Functional life after a StrokeFunctional life after a Stroke

Your Personal Guide to Your Personal Guide to Functional Ability and Functional Ability and Living Modifications.Living Modifications.

Leonora DapontesLeonora Dapontes&&

Tanika AllenTanika Allen

What is a Stroke?What is a Stroke? Occurs when a blood vessel in or Occurs when a blood vessel in or

around the brain becomes blocked or around the brain becomes blocked or ruptures, depriving the brain of blood.ruptures, depriving the brain of blood.

When that area of the brain is deprived When that area of the brain is deprived of blood it fails to work properly, of blood it fails to work properly, producing symptoms of a stroke, such producing symptoms of a stroke, such as difficulty speaking, weakness, as difficulty speaking, weakness, paralysis, loss of sensation and thought paralysis, loss of sensation and thought and memory difficulties.and memory difficulties.

Specific Characteristics of Your CVA

Difficulty in the ability to dress oneselfLeft visual neglectImpulsitivityDisorganizationInattention

Addressing Treatment on a Personal Level

Extensor tone throughout the left side of the body.Treatment should include trunk rotation, side to side movement using

functional tasks such as reaching for items or objects normally used throughout daily activities.

Poor Static sitting balance.Treatment should include proper positioning and body alignment

during static sitting such as symmetrical sitting (even weight distribution on both sides of the body) head aligned with trunk. Affected arm should be secured and supported with arm rest.

Hand edema (Swelling) To decrease swelling in the left hand, keep the affected hand elevated

above the level of the heart. Passive and active range of motion exercises should be given to the

effective hand.Retrograde massage technique used to alleviate swelling of the hand.

……Treatment ContinuedTreatment ContinuedIdeation apraxia – an inability to form the concept Ideation apraxia – an inability to form the concept

of movement or execute the act automatically.of movement or execute the act automatically.

Treatment should include:Treatment should include: Clear, concise and concrete directions.Clear, concise and concrete directions.

Breaking down tasks into small parts that are Breaking down tasks into small parts that are taught separately.taught separately.

Combine steps gradually to complete task.Combine steps gradually to complete task.

Use of verbal and imitative cues.Use of verbal and imitative cues. Touch along with joint and muscle stimulation.Touch along with joint and muscle stimulation.

…Treatment ContinuedDressing apraxia – The inability to plan or perform the acts

necessary to dress one self such as putting clothes on the wrong side of the body, inside out or upside down.

Treatment should include: Teaching a set pattern for dressing.

Give cues to distinguish right, left, front and back.

Lay out clothing in order.

Use color coding.

……Treatment ContinuedTreatment Continued

Positive supporting reaction,Positive supporting reaction, patient should patient should be aware of potential impact:be aware of potential impact:

► Difficulty pushing up into the bridge Difficulty pushing up into the bridge position.position.

► Difficulty putting on shoes and keeping Difficulty putting on shoes and keeping them on.them on.

► Difficulty with walking.Difficulty with walking.

► Patient should be referred to physical Patient should be referred to physical therapy for treatment.therapy for treatment.

……Treatment ContinuedTreatment ContinuedFunctional implications of the left Functional implications of the left

handhand

Since patient is unable functionally use his left Since patient is unable functionally use his left hand, patient will be taught how to use the hand, patient will be taught how to use the

hand as a stabilizer.hand as a stabilizer.

• Compensatory techniques skills could be Compensatory techniques skills could be employed by one-handed performances of employed by one-handed performances of activities.activities.

• Teach one-handed dressing techniques while Teach one-handed dressing techniques while seated.seated.

……Treatment ContinuedTreatment ContinuedImpaired sensations for sharp, dull Impaired sensations for sharp, dull

and temperature in the left handand temperature in the left hand..

Patient should be made cognitively aware Patient should be made cognitively aware of this deficit and safety techniques of this deficit and safety techniques

should be taught.should be taught.

Home ManagementHome ManagementSuggestions for bathroom Suggestions for bathroom

modifications, assistive devices modifications, assistive devices and adaptive equipmentsand adaptive equipments

All hygiene and grooming should be done in a All hygiene and grooming should be done in a seated position.seated position.

For bathing, a high transfer tub bench, hand For bathing, a high transfer tub bench, hand held shower, grab bar, non-skid rubber strips, held shower, grab bar, non-skid rubber strips, long handled bath sponge, and a high-john are long handled bath sponge, and a high-john are very useful and is recommended.very useful and is recommended.

Electrical razor, spray deodorant, and pump Electrical razor, spray deodorant, and pump action toothpaste are also recommended.action toothpaste are also recommended.

Home ManagementHome ManagementSuggestions for kitchen modifications, assistive Suggestions for kitchen modifications, assistive

devices and adaptive equipmentdevices and adaptive equipment

• Stabilize items using a board with two stainless steel nails Stabilize items using a board with two stainless steel nails and a raised corner to stabilize food items. Use suction and a raised corner to stabilize food items. Use suction cups or a rubber mat to provide stabilization.cups or a rubber mat to provide stabilization.

• Use electrical appliances that can be managed with one Use electrical appliances that can be managed with one hand.hand.

• Stabilize pots on the counter or range for mixing or Stabilize pots on the counter or range for mixing or stirring by using a pan holder with suction feet.stirring by using a pan holder with suction feet.

• Use a rocker knife for cutting.Use a rocker knife for cutting.

• Use sponge cloths, non-skid mats or pads, wet dishcloths Use sponge cloths, non-skid mats or pads, wet dishcloths or suction devices to keep pots, bowls and dishes from or suction devices to keep pots, bowls and dishes from turning or sliding during food preparations. turning or sliding during food preparations.

Home ManagementOverall considerations

Make sure apartment has adequate bright lighting.

Remove all scatter rugs and clutter.

Place items on lower shelves for easy access.

Install lazy susans for easy accessibility of items.

Helpful Hints for the Patient Helpful Hints for the Patient and Caregiversand Caregivers

It is important to stress energy It is important to stress energy conservation through out activities.conservation through out activities.

Activities should be paced to Activities should be paced to accommodate the client’s physical accommodate the client’s physical endurance and tolerance for one-endurance and tolerance for one-handed performance and the use of handed performance and the use of special devices.special devices.

Work simplification is encourage and Work simplification is encourage and should be apart of daily routine.should be apart of daily routine.

Referrals Physical Therapy - for ambulation

and mobility treatment.

Nutritionist - to address hypertension and diabetes condition.

Suggest that patient move to a lower level apartment or an elevator building.