Definition Of Stroke

Rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin and of more than 24 hours WHO TIA (Transient Ischaemic Attack) recovery is complete within 24 hours. 10% of patients will go on to have a stroke.

Stroke
Stroke is the third largest killer in the Western World. It accounts for up to 6% of in-patient hospital costs in Scotland. Stroke is one of the major causes of disability, particularly in the elderly. Stroke patients may present with a variety of physical, cognitive and psychosocial problems. Most stroke patients show signs of recovery over time.

Sub-types Of Stroke
Ischaemic obstruction to one of major cerebral arteries, brainstem strokes are less common. Haemorrhage 9% are caused by haemorrhage to the deep parts of the brain. Patients are usually hypertensive.

Risk Factors

OBESITY

 SMOKING

 DRUG ABUSE

 OLD AGE
Wee Betty lived a long and fruitfull life, RIP Betty (18751997). Thats 122 years dont you know!

 ALCOHOL

Stroke Classification
TACI (Total Anterior Circulation Infarct) PACI (Partial Anterior Circulation Infarct) LACI (Lacunar Infarct) POCI (Posterior Circulation Infarct)

Adverse Prognostic Indicators

Prior Stroke Older Age Persistent urinal and faecal incontinence Visuo-spatial deficits Additional Influences
Consciousness at onset, severity of paralysis, sitting balance, admission ADL score, level of social support, metabolic rate of glucose outside the infarct area in hypertensive patient.

Physiotherapy Aims
To normalise muscle tone To restore muscle function To control compensation strategies To maintain muscle length To re-educate balance To retrain walking and restore mobility To maximise functional ability while allowing ongoing neuromuscular recovery

Physiotherapy In Stroke
Size Of BOS
Large to reduce tone Small to increase tone

Alignment
Flexor eg sitting/prone Extensor eg standing/supine Positioning Strategies

Handling
Proximal/Distal/Anatomical

Communication
Volitional/Automatic/Voice

Stroke Assessment
Motor function Muscle tone (high/low) Sensation/Proprioception/Co-ordination Alignment/Stability in various positions Neuromuscular anatomy Compensation Strategies Balance Mobility

Outcome Measures
Mobility Milestones
1minute sitting balance 10 second standing balance 10 independent steps 10 metre walk

Berg Balance Scale 9 Hole Peg Test Elderly Mobility Scale Motor Assessment Scale

Treatment Strategies
Approaches
Bobath, Motor Relearning etc.

Hydrotherapy AFO/Calipers/Malleolar Locks Strapping Electrical Stimulation Positioning

Positioning
Base Of Support Alignment
Flexor Extensor Combination

Bed Type
Mattress Pillows how many?

Chair Type
Cushion soft, firm, intermediate

The Stroke Team

Doctor Nurse Physiotherapist Occupational Therapist Speech & Language Therapist Social Worker Dietician Psychologist Dentist Podiatrist Art Therapist Volunteers Carers

Other Problems To Consider

Multipathologies
UTIs RTIs D&V

Emotional Conditions
Lability Depression

Speech and Language Deficits

Dysphasia (expressive/receptive) Dyspraxia Dysarthria