1. Stroke

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4. • Introduction
• Definition of stroke
• Causes of stroke
• Effects of stroke
• Medical management
• Evaluation and intervention procedures for clients who
sustained a stroke
• Adopting a framework for intervention
• Functional limitations commonly observed after stroke
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5. •
‫میر‬ ‫و‬ ‫مرگ‬ ‫علت‬ ‫سومین‬
•
‫هر‬
40
‫هر‬ ‫و‬ ‫شود‬ ‫می‬ ‫استروک‬ ‫به‬ ‫مبتال‬ ‫نفر‬ ‫یک‬ ‫ثانیه‬
4
‫نفر‬ ‫یک‬ ‫دقیقه‬
...
•
28
%
‫زیر‬ ‫مبتالیان‬
65
‫دارند‬ ‫سن‬ ‫سال‬
!
•
5
‫مرد‬
/
4
‫زن‬
•
‫مبتالیان‬ ‫بین‬ ‫در‬
:
50% hemiparesis
30% cannot walk
26% dependent in ADL
19% aphasic
35% clinically depressed
26% require home nursing care.
OT => from ICU to Community based programs
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6. WHO:
I. Acute neurologic dysfunction
II. vascular origin
III. Focal areas of the brain
limbs
CVA=> UMN dysfunction => Hemiplegia => trunk
face,oral structure
Left CVA = Right hemiplegia
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7. • Motor paralysis
• Sensory disturbances
• Cognitive and perceptual dysfunction
• Visual disturbances
• Personality and intellectual changes
• Speech and language disorder
Longer than 24 hours to be labeled a CVA
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8. • Ischemia
• Hemorrhage
• Related syndromes
• Transient ischemic attacks
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10. • ICA:
hemiplegia,hemianesthesia,homonymous
hemianopia
DH=> Aphasia,agraphia,acalculia,right-left
confusion,finger agnosia
NDH=>Visual perceptual dys,unilateral
neglect,anosognosia,dressing apraxia,attention
deficits,loss of topographic memory.
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11. • Most common cause
• Contralateral hemiplegia
• Sensory deficit
• Contralateral homonymous
hemianopia
DH=> aphasia
NDH=> perceptual deficit
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12. • Lower extremity
• Apraxia
• Mental changes
• Primative reflexes
• Bowel and bladder incontinence
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13. • Upper brainstem region
• Temporal and occipital lobes
Dysfunction:
1. Sensory and motor deficits
2. Involuntary movement disorder
3. Memory loss
4. Alexia
5. Astereognosis
6. Dysesthesia
7. Akinesthesia
8. Contraleteral homonymous hemianopia
9. Anomia
10. Topographic disorientation
11. Visual agnosia
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14. • Ipsilateral ataxia
• Contralateral loss of pain and temprature
sensitivity
• Ipsilateral analgesia
• Dysphagia
• Dysarthria
• Nystagmus
• Contralateral hemiparesis
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15. • Cerebellar dysfunction
• Loss of proprioception
• Hemiplegia
• Quadriplegia
• Sensory disturbances
• Unilateral or bilateral involvement of cranial
nerves III to XII
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16. • First step: which client factors are impaired
and affecting performance in area of
occupation
• Medically stabilized
• First 3 to 6 months after stroke
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17. • COPM
1. Identify areas of difficulty
2. Rate the importance of each area
3. Rate his or her satisfaction with current
performance
COPM
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18. • focused on the Roles that are important to the client
• Top-down approach to evaluation is in contrast to a
bottom-up approach
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19. • Activity analysis identify errors during
• Keen observation task performance
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20. • A-ONE
occupation based neurobehavioral evaluation(ADL)
• AMPS
performance skills and process skills(IADL)
• Barthel index
BADL 10 item
• TEMPA= UE performance,9 tasks , bilateral and
unilateral
• Jebson = hand function
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21. • In the past,sensorimotor approaches
• Rood,Bobath,Knott and Voss and brunnstrom
• Task-oreinted approaches
focus on the use of functional activities
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22. 1. Inability to perform chosen occupations while seated
2. Inability to engage in chosen occupations while
standing
3. Inability to communicate secondary to language
dysfunction
4. Inability to perform chosen occupations secondary to
neurobehavioral/cognitive-perceptual impairment
5. Inability to perform chosen tasks secondary to upper
extremity dysfunction
6. Inability to perform chosen tasks secondary to visual
impairment
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23. Loss of trunk and postural control
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25. client’s perceived limits
Limits of stabilty
actual limits
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26. Treatment interventions
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Establishing a neutral yet active starting alignment
attempt reaching activities
Maintain the trunk in the midline by using external cues
Maintain trunk ROM by positioning
Prescribing dynamic weight-shifting activities
Strengthening the trunk
Compensatory strategies and environmental adaptation

27. • Loss of Postural reaction
• Inability to bear and shift weight
• Treatment strategies
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Establishing a symmetric base of support and proper alignement
Bear and shift weight throgh the more affected LE
Dynamic reaching in activities
Grade task difficulty and provide external support
Training upright control

28. • Most frequently => left hemisphere of the brain
• Communication techniques
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30. • Global aphasia
• Broca’s aphasia
• Wernicke’s aphasia
• Anomic aphasia
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32. • Affect
• Body scheme
• Cognition
• Emotion
• Gnosis
• Language
• Memory
• Motor movement
• Perception
• Personality
• Sensory awarness
• Spatial relations
• Visuospatial skills
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33. • Near transfer => 1 or 2
• Intermediate => 3 to 6
• Far => conceptually similar
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34. • Pain
• Contracture and deformity
• Loss of selective motor control
• Weakness
• Orthopedic limitations
• Loss of postural controls to support UE control
• Learned nonuse
• Loss of biomechanical alignment
• Ineffecient and ineffective movement patterns
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35. • Integration into function
• UE complications after stroke
• The nonfunctional UE
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36. Category tasks
Nonfunctional use of the arm ?
Postural support/weight bearing ?
Support reach ?
reach ?
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37. Treatment activities
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Using objects of different sizes and shapes
Activities that are appropriate to the level of available
motor control
CIMT
WB,reach,manipulation within the context of ADLs and
mobility
Graded tasks

38. • Subluxation
• Abnormal skeletal muscle activity
• Prevention of pain syndromes and contracture
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39. • Protection of unstable joints
• Maintaining soft tissue length
• Positioning programs
• Soft tissue elongation
• Splinting
• Client management
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40. Right hemisphere Left hemisphere
Visual field inattention or neglect Visual object agnosia
Lack of controlled eye movement Lack of controlled eye movement
Spatial relation dysfunction Spatial relation dysfunction
Visual loss Visual loss
Anomia and grammatical language
problems
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42. • Depression => 35%
• Anxiety
• Agoraphobia
• Substance abuse
• Sleep disorder
• Mania
• Aprosody
• Behavioral problems
• Lability
• Personality changes
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43. Pedretti’s , Occupational Therapy: practice skills for physical
dysfunction,
7th edition, chapter 33
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