Predicting the Discharge Level of Care of the Acute Stroke Patient Judy Skarbek, OTR, MSRS

Learning Objectives: Acute Stroke Patient The participant will understand how co-morbidities affect the next level of care. The participant will recognize how the comprehensive evaluation assists in determining the next level of care options. The participant will understand restorative care options after acute care.

Acute Stroke Patient Family history Medical history Age Genetics Diabetes Vascular disease HTN HLD A-fib PFO

NIHSS

mNIHSS

Acute Stroke Patient Chart review Physician Orders Understanding precautions: tPA Surgery: neuro, cardiac, orthopedic Isolation, contact Understanding the Pt’s PMH (chronic & acute) Social history (work, family, leisure)

Acute Stroke Patient Lab results Imaging: MRI, CT, venous duplex, ultrasounds Vital signs Medications Review of physician’s progress notes Talk with nurse Collaborate with Speech and PT

Acute Stroke Patient Interview DME review History of falls Previous level of function Current level of function Bed mobility Functional mobility Bathroom transfers Shower transfers

Acute Stroke Patient UE A/PROM Tone Grip strength Upper Extremity Testing UE A/PROM Tone Modified Ashworth Scale Edema Scale Grip strength Dynamotor Pinch gauge

Acute Stroke Patient Fine motor skills 9 Hole peg test Round blocks Block test

Acute Stroke Patient Fugl-Meyer (UE) Modified BiVABA screen (vision) Katz Index of Independence in Activities of Daily Living Barthel Index Boston AM-PAC Functional Reach Test Texas Functional Living Skills KELS

Acute Stroke Patient Tinetti Balance Assessment 5x Sit to Stand TUG PASS

Acute Stroke Patient Short Blessed Test (SBT) MOCA Mini Mental

Acute Stroke Patient Cognitive Motor skills Judging Selecting Sequencing Organizing Motor skills Apraxia

Acute Stroke Patient Proprioception Sensation Performance skills Right or Left neglect Body awareness in space Sensation Stereognosis Sharp/dull Light touch Performance skills Communication & interaction

Acute Stroke Patient Functional Independence Measure (FIM) Eating Grooming Bathing Dressing: Upper Dressing: Lower (sock test) Toileting 1=Total assist to 7=independent (scoring)

Acute Stroke Patient Attending comprehensive team rounds in acute care What is the next level of care? Attending comprehensive team rounds in acute care Talking with physician in regards to the Pt’s progress in therapy Pt treatment session in acute care Determining frequency Discussion with family members Pt goals/family goals

Acute Stroke Patient Government Plans Medicare Medicaid Insurance Options Government Plans Medicare Advantage Plan Providers: Texas HealthSpring Medicaid Amerigroup Molina Star+Plus/United Healthcare Community Plan

Acute Stroke Patient VA Services Non-Insured Charity care Insurance Options VA Services Non-Insured Charity care

Acute Stroke Patient Home (no therapy) Home with OP therapy Next level of care options Home (no therapy) Home with OP therapy Home Health Inpatient Rehab SNF Community based vs hospital based LTAC

Acute Stroke Patient Literature Citations: Gialanella B, Santoro R, & Ferlucci C. (2013). Predicting outcome after stroke: the role of basic activities of daily living. European Journal of Physical and Rehabilitation Medicine, 49:629-37. Ifejika-Jones NL, Harun N, Peng H, Noser EA, Grotta JC, & Francisco GE. (2012). The Interaction of Aspiration Pneumonia with Demographic and Cerebrovascular Disease Risk Factors is Predictive of Discharge Level of Care in the Acute Stroke Patient. American Journal of Physical Medicine & Rehabilitation, 91:141-147.

Acute Stroke Patient Chung A, & Wiemer H. (2016). Stroke Rehabilitation: Occupational Therapy –an Overview. Published by Cinahl Information Systems, a division of EBSCO Information Services. June 16. Freburger JK, Li D, Fraher EP. (2017).Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission. Archives of Physical Medicine & Rehabilitation. August 12. Britton, L, Rosenwax, L, & McNamara, B. (2015). Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review. Australian Occupational Therapy Journal, 62: 370-377.

Acute Stroke Patient Wolf, T. J., Baum, C., & Connor, L. T. (2009). Changing face of stroke: Implications for occupational therapy practice. American Journal of Occupational Therapy, 63, 621–625. Crennan M. & MacRae A. (2010). Occupational Therapy Discharge Assessment of Elderly Patients from Acute Care Hospitals. Physical & Occupational Therapy in Geriatrics, 28(1): 33-43. Holm, S. E., & Mu, K. (2012). Discharge Planning for the Elderly in Acute Care: The Perceptions of Experienced Occupational Therapists. Physical & Occupational Therapy in Geriatrics, 30(3): 214-228.