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 (18751997). Thats 122 years dont
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 ongoing 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