OT for cva
- 1. CEREBROVASCULAR ACCIDENT/STROKE • Also called “brain attack”, cerebral infarction, cerebral hemorrhage, ischemic stroke or stroke • A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.
- 2. DIRECT CAUSES: • CEREBRAL THROMBOSIS • a blood clot or plaque blocks an artery that supplies a vital brain center • CEREBRAL HEMORRHAGE/ANEURYSM • an artery in the brain bursts, weakens the aneurysm wall; severe rise in BP causing hemorrhage and ischemia • CEREBRAL EMBOLISM • a blood clot breaks off from a thrombus elsewhere in the body, lodges in a blood vessel in the brain and shuts off blood supply to that part of the brain
- 3. TYPES: • ISCHEMIC STROKE • Occurs when a clot or a mass clogs a blood vessel, cutting off the blood flow to brain cells. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis. • Almost 85% of strokes are ischemic ATHEROSCLEROSIS - “hardening of the arteries” - “athero” – gruel or paste - “sclerosis” – hardness - It’s the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.
- 4. TYPES: • HEMORRHAGIC STROKE • Results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. • About 15% of all strokes but responsible for 30% of stroke deaths 2 TYPES SUBARACHNOID HEMORRHAGE (SAH) occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull INTRACEREBRAL HEMORRHAGE (ICH) Occurs when a blood vessel bleeds into the tissue deep within the brain.
- 5. Types of Stroke Ischemic (~74%) Intracerebral hemorrhage(~24%) 30 day survival 73-81% 30 day survival 36%
- 6. STAGES OF CVA Transient Ischemic Attack • sudden and short-lived attack • Is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. • What is the difference between stroke and TIA? • There's no way to tell if symptoms of a stroke will lead to a TIA or a major stroke. It's important to call 9-1-1 immediately for any stroke symptoms. Reversible ischemic neurologic deficit (RIND) similar to TIA, but symptoms can last up to a week Stroke in evolution (SIE) • Gradual worsening of symptoms of brain ischemia Completed stroke (CS) – symptoms of stroke stable over a period and rehab can begin
- 7. Signs and Symptoms In embolism • Usually occurs without warning • Client often with history of cardiovascular disease In thrombosis • Dizzy spells or sudden memory loss • No pain, and client may ignore symptoms In cerebral hemorrhage • May have warning like dizziness and ringing in the ears (tinnitus) • Violent headache, with nausea and vomiting Sudden Onset CVA • Usually most severe • Loss of consciousness • Face becomes red • Breathing is noisy and strained
- 8. Signs and Symptoms Sudden Onset CVA • Usually most severe • Loss of consciousness • Face becomes red • Breathing is noisy and strained • Pulse is slow but full and bounding • Elevated BP • May be in a deep coma
- 9. •RISK FACTORS: • Being over age 55 • Being an African-American • Having diabetes • Having a family history of stroke • MEDICAL STROKE RISK • Previous stroke • Previous episode of transient ischemic attack (TIA) or mini- stroke • High cholesterol • High blood pressure • Heart disease
- 10. •RISK FACTORS: • LIFESTYLE STROKE RISK • Smoking • Being overweight • Drinking too much alcohol • You can control lifestyle risks by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.
- 11. Common STROKE symptoms… Weakness or paralysis Numbness, tingling, decreased sensation Vision changes Speech problems Swallowing difficulties or drooling Loss of memory Vertigo (spinning sensation) Loss of balance and coordination Personality changes Mood changes (depression, apathy) Drowsiness, lethargy, or loss of consciousness Uncontrollable eye movements or eyelid drooping
- 12. MAJOR EFFECT of STROKE • HEMIPLEGIA – most common result of CVA • Paralysis of one side of the body • May affect other functions, such as hearing, general sensation and circulation • The degree of impairment depends on the part of the brain affected • Stages: • Flaccid – numbness and weakness of affected side • Spastic – muscles contracted and tense, movement hard • Recovery – therapy and rehab methods successful
- 13. MAJOR EFFECT of STROKE • Aphasia and Dysphasia • Brain Damage – extent of brain damage determines chances of recovery • Hemianopsia – blindness in half of the visual field of one or both eyes • Pain – usually very little; injection of local anesthetic provides temporary relief • Autonomic Disturbances • Such as perspiration or “goose flesh” above the level of paralysis • May have dilated pupils, high or low BP or headache • Treated with atropine-like drugs
- 14. DIAGNOSIS • Physical Examination (neurological examination & medical history) • Imaging (CT scan and MRI)
- 15. ISCHEMIC STROKE
- 18. ACT F.A.S.T F – FACE • Ask the person to smile. Does one side of the face droop? A – ARMS • Ask the person to raise both arms. Does one arm drift downward? S – SPEECH • Ask the person to repeat a simple sentence. Does the speech sound slurred or strange? T – TIME • Call an ambulance Immediately
- 19. ASSESSMENT • Swallowing ability/aspiration risk • Level of consciousness • Neurological status • Motor, sensory and cognitive functions • Glasgow Coma Scale score
- 20. STROKE PREVENTION • Get screened for high BP. • Have your cholesterol level checked. LDL should be lower than 70 mg/dL. • Follow a low-fat diet. • Quit smoking! • Exercise! • Limit alcohol intake!
