right-side cerebrovascular accident by: ciera jackson
TRANSCRIPT
Right-Side Cerebrovascular AccidentBY: CIERA JACKSON
DESCRIPTION AND DEFINITION
Cerebrovascular accident is the leading cause of serious long-term disability in the U.S..
Affects approximately 795,000 people each year
Sudden loss of blood supply to the brain that damages and kills brain cells, thus resulting in neurological deficits related to the involved areas of the brain
Stroke commonly results in hemiplegia or hemiparesis
A lesion on the right-side of the brain produces left-side hemiplegia
ETIOLOGY
A stroke generally occurs in either of two ways
Ischemic stroke, which cause 87% of total strokes
Hemorrhagic stroke which accounts for approximately 10%
WARNING SIGNS
Before stroke, may adults experience sudden warning signs, which include:
Sudden weakness or numbness of the face, arm, or leg
Confusion
Difficulty speaking
Blurred vision
Severe headache
SYMPTOMS
Weakness, paralysis of left side
Decreased attention span
Left hemianopsia
Decreased awareness & judgment
Left inattention
Emotional lability
Impulsive behaviors
Decreased spatial orientation
Memory deficits
COURSE AND PROGNOSIS
Recovery depends on the location, type and severity of a stroke
one month
one year
20-plus years
PRECAUTIONS
Practitioners working with Right CVA pts should be precautious of:
Warning signs of stroke
Deep vein thrombosis (DVT)
Subluxation
Muscle weakness
DEMOGRAPHICS OF DIAGNOSIS
AGE RANGE Right-side CVA can affect anyone but it increases with age, with 2/3 affecting
people older than 65.
PREMORBID
CONTRIBUTIN
G FACTORS
Hypertension
Cardiac diseases
Diabetes mellitus
Obesity
High cholesterol
GENDER Men have a slightly higher risk of stroke than women do.
TREATMENT TEAM
Occupational Therapists
Improving motor and sensory abilities, and ensuring patient safety in the post-stroke period
Help survivors relearn skills needed for performing ADL’s and iADL’s
Teach compensatory strategies and change elements of their environment that limit activities of daily living
Rehabilitation Nurses
Help survivors relearn how to carry out the basic activities of daily living
Educate survivors about routine health care
Reduce risk factors that may lead to a second stroke, and provide training for caregivers
Physical Therapists
Assess the stroke survivor's strength, endurance, range of motion, gait abnormalities, and sensory deficits
Aimed at regaining control over motor functions
Speech-Language Pathologists
Help stroke survivors with aphasia
Relearn how to use language or
Develop alternative means of communication
Improve ability to swallow, and they work with patients to develop problem-solving and social skills needed to cope with the after-effects of a stroke
Vocational Therapists
Identify vocational strengths and develop résumés that highlight those strengths
Identify potential employers, assist in specific job searches, and provide referrals to stroke vocational rehabilitation agencies
Educate disabled individuals about their rights and protections as defined by the Americans with disabilities act of 1990
FRAMES OF REFERENCES
Perceptual motor training
This FOR works with the client on improving memory, cognitive skills, safety awareness, and visual perception, because right CVA patients generally have problems in these areas this would be an ideal FOR for practitioners to implement
Neurodevelopment
Developmental
MODELS OF PRACTICE
Person Environment Occupation Performance (PEOP)
The main focus of OT is to promote maximal independent functioning in the patients natural environment. PEOP focus on the person, environment, occupation and those thing that interfere with the individual’s performance
Model of Human Occupation (MOHO)
Canadian Model of Occupational Therapy (CMOP)
EVALUATION METHODS
Standardized Functional Independence
Measure (FIM)
Measures the level of a patient’s disability and indicates how much assistance is required for the individual to carry of ADL’s
Clock Drawing Test
Assesses visuospatial and praxis abilities (may reflect both attention and executive dysfunction)
Non-Standarized Observation
Assesses patient performance in various areas of the OTPF
Manual Muscle testing
Manual muscle testing is a means of measuring the maximal contraction of a muscle or muscle group.
OCCUPATIONAL PERFORMANCE IMPACTOCCUPATIONAL PROFILE: JOANA
OCCUPATIONAL PROFILE
Joana is a 66 year old retired school teacher who has a master’s degree in early childhood education. She continues to educate through volunteer tutoring, and attends monthly educational classes. She lives alone but has constant gatherings and family visits. Joana enjoys cooking and working out in her free time. Although she suffered hypertension, it was controlled by diet and regular exercise. Joana now has weakness of her left side, which has impacted her mobility, strength and ROM, she also has decreased attention span which limits her ability to attend classes or tutor. Joana has found herself in a deep depression but is ready and determined to continue life at her prior level of functioning.
