Stroke

Question 1

8 risk factors for post-stroke pain (CPSP/central post-stroke pain syndrome and other causes)

Answer 1

• female
• younger age at stroke onset
• ischemic stroke
• smoking
• thalamic stroke
• brainstem stroke, involving the spinothalamic tract
• sensory deficits
• spasticity
• depression
• peripheral vascular disease
• reduced upper extremity movement

Question 2

4 interventions to prevent and 4 interventions to treat post stroke shoulder pain

Answer 2

PREVENT
- joint protection strategies, support arm
- don’t use sling, or overhaul pulley
- don’t move arm passively beyond 90 degrees
- education for staff and family

TREAT
- electrical stimulation for flaccid arm
- gentle stretching and mobilization techniques
- taping
- shoulder orthoses
- analgesics
- botox of subscapularis and pectoralis
- subacromial steroid injections
- Extracorporeal shock wave therapy (ESWT)

Question 3

4 specific rehab therapeutic interventions for upper extremity motor and sensory stroke

Answer 3

• Learning to use non-dominant hand
• Range of motion exercises
• Strength training
• Functional electrical stimulation (FES)
• Mirror therapy
• Virtual reality therapy
• Constraint-induced movement therapy (CIMT)

Question 4

5 common medical complications post stroke requiring prevention

Answer 4

Aspiration
Malnutrition
Falls
VTE
Infection (monitoring for fever) - UTI, PNA
Constipation
Pressure ulcers

Question 5

10 modifications to the bed and bathroom for falls prevention?

Answer 5

Making sure doorways are clear/ramp/lifts (depending on degree of gait impairment/gait aid)
Shower chair
Shower grab bars
Raised toilet seat
Non-skid floor mat
Use of gait aid
Transfer bench
Roll-in shower
Hand-held shower head
Adjustable bed
Transfer pole

Question 6

5 reasons for aspiration in a patient recently suffering from a stroke

Answer 6

1. Delayed pharyngeal phase of swallowing
2. Poor oral motor control
3. Impaired cough reflex
4. Decreased LOC
5. Cognitive impairment

Question 7

4 goals of speech therapy

Answer 7

1. restoring functional communication
2. developing compensatory strategies
3. educating and training communication partners
4. reducing psychosocial isolation
5. improving quality of life

Question 8

Contrast neurological and functional stroke recovery time

Answer 8

ADL recovery occurs in most patients within 13 weeks, with most patients reaching peak potential at 6 weeks

Neurological recovery achieved faster than functional recovery, on average 2 weeks earlier

Question 9

4 prognostic features relating to functional recovery post-stroke

Answer 9

• initial stroke severity
• baseline functional status
• cognitive function
• age
• caregiver support
• co-morbidities

Question 10

4 reversible risk factors for stroke, ARR for two of them

Answer 10

1. Hypertension (ARR was 3%, NNT 33 in SHEP)
2. Anticoagulation in afib (ARR 7.3% in Canadian Stroke Best Practice Guidelines)
3. Obesity
4. Smoking

Question 11

6 factors predict if a post-stroke patient will be able to return home? (CIHI 2009)

Answer 11

• Male
• Younger age (<65)
• Admission functional scores
• Living with a spouse/family member
• Unilateral involvement
• Earlier admission to rehab
• Absence of depression

Question 12

Algorithm of CHA₂DS₂-65

Answer 12

Age > 65 = yes OAC

Any CHADS = yes OAC
CHF
HTN
Diabetes
Stroke

Arterial vascular disease only = ASA

Question 13

4 upper extremity complications post-stroke

Answer 13

glenohumural subluxation
RCT
CRPS
Hand edema
Spasticity / contracture
Shoulder pain

Question 14

2 clinical outcomes associated with presence of covert infarct following non-cardiac surgery

Answer 14

• cognitive decline 1 year after surgery
• increased risk of perioperative delirium
• overt stroke or TIA

Question 15

3 things that are important to prevent after a middle cerebral artery stroke.

Answer 15

DVT
Aspiration PNA
Delirium
Depression
Recurrent ischemic stroke