3. Definition Of Stroke “Rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin and of more than 24 hours” WHO TIA (Transient Ischaemic Attack) recovery is complete within 24 hours. 10% of patients will go on to have a stroke.

4. Stroke Stroke is the third largest killer in the Western World. It accounts for up to 6% of in-patient hospital costs in Scotland. Stroke is one of the major causes of disability, particularly in the elderly. Stroke patients may present with a variety of physical, cognitive and psychosocial problems. Most stroke patients show signs of recovery over time.

5. Sub-types Of Stroke Ischaemic – obstruction to one of major cerebral arteries, brainstem strokes are less common. Haemorrhage – 9% are caused by haemorrhage to the deep parts of the brain. Patients are usually hypertensive.

6. Risk Factors

7. OBESITY

8. SMOKING

9. DRUG ABUSE

10. OLD AGE Wee Betty lived a long and fruitfull life, RIP Betty (1875- 1997). That’s 122 years don’t you know!

11. ALCOHOL

12. Stroke Classification TACI (Total Anterior Circulation Infarct) PACI (Partial Anterior Circulation Infarct) LACI (Lacunar Infarct) POCI (Posterior Circulation Infarct)

13. Adverse Prognostic Indicators Prior Stroke Older Age Persistent urinal and faecal incontinence Visuo-spatial deficits Additional Influences –Consciousness at onset, severity of paralysis, sitting balance, admission ADL score, level of social support, metabolic rate of glucose outside the infarct area in hypertensive patient.

14. Physiotherapy Aims To normalise muscle tone To restore muscle function To control compensation strategies To maintain muscle length To re-educate balance To retrain walking and restore mobility To maximise functional ability while allowing on- going neuromuscular recovery

15. Physiotherapy In Stroke Size Of BOS –Large to reduce tone –Small to increase tone Alignment –Flexor eg sitting/prone –Extensor eg standing/supine –Positioning Strategies Handling –Proximal/Distal/Anatomical Communication –Volitional/Automatic/Voice

16. Stroke Assessment Motor function Muscle tone (high/low) Sensation/Proprioception/Co-ordination Alignment/Stability in various positions Neuromuscular anatomy Compensation Strategies Balance Mobility

17. Outcome Measures Mobility Milestones –1minute sitting balance –10 second standing balance –10 independent steps –10 metre walk Berg Balance Scale 9 Hole Peg Test Elderly Mobility Scale Motor Assessment Scale

18. Treatment Strategies Approaches –Bobath, Motor Relearning etc. Hydrotherapy AFO/Calipers/Malleolar Locks Strapping Electrical Stimulation Positioning

19. Base Of Support Alignment –Flexor –Extensor –Combination Bed Type –Mattress –Pillows – how many? Chair Type –Cushion – soft, firm, intermediate

20. The Stroke Team Doctor Nurse Physiotherapist Occupational Therapist Speech & Language Therapist Social Worker Dietician Psychologist Dentist Podiatrist Art Therapist Volunteers Carers

21. Other Problems To Consider Multipathologies –UTIs –RTIs –D & V Emotional Conditions –Lability –Depression Speech and Language Deficits –Dysphasia (expressive/receptive) –Dyspraxia –Dysarthria