Occupations Impacted
ADLS
Bathing, Dressing, functional mobility, personal hygiene and grooming,
toilet hygiene
IADLSCommunity mobility, home management, Meal preparation and cleanup
WORK Volunteer participation
LEISURE Leisure participation
EDUCATION Informal personal education participation
PERFORMAN
CE SKILLS
MOTOR SKILLS Posture, Mobility, Coordination,
Strength
PROCESS SKILLS Energy (attend)
COMMUNICATION/
INTERACTION SKILLS
physicality
PERFORMAN
CE
PATTERNS
HABITS Healthy eating, organized, gets
adequate rest
ROUTINES Routines include, working out,
preparing meals , personal hygiene
ROLES Mother, teacher, friend, planner, cook,
head of house
CONTEXTS
CULTURAL Family, friends
PHYSICAL Ambulation in wheel chair
SOCIAL Decreased interaction due to limited
functional mobility
SPIRITUAL Promote education
TEMPORAL Pt is retired, is accustomed to being
active and independent
Client Factors
BODY
FUNCTION
S
SPECIFIC MENTAL Decreased attention
SENSORY Visual-motor coordination
HEARING/VESTIBULAR Balance
NEUROMUSCULAR/ MOVEMENT RELATED involuntary control of left side
decreased strength
CARDIOVASCULAR hypertension
ASSETS
Determination/Motivation
Full function of right side
Useful habits (eating healthy, regular exercise)
PROBLEMS REQUIRING OT
Weakness of left-side,
Limited ROM to complete ADL’s iADL’s
Decreased attention span
Adjustment to disability
TREATMENT PLAN
FUNCTIONAL PROBLEMInability to prepare full course meals due to left side paresis causing limited ROM and strength
STG Client will build the grip strength
and UE strength needed to prepare a meal (lift 10 pounds) with less than 50% assistance within 2 weeks.
Client will be able to complete full UE ROM required to prepare a meal independently by 3 weeks.
Intervention Client will participate in weight lifting
requiring both UE. Using different weight dumbbells. (Adjunctive)
Client will engage in enabling activities that require full UE ROM: stacking cones, block building, and shoulder abduction ladder. Client will demonstrate achievement of goal by completing simulated preparation of a meal.
LTG: Client will be able to complete a full course meal independently using both UE within 4 weeks.
FUNCTIONAL PROBLEMClient suffers from decreased attention span that limits her from being able to tutor.
STG Client will be able to complete 3
decorative baskets in 45 minutes with less than 2 verbal cues of redirection within 1 week.
Client will be able to complete 25 simple math problems in a classroom setting in 60 minutes with less than 1 verbal cue of redirection within 2 weeks.
Intervention Gradation is important so pt will
complete simple but meaningful crafts. Purposeful activity, ex. decorating baskets for a gathering.
Gradation is important so pt will complete math problems which would be a purposeful activity.
LTG: Client will be to substation attention during group session for 60 minutes without any redirection in 4 weeks.
DISCHARGE PLAN
Indications that client is ready for discharge Client is able to independently stand, balance and ambulate.
Client still shows weakness. in left UE, but is able to independently complete ADL’s and iADL’s using adaptive devices and more time
Client has adjusted to disability and participates in leisure activities
After Discharge Client will continue living at home alone
Minor modification will be made: ramp, grab rails throughout house
Client will attend post-stroke informative support groups
Client can be referred to Outpatient Services
REFERENCES
After Stroke. (n.d.). - National Stroke Association. Retrieved July 6, 2014, from http
://www.stroke.org/site/PageServer?pagename=afterstroke
Early, M. B. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd ed.). St. Louis, Mo.:
Elsevier/Mosby.
Post-Stroke Rehabilitation Fact Sheet. (n.d.). : National Institute of Neurological Disorders and Stroke (NINDS).
Retrieved July 6, 2014, from http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm#professionals
. (n.d.). The Rehabilitation Measures Database. Retrieved July 7, 2014, from
http://www.rehabmeasures.org/default.aspx
Watson, D. E., & Wilson, S. A. (2003). Task analysis: an individual and population approach (2nd ed.). Bethesda, MD:
AOTA Press (The American Occupational Therapy Association).