Rehabilitation of CVA1
Rehabilitation of CVA1
Rehabilitation of CVA1
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Stroke syndromes Stroke syndromes
Internal Carotid Syndrome Middle Cerebral Artery Syndrome
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Stroke Syndromes Stroke Syndromes
Anterior Cerebral Artery Syndrome Vertebrobasilar syndromes
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Other
syndromes Stroke Syndrome
Vertebrobasilar Syndrome
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Other
syndromes Stroke Syndrome
Vertebrobasilar Syndrome
• Weber’s Syndrome
• Involves the third cranial nerve
nucleus
• Seen in focal midbrain
infarctions
• Ipsilateral cranial nerve III
palsy with contralateral motor
and sensory deficit
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Other
Syndromes Stroke Syndrome
Posterior Cerebral artery syndrome
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Evaluation Evaluation
Special populations
• History • In children
• Physical examination and vital signs
• Check fo coagulation
• Diagnostics abnormalities
• CT scan
• Carotid and cardiac anomalies
• MRI (rare)
• Blood chemistry
• Young adults, check for:
• ECG
• Carotid ultrasound • Carotid dissection
• Cerebral angiography • Vasculitides
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Acute Management Secondary prevention
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• Compensatory
• Use of orthotics
• Use of Assistive devices
• Maximize Neural reorganization and return of function
• No hand function by 4 weeks post stroke-poor
recovery
• Recovery from Aphasia
• Dependent on type and severity
• Visuospatial deficit recovery
• Unilateral neglect
• Anosognosia
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Classification of Aphasia Rehabilitation
Cognition and communication treatment strategies
• Evaluation
• mental status assessment should be done
• Mini mental status assessment tool
• NIH stroke scale tool
• Formal Neuropsychological assessment
• Hemispatial neglect assessment and
management
• Use of cues to remind of the other side
• Fresnel prisms
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Rehabilitation Rehabilitation
Cognition and Communication management strategies
Visual Deficits
• Evaluation and management of
other cognition problems such as:
• Evaluation of visual deficits done
• Apraxia at bedside
• Dementia • Compensatory strategies for
patients with visual deficits
• Attention deficits without hemispatial defects
• Depression
• Patching -extra ocular muscle
• Use of anti depressants and incoordination and diplopia
serotonin reuptake inhibitors
(SSRI’s)
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Rehabilitation Rehabilitation
Dysphagia Dysphagia
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Rehabilitation Rehabilitation
Motor function Brunstromm’s stages of recovery
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Rehabilitation Rehabilitation
Motor Recovery Motor Recovery
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Rehabilitation Rehabilitation
Mobility Pain and sensation
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Outcomes Medical management during
Rehabilitation
Cardiac Disease
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• C atheterization program s
• NSAiDs as rescue meds
• C lean interm ittent catheterization • Antispasticity meds
• In dw elling foley catheterization • Desensitization techniques and stretching
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Sexuality in Stroke Long term care
• Sexual performance and libido is affected by: • Recovery rates may depend on the
• Co morbidities like hypertension and diabetes severity of stroke
• Fear of a repeat of stroke during the act of sex • Mortality rates increase for every
• Medications such as SSRIs recurrence of stroke
• Treatment • Strategies include:
• Sildenafil or tadalafil for erectile dysfunction
(use with caution, not allowed if patient is
• Prevention of recurrence of stroke
taking nitroglycerin etc)
• Maintenance of Independence and
• Flibanserin to improve libido in women (under community relations
study)
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Thank you!
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