Functional Impairments Of Stroke

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Functional Impairments Of Stroke
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Purpose

• The purpose of this presentation is to provide a
  general overview of common functional impairments
  of stroke, the basic anatomy and physiology
  related to these impairments and to provide the
  learner with tips on how to deal with each
  functional impairment.

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Target Audience

• Health care providers who require basic knowledge
  of the functional impairments of stroke

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Learning Objectives

• Identify 10 common functional impairments of
  stroke
• Identify the basic anatomy and physiology related
  to each functional impairment
• Identify tips to assist stroke survivors to
  manage the functional impairments

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Common Effects By Hemisphere
Figure 1, HSFO, 2002
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Common Functional Impairments

• Mobility
• Arm/hand function
• Speech and language
• Cognition
• Vision
• Visual perception
• Motor planning
• Urinary continence
• Swallowing and aspiration
• Nutrition

Figure 2, adapted from WHO, 2001
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Mobility

• Hemiplegia and mobility
• Mobility after stroke may be affected by a number
  of factors
• Loss of motor control
• Sensation
• Fatigue
• Muscle tone
• Balance
• Posture
• Perception

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Tips For Assisting With Mobility

• Stroke survivors should be mobilized as early as
  possible
• Ensure safety and comfort while promoting
  independence
• Avoid over-tiring the survivor
• Each person is unique
• Move slowly and gently
• Talk with the survivor
• Encourage participation
• Use good body mechanics
• Position the affected arm

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Hand And Arm Function

• Stroke may affect a survivors hand and arm
  function
• Hand and arm recovery may be slower than the
  lower extremity
• Most recovery occurs in the first 3 months but
  improvement can occur even months and years in
  the future

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Painful Hemiplegic Shoulder

• Painful shoulder occurs in 40 to 60
• Major impact on ADLs and rehab
• Etiology is complex
• Glenohumeral subluxation
• Spasticity of the shoulder muscles
• Impingement
• Soft tissue trauma
• Rotator cuff tears
• Reflex sympathetic dystrophy
• Myofascial pain
• Referred pain from the neck
• Take home message HANDLE WITH CARE

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Painful Hemiplegic Shoulder

Subluxation
Figure 3 Normal and subluxed shoulder
Figure 4
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Tips For Assisting With Hand And Arm Function

• Never pull on the survivors affected arm
• Positioning
• Reposition the forgotten arm
• Support the affected arm during transfers
• Sling use

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Speech And Language

• Difficulty in using or understanding language,
  which results from damage to the brain
• Aphasia or dysphasia
• Dysarthria
• Dyspraxia of speech

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Tips For Communication

• Strategies to help you get your message across
• Look at the person
• Appropriate tone of voice
• One idea at a time
• Write down key words
• Use gestures and facial expressions
• Use objects
• Use YES/NO questions
• Draw simple pictures

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Tips For Communication

• Strategies to help the person with communication
  problems get their message across
• Encourage writing or drawing
• Encourage pointing
• Identify the general topic and then move to the
  details
• Ask YES/NO questions
• Use words that you have written down

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Cognition

• Two-thirds may experience cognitive impairment
• Most recovery occurs in the first three months,
  but may continue for at least the first year
• Cognitive changes may include
• Attention
• Executive functioning
• Processing speed
• Memory
• Orientation

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Tips To Assist With Cognition

• Depends on the nature of cognitive impairment
• Orientation
• Attention
• Memory
• Impulsivity
• Planning and starting a task
• Decreased information processing speed

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Vision

• Vision problems are common following stroke
• Double vision (diplopia)
• Changes in clarity of vision (visual acuity)
• Visual field impairment (hemianopia)

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Tips To Assist With Vision

• Visual acuity
• Bring glasses to hospital or rehabilitation
• Optometrist referral if glasses are in poor
  condition
• Double vision
• Patching
• Consider the use of prisms
• Hemianopia
• Compensate through scanning
• Consider the use of prisms

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Visual Perception

• Unilateral spatial neglect (USN) is inability to
  respond to sensory stimuli presented on the
  survivors affected side
• USN is more common in individuals who have
  right-sided lesions than left.

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Tips To Assist With Unilateral Spatial Neglect

• Arrange the environment
• Approach the survivor from the unaffected side
• Use a positive approach
• Use visual cues to assist the survivor

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Motor Planning

• The inability to perform purposeful movements
  even though the survivor has the physical ability
  and understands the task

Figure 5
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Tips To Assist With Motor Planning

• Use physical cues
• Use short and simple instructions
• Use verbal cues and instructions
• Break the task down into small steps
• Maintain a consistent routine
• Provide support and encouragement
• Provide hand-over-hand guidance
• Refer to rehab

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Urinary Continence

• The loss of control of urine or inability to hold
  urine until the bathroom is reached
• Stroke may impact normal bladder function
• Indirect impact of stroke
• Environmental considerations

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Tips For Assisting With Urinary Continence

• Urinary incontinence can be treated
• Timed voiding
• Prompted voiding
• Bladder retraining with urge suppression
• Pelvic muscle exercises
• Compensatory rehabilitation
• Remove catheter ASAP

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Swallowing And Aspiration

• Dysphagia is difficulty swallowing
• 29 to 65 of stroke survivors
• Common in brainstem or bilateral stroke
• Frequent in unilateral stroke
• Aspiration

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Tips For Swallowing And Aspiration

• NPO until screened by a trained individual
• Referral to an expert in swallowing
• Referral to a dietician
• Individuals with dysphagia should feed
  themselves
• Low risk feeding strategies

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Nutrition

• Malnutrition is common problem after stroke
• Patients consume fewer calories and protein
  following stroke

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Tips For Nutrition

• Nasogastric tubes
• Intragastric feeding tubes
• Oral supplementation improves energy and protein
  intake

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Discussion

• Discussion and questions

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Functional Impairments of Stroke

• Prepared by
• Margaret Grant, BScOT
• Rehabilitation Education Coordinator
• Alberta Provincial Stroke Strategy
• Reviewed by
• Dr. Carmen Tuchak, BSc(Hons), MD, FRCP(C)
• Clinical Director
• Glenrose Hospital Stroke Program
• Edmonton , Alberta
• Luchie Swinton, BScOT
• Rehabilitation Facilitator
• Calgary Stroke Program
• Calgary, Alberta

Gayle Thompson RN(NP), MN Education
Project Manager Alberta Provincial Stroke
Strategy