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

2. 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.

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

4. NIHSS

5. mNIHSS

6. 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)

7. 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

8. 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

9. 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

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

11. 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

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

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

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

15. 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

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

17. 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

18. 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

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

20. 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

21. 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:
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:

22. 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:

23. 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):
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):