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 (1875-1997). That’s 122 years don’t 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 on-

going 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