behavior is based on continuous interaction between individual, environment, and task.
Animal Study of Motor Relearning
- Rehabilitation training (enriched environments with animals) to increase brain reorganization & functional recovery.
- Key factors: increased activity, complex, and stimulating environment.
- Lack of stimulating active environment causes decline in cortical representation and recovery delay.
Animal Study (cont')
- Earlier intervention (e.g., Day 5 admission) leads to marked improvement (vs. admission on Day 14 or Day 30), better functional outcomes (FIM, BI).
Constraint-Induced Movement Therapy (CIMT)
- Discourage unaffected extremity use (primarily upper limb (UL)) and encourage active use of hemiplegic arm.
- Affected UL's learned non-use, aims to improve ceasing reliance on less affected parts and improving motor ability of affected part.
- Arm restraint (sling or mitt) during most waking hours (2-3 weeks), actively training weaker arm during therapy (6 hours daily) at home.
CIMT Training (Home Program)
- Good side (right) restrained; affected side (left) encouraged in rehabilitation training.
Task-Specific Therapy
- Stroke rehab must be task-specific; meaningful, repetitive activity is necessary for beneficial reorganization of cortex greater than repetitive activity not enough (Hubbard, 2009).
- Task-specific therapy focusing on tasks important & meaningful to patient, early on, simulated real-life tasks.
- Task-specific therapy to reduce LOS
Technology-based Rehabilitation
- Robotic assisted rehabilitation (controlled guidance) for paralyzed muscles and specific tasks to enhance motor learning, to initiate and produce assistive force for movement.
- Robotic + Functional Electrical Stimulation (FES) to enhance high repetitive practice & motor relearning
Armeo Robotic Training
- Arméo Boom
- Arméo Power
Resources for Practice Knowledge and Service Information
- Information for patients, carers, and therapists.
- Local service information (Smart Patient, Hospital Authority of Hong Kong, Department of Health).
- Community programs for stroke survivors, by NGOs.
- Global resources (WHO, Heart & Stroke Foundation of Canada, National Stroke Association, US).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on the key aspects of stroke rehabilitation, including risks, complications, and effective strategies. This quiz covers various components such as the role of multidisciplinary teams, rehabilitation techniques, and the importance of social support for stroke patients.
