Stroke rehabilitation and its aspects to work with patients with hemiplegia and other effects of stroke, other than that you will see some pictures of the used interventions and adaptive equipment used with stroke patients
2. National Stroke Association
10% of stroke survivors recover almost
completely
25% recover with minimal impairment
40% experience moderate to severe
impairments that require special care
10% require care in a nursing home or other
long-term facility
15% die shortly after the stroke
Approximately 14% of stroke survivors
experience a second stroke in the first year
following a stroke
3. Effect of a Stroke
1. Weakness on the side of the body opposite the site
of the brain affected by the stroke
2. Spasticity, stiffness in muscles, painful muscle
spasms
3. Problems with balance and/or coordination
4. Problems using language, including having difficulty
understanding speech or writing(aphasia); and knowing
the right words but having trouble saying them
clearly (dysarthria)
5. Being unaware of or ignoring sensations on one side
of the body (bodily neglect or inattention)
6. Pain, numbness or odd sensations
4. Effect of a Stroke (con’t)
7. Problems with memory, thinking, attention
or learning
8. Being unaware of the effects of a stroke
9. Trouble swallowing (dysphagia)
10. Problems with bowel or bladder control
11. Fatigue
12. Difficulty controlling emotions (emotional
lability)
13. Depression
14. Difficulties with daily tasks
5. Rehabilitation Goal
To restore lost abilities as much as
possible
To prevent stroke-related complications
To improve the patient's quality of life
To educate the patient and family about
how to prevent recurrent strokes
Promote re-integration into family,
home, work, leisure and community
activities
6. Successful Rehabilitation
Depend on
- how early rehabilitation begins
- the extent of the brain injury
- the survivor’s attitude
- the rehabilitation team’s skill
- the cooperation of family and
caregiver
7. Basic Principles of Rehabilitation
To begin as possible early
To assess the patient systematically (first
hours to first day)
To prepare the therapy plan carefully
To build up in stages
To include the type of rehabilitation approach
specific to deficits
To evaluate patient’s progress regularly
8. Inter/Trans /
Multidisciplinary Team
Rehabilitation specialist
Physical, occupational and speech therapist
Social worker
Dietician
Recreational therapist
Psychologist
Vocational rehabilitation counsellor
Nurses
Orthotist
Patient, caregiver
9. Early Mobilisation
If patient's condition is stable, however, active
mobilisation should begin as soon as possible, within
24 to 72 hours of admission
Early mobilisation is beneficial to patient outcome
by reducing the complication
It has strong positive psychological benefit for the
patient
Specific tasks (turning from side to side in bed,
sitting in bed) and self-care activities (self-
feeding, grooming and dressing) can be given for
early mobilisation.
18. 2. Activity of daily living
Occupational therapy
– Self care Dressing
Grooming
Toilet use
Bathing
Eating
– Adapt or specially design device
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30. 3. Communication
Speech and language therapy
Common communication disorder
– Aphasia *Receptive - auditory
- reading
*Expressive - speaking
- writing
*Global
*Anomic - forget interrelated
groups of words
– Dysarthria
31. Goal of treatment
Facilitate recovery of communication
develop strategies to compensate
- Gesture
- Picture
- Communication board
- Computer
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36. 4. Swallowing
Dysphagia : abnormal in swallowing fluids
or food
– Increase risk of pneumonia and malnutrition
53. 9. Mood
1. Post stroke depression (PSD)
2. Anxiety
3. Emotionalism (emotional lability)
– Improve with time
54. 10. Bowel and bladder
incontinence
Urinary incontinence
- 50% incontinence during acute phase
- with time, ~ 20% at six months
- Risk: age, stroke severity, diabetes
- Indwelling catheter : management of
fluids, prevent urinary retention, skin
breakdown
- Use of foley catheter > 48 hours
UTI
56. Constipation, fecal impaction
– More common
– Immobility, inadequate fluid or food intake,
depression or anxiety, cognitive deficit
Management
– Adequate intake of fluid
– Bulk and fiber food
– Bowel training
57. Conclusion
Rehabilitation therapy should start as early
as possible, once medical stability is reached
Spontaneous recovery can be impressive, but
rehabilitation-induced recovery seems to be
greater on average.
Even though the most marked improvement is
achieved during the first 3 months,
rehabilitation should be continued for a longer
period to prevent subsequent deterioration.
58. Conclusion
No patient should be excluded from rehabilitation
unless he is too ill or too cognitively devastated to
participate in a treatment program.
Proper positioning and early passive ROM exercises
help to avoid complications at a flaccid stage.
Family members should participate in therapy
sessions.
The family should also be referred to community
groups that offer psychosocial support such as stroke
clubs at the time of discharge.