ACUTE CARE REHABILITATION COMMUNITY

STROKE IS A NEUROVASCULAR CONDITION AFFECTING BLOOD VESSELS IN THE BRAIN

ISCHEMIC STROKE – occlusion of a cerebral artery causing damage to that portion of the brain dependent on the blood supply from the affected vessel.

HEMORRHAGIC STROKE – blood leakage from a cerebral artery that damages adjacent brain tissue.

CAROTID ARTERIES – supply the anterior portion of the brain – including most of the cerebrum.

VERTEBRAL ARTERIES – housed in the cervical vertebral column – they merge to form the basilar artery – supply the posterior portion of the brain – the cerebellum and brain stem.

MID CEREBRAL ARTERY – the largest vessel branching off the internal carotid artery – the most common site of cerebral occlusion. The MCA feeds:◦ Frontal Lobes◦ Temporal Lobes◦ Parietal Lobes◦ Basal Ganglia◦ Internal Capsule

The MCA has a main stem and several branches. Occlusion of the main stem affects the entire area of the brain supplied by the MCA. This distribution of the MCA is so large that a stroke of the main stem puts the victim at risk of death or severe disability.

Hemiplegia (paralysis) of the contral lateral (opposite) side affecting the lower side of the face, the arm, the hand, less affecting the leg

Contra lateral sensory loss in the same area Contra lateral homonymous hemaniopsia –

visual field defects affecting the same half of the visual fields of both eyes

Aphasia – partial or total loss of the ability to communicate through language

Expression – difficulty converting thoughts into language

Reception – difficulty understanding verbal and written language

Both – global aphasia Paralysis on the right side of the body Dysphagia

Impaired thought process – information processing delays

Impaired voluntary motion – apraxia Confusion between left and right – poor

discrimination Loss of right visual field – right hemaniopsia Easily frustrated Compulsiveness or slowness

Do not underestimate his ability to learn and communicate

Use other forms of communication if he cannot speak

Do not overestimate his understanding of speech and overload him with “static”

Do not shout – keep the message short and simple Do not use special voices Divide tasks into simple steps Give much feedback and point out every

indication of progress. It is better to give too much encouragement than too little.

Unilateral neglectDecreased awareness or failure to attend to the left side

Lack of awareness or concerns about deficits Paralysis on the left side of the body

(hemiplegia or hemiparesis) Excessive talking Short attention span Memory problems Poor judgment

Time disorientation Loss of left field of vision (left hemaniopsia) Unconscious of neglect – person and

environment Impaired abstract thinking – concrete

thinking predominates – doesn’t get the joke

Emotional lability Lack of interest and motivation – lethurgy Acts without thinking - impulsivity

Do not overestimate his abilities. Spatial deficits are difficult to spot.

Use verbal clues Break tasks into small steps with much

feedback Watch to see what he can do safely, rather

than taking his word for it Minimize clutter around him Anticipate falls

Anterior Cerebral Artery (ACA) branches off the Internal Carotid Artery and supplies the frontal and parietal lobes

Least commonly affected by strokesContral lateral leg weaknessSensory loss

Posterior Cerebral Artery arises from the top of the Basilar Artery and supplies the medial occipital lobe and inferior and medial temporal lobes

Vision is the primary function of the occipital lobeVisual defects – contra lateral hemaniopsia

Vertebal Artery – basilar stroke affect the cerebellum, brain stem or both

Cerebellar strokes impair balance and coordination – ataxia

Brain stem stroke – rare, with devastating symptomsHemiparesis or TetraplegiaSensory loss affecting either one or both sides of

the bodyDouble vision – diplopiaDysconjugate gazeSlurred speechDysphagiaDecrease level of consciousness

HTN Rupture Aneurysm Arteriovenous Malformation Cause same focal symptoms as ischemic

stroke Results in more pronounced neck pain Headache- “The worst headache of my life” Light intolerance Nausea and vomiting Impaired level of consciousness

1. Medical necessity to be in an acute setting Would benefit from daily doctor’s visit Requires 24 hour nursing care

2. Capable of doing 3 hours of therapy a day3. Has a rehab diagnosis that prevents them

from returning to community living4. Has a reasonable chance of returning to

community living5. We can reasonably document a significant

change in function Change from max to min assist transfers Incontinent to continent De-cannulize trach

Daily Program That Includes:

3 hours of therapy with OP therapist RN supervision of program Group therapy with peers and psychologist 5-6 hours per day Facilitates transition to community