- 21. Recovery • Neurological recovery • from early spontaneous recovery • usually within the initial few weeks when penumbral area recovers their function • Functional recovery • recovery in everyday function with adaptation and training in presence/ absence of natural neurologic recovery • lags neurological recovery by 2 weeks • the part most helped by rehabilitation
- 22. How OT can help a person with stroke • Often Functional independence is the goal and can be achieved through: • Skilled treatment in rehabilitating lost physical function • Remediating or Compensatory method • Adaptive equipment • Home modifications • Client and caregiver guidance
- 23. When OT services are is indicated ?OT is indicated if there is a decline in • upper extremity strength, sensation, endurance, hand function • activities of daily living (ADL) (feeding, grooming, dressing, bathing, toileting) • functional transfers (tub transfers, toilet transfer) • home management abilities (cooking, laundry, house hold activities) • or if there is need for work simplification /modification / energy conservation
- 24. Stroke Rehab Principles • Identify impairments • Careful attention to comorbidities and complications • Early goal directed treatment • Systematic assessment of progress • Experienced interdisciplinary team • Education • Comprehensive discharge planning
- 25. Early Mobilisation • Physiologically sound changes in bed position • Range of motion exercises • Specific tasks ( sitting up, turning from side to side ) • Self care activities ( feeding, grooming, dressing )
- 26. Secondary Complications • Recurrent Stroke • DVT • Pressure sores • Bowel /bladder dysfunction • Dysphagia
- 27. Stroke Impairments • Cognitive • Communication • Motor • Sensory • Visual
- 28. Outcome Measures • Stroke Severity – NIHSS • Upper and lower extremity function – Fugyl Meyer • Visual perception – Line bisection • Balance – Berg Balance • Cognition – MMSE • ADLs and ambulation – FIM score, Barthel index
- 29. Interdisciplinary Team • Rehabilitation physician • Nurse • Physiotherapist • Occupational therapist • Speech therapist • Psychologist • Social Worker • Prosthetist and Orthotist • Dietician
- 30. Stroke rehab: Where? • Inpatient • Community Hospital • Nursing Home • Day Rehabilitation Centres • Home based therapy (eg. Community rehab programme)
- 31. Stroke- Awareness of Self
- 32. Stroke: Improving Mobility and Balance
- 33. Stroke: Improving Upper Limb Function Functional electrical stimulationFunctional electrical stimulation (FES)(FES)
- 34. Stroke- Upper Limb Function
- 35. Stroke- Improving self care
- 39. Late Rehabilitation Issues • Psychological maladjustment • Depression • Sexuality • Vocational • Driving • Equipment needs • Spasticity • Hemiplegic shoulder pain • Rotator cuff injury • Spasticity • Subluxation • Complex regional pain syndrome • Contactures • Central post stroke pain
- 40. Constraint Induced Movement Therapy (CIMT ) •Evidence for arm improvement ( EXCITE trial ) •Good upper limb is constrained ( 90% of patient’s waking time ) •Affected upper limb trained in functional tasks •Must have some wrist and finger function before starting Rehabilitation Toolbox
- 41. Mental Imagery • Mirror box therapy • Small trials • Better evidence for use to improve upper limb function • Must be used in combination with therapy
- 42. Functional Electrical Stimulation • Bioness Arm Unit • Used as a neuroprosthesis • Functional aid to performing ADL • Can aid motor recovery
- 43. Functional Electrical Stimulation • Lower extremity FES unit • Facilitate more fluid gait • Has a gait sensor, miniature control unit and is wireless • Increased walking speed
- 44. Virtual Rehab • Shown to have improvement in balance and gait • Immersive vs. non immersive • Wii games
- 45. Robotic Technology • New class of clinical tools • Highly reproducible motor learning experience • Relieves strenous repetitive effort of therapists
- 47. Benefits of OT services • OT services can help a person with stroke to • adapt to his / her living environment • restoration of maximum possible function • participate more fully in day – to – day activities • Enhance recovery & outcomes • Improved quality of life • Prevention • Secondary Complications