Functional life after a Stroke

Your Personal Guide to Functional Ability and Living Modifications. Leonora Dapontes & Tanika Allen

What is a Stroke? OOOOccurs when a blood vessel in or around the brain becomes blocked or ruptures, depriving the brain of blood. WWWWhen that area of the brain is deprived of blood it fails to work properly, producing symptoms of a stroke, such as difficulty speaking, weakness, paralysis, loss of sensation and thought and memory difficulties.

Specific Characteristics of Your CVA Difficulty in the ability to dress oneself Left visual neglect Impulsitivity Disorganization Inattention

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 Continued Ideation apraxia – an inability to form the concept of movement or execute the act automatically. Treatment should include: Clear, concise and concrete directions. Clear, concise and concrete directions. Breaking down tasks into small parts that are taught separately. Breaking down tasks into small parts that are 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 Continued Dressing 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 Continued Positive supporting reaction, patient should be aware of potential impact: ► Difficulty pushing up into the bridge position. ► Difficulty putting on shoes and keeping them on. ► Difficulty with walking. ► Patient should be referred to physical therapy for treatment.

…Treatment Continued Functional implications of the left hand Since patient is unable functionally use his left hand, patient will be taught how to use the hand as a stabilizer. Compensatory techniques skills could be employed by one-handed performances of activities. Compensatory techniques skills could be employed by one-handed performances of activities. Teach one-handed dressing techniques while seated. Teach one-handed dressing techniques while seated.

…Treatment Continued Impaired sensations for sharp, dull and temperature in the left hand.  Patient should be made cognitively aware of this deficit and safety techniques should be taught.

Home Management Suggestions for bathroom modifications, assistive devices and adaptive equipments All hygiene and grooming should be done in a seated position. All hygiene and grooming should be done in a seated position. For bathing, a high transfer tub bench, hand held shower, grab bar, non-skid rubber strips, long handled bath sponge, and a high-john are very useful and is recommended. For bathing, a high transfer tub bench, hand held shower, grab bar, non-skid rubber strips, long handled bath sponge, and a high-john are very useful and is recommended. Electrical razor, spray deodorant, and pump action toothpaste are also recommended. Electrical razor, spray deodorant, and pump action toothpaste are also recommended.

Home Management Suggestions for kitchen modifications, assistive devices and adaptive equipment Stabilize items using a board with two stainless steel nails and a raised corner to stabilize food items. Use suction cups or a rubber mat to provide stabilization.Stabilize items using a board with two stainless steel nails and a raised corner to stabilize food items. Use suction cups or a rubber mat to provide stabilization. Use electrical appliances that can be managed with one hand.Use electrical appliances that can be managed with one hand. Stabilize pots on the counter or range for mixing or stirring by using a pan holder with suction feet.Stabilize pots on the counter or range for mixing or 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 or suction devices to keep pots, bowls and dishes from turning or sliding during food preparations.Use sponge cloths, non-skid mats or pads, wet dishcloths or suction devices to keep pots, bowls and dishes from turning or sliding during food preparations.

Home Management Overall 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 and Caregivers  It is important to stress energy conservation through out activities.  Activities should be paced to accommodate the client’s physical endurance and tolerance for one-handed performance and the use of special devices.  Work simplification is encourage and 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.