"Strokes are the leading cause of disabilities in adults,” reports The American Stroke Association. So, stroke victims will require a large segment of therapy resources.
The majority of strokes occur for two reasons:
1. A stationary blood clot (thrombus) forms and interferes with the circulation to the brain.
2. A traveling blood clot (embolus) gets lodged and stops the flow of blood to the brain.
The thrombus is a solid mass that forms in a vessel. The embolus is often a piece of thrombus that broke away and travelled through the bloodstream…until it reached a spot too narrow to pass through. Once it becomes stuck, it cuts off circulation to that area. These clots account for 80% of strokes.
Vascular ruptures account for the other 20% of strokes. An example would be an intracranial hemorrhage, or bleeding in the brain.
Any one of these events causes a blood flow interruption and damages the brain, resulting in a stroke.
The level of impairment depends on the area of the brain damaged, and the extent of that damage. If the damage is on the right side of the brain, the left side of the body will experience problems. If the damage is on the left side of the brain, the right side of the body suffers.
Hemiplegia is the total paralysis of half (hemi) the body. The person has NO control over it.
(When dealing with hemiplegia, you need to approach from the “good” side so the person can see you.)
Hemiparesis is weakness of half of the body. The person has some control and movement, but it is awkward and unstable.
The main impairments that will concern physical therapists will be:
· Emotional control
Patients with strokes usually have difficulty communicating.
Dysarthria is when the speech becomes slurred, slow, or difficult to understand. However, the person CAN speak.
Aphasia often accompanies the stroke in the forms of expressive aphasia or receptive aphasia.
Expressive aphasia is when a person is not able to produce the words he wants to say. He cannot express himself. The person may answer “Yes” when he means to say “No”.
Receptive aphasia is when the message someone else transmits gets garbled inside the patient’s brain.
You might ask the person to close her eyes but she lifts her hand instead. She is having difficulty receiving the message.
The National Institute of Health has a standardized measure that shows the relationship between the damage and prognosis. It gives detailed instructions on testing and obtaining a score which will help determine what therapies the patient will need.
CRITERION FINDING SCORE
Level of consciousness (LOC) Alert 0
LOC questions Answers both correctly 0
(Ask patients their age and the month) Answers one correctly 1
Answers both incorrectly 2
( Ask patient to open and close eyes Performs both correctly 0
and to make a fist) Performs one correctly 1
Performs neither task correctly 2
Gaze Only horizontal movements are tested. Partial gaze palsy means that gaze is abnormal but forced deviation or total gaze pareses is not present. Forced deviation, or total gaze paresis NOT overcome by the oculocephalic maneuver. That maneuver is done by turning the head quickly to the right and left and watching to see if the eyes move normally. NOTE: The oculocephalic maneuver is done on comatose patients.
Partial gaze palsy 1
Forced deviation 2
Visual field (Hemianopia is the loss of vision on the left or right side)
No visual loss 0
Partial hemianopia 1
Complete hemianopia 2
Bilateral hemianopia/blind 3
Facial palsy None 0
Minor (assymetry on smiling) 1
Partial (paralysis on lower face) 2
Complete (absence of facial movement) 3
Motor arm function No drift (holds limb at 45° or 90 ° for 10 sec) 0
(score for both left and right sides) Drift (drifts down before 10 sec.) 1
Some effort against gravity
(limb drifts but has some effort ) 2
No effort against gravity (Limb falls) 3
No movement 4
Motor leg function No drift (Holds 30 ° position for 5 sec.) 0
(score both left and right sides) Drift (falls before 5 sec. but does not hit bed) 1
Some effort against gravity ( leg falls by 5 sec.,
but has some effort against gravity) 2
No effort against gravity ( falls on bed immediately) 3
No movement 4
Limb ataxia Ataxia is poor coordination, unsteadiness, or difficulty functioning.
(Finger to nose and heel to shin tests are done )
Present in one limb 1
Present in two limbs 2
Untestable ( explain why) __
(Test by pinprick on face, arm, leg) Normal 0
Mild to moderate loss (feels, but less so than usual) 1
Severe loss (is not aware of being touched) 2
Best language function No aphasia 0
Mild to moderate aphasia 1
Severe aphasia 2
Mute, global aphasia 3
Dysarthria Normal articulation 0
Mild to moderate dysarthria 1
Severe dysarthria (unintelligible or worse) 2
Untestable (explain why) __
Neglect For this test it means the lossof ability to see, hear, use space correctly, or pay attention.
No neglect 0
Partial neglect 1
Profound neglect 2
(does not recognize own hands or orients to only one side of space)
Total the score of each individual test. The higher the score…the worse the damage.
(You may download a copy of this by typing--nih stroke score””into your computer search engine.)
Exercising effected areas is vital. Physical therapists can help determine the person’s progress.
When you explain what is going to happen and why therapy is the key to a better outcome…the person is more likely to do it.
What you do and what you get the stroke victims to do, will make all the difference in their recovery. Therefore, YOU are essential to their progress!