epidemiology
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in US;
#5 most common cause of death in U.S.
Second most common cause of disability in adults
700 -795,000 strokes/year
200,000 recurrent - nearly 1 in 4
Incidence
◦1.2 X > men
◦African-American 2X whites, Latin-American & Native-American also
higher
◦2/3 after age 65
◦After 55 doubles every 10 years
don't memorize numbers, but appreciate them and understand the concept
of what they are telling me
In last 20 years, we've done better in preventing stroke and/or death from
stroke since it has moved down the list
The first most common cause of disability is arthritis
Types:
◦Cerebral infarction (thrombosis or embolism)
, most common
70%
◦hemorrhages 20%
◦unspecified 10%
About ¼ die within 1 year
16-26% of survivors in long term care
posterior cerebral artery syndrome Peripheral territory
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Signs & Symptoms
Structures
Contralateral homonymous hemianopsia (occipital lobe)
1˚ visual cortex or optic radiation
Bilat homonymous hemianopsia with some degree of macular sparing
Calcarine cortex
Visual agnosia
Left occipatal lobe
Prosopagnosia
Visual association cortex
Dyslexia without agraphia, anomia, and color discrimination problems
Dominant calcarine lesion and posterior part of corpus callosum
Memory defect
Inferomedial portions of temporal lobe bilat or on dominant side
Topographic disorientation
Nondominant 1˚ visual area, usually bilaterally
If the stroke happens in the peripheral territory - this is what we will see
reaching
Give this one a try later!
, ideas for retraining these tasks -
Various Patterns:
Arc
Circles
Alphabet
Star
Using towel or cloth for sliding on walls or table
Bimanual with claped hands first and progress down the list until they can
do it unilater then sitting ot standing or any where in between
weakness
Give this one a try later!
primary impairment;
80-90% of all stroke patients
Amount & distribution depends of site and severity of lesion
MCA- UE more involved than LE
Distal usually weaker than proximal (inconsistent in research)
◦I.e. weaker in ankle than hip
Mild weakness on ipsilateral side
◦10-15% uncrossed fibers
◦R stroke - majority L hemi with potential mild weakness R side
aerobic
Give this one a try later!
AHA/ASA rehab exercise program recs for stroke;
large muscle exercise
1° and 2° prevention
Increase functional capacity for walking and ADL's
Reduce motor impairment
Improve cognition
40%-70% peak O2 uptake or RPE 11-14
, 3-5 d/wk
20-60 min/session (or multiple 10 min sessions)
Complement with pedometer to increase lifestyle physical activity
options in acute, ICU, early IPR - obtained by arm/leg cycling, NuStep,
seated stepper, walking, repeated transfers (be creative - just get HR up
and keep it up)
other tests
Give this one a try later!
management - acute exam; these are highly recommended for acute care;
6 minute walk
10 meter walk
Functional Reach
Postural Assessment Scale for Stroke Patients (PASS) - lab, in postures and
moving in/out of them
Timed Up and Go
Specific to acute care - in addition to orpington and core set
diagnosis
Give this one a try later!
PT management;
Medical Diagnosis
◦Stroke
PT Diagnosis
◦Look up ICD-10 codes
Typically receive physician referral that has the med dx or the pt says I have
a stroke
We can look up the ICD stroke codes - not many helpful options for what
we address because we don't address the stroke and we have to say what
we are helping in their body problems not the stroke
Give this one a try later!
in US;
#5 most common cause of death in U.S.
Second most common cause of disability in adults
700 -795,000 strokes/year
200,000 recurrent - nearly 1 in 4
Incidence
◦1.2 X > men
◦African-American 2X whites, Latin-American & Native-American also
higher
◦2/3 after age 65
◦After 55 doubles every 10 years
don't memorize numbers, but appreciate them and understand the concept
of what they are telling me
In last 20 years, we've done better in preventing stroke and/or death from
stroke since it has moved down the list
The first most common cause of disability is arthritis
Types:
◦Cerebral infarction (thrombosis or embolism)
, most common
70%
◦hemorrhages 20%
◦unspecified 10%
About ¼ die within 1 year
16-26% of survivors in long term care
posterior cerebral artery syndrome Peripheral territory
Give this one a try later!
Signs & Symptoms
Structures
Contralateral homonymous hemianopsia (occipital lobe)
1˚ visual cortex or optic radiation
Bilat homonymous hemianopsia with some degree of macular sparing
Calcarine cortex
Visual agnosia
Left occipatal lobe
Prosopagnosia
Visual association cortex
Dyslexia without agraphia, anomia, and color discrimination problems
Dominant calcarine lesion and posterior part of corpus callosum
Memory defect
Inferomedial portions of temporal lobe bilat or on dominant side
Topographic disorientation
Nondominant 1˚ visual area, usually bilaterally
If the stroke happens in the peripheral territory - this is what we will see
reaching
Give this one a try later!
, ideas for retraining these tasks -
Various Patterns:
Arc
Circles
Alphabet
Star
Using towel or cloth for sliding on walls or table
Bimanual with claped hands first and progress down the list until they can
do it unilater then sitting ot standing or any where in between
weakness
Give this one a try later!
primary impairment;
80-90% of all stroke patients
Amount & distribution depends of site and severity of lesion
MCA- UE more involved than LE
Distal usually weaker than proximal (inconsistent in research)
◦I.e. weaker in ankle than hip
Mild weakness on ipsilateral side
◦10-15% uncrossed fibers
◦R stroke - majority L hemi with potential mild weakness R side
aerobic
Give this one a try later!
AHA/ASA rehab exercise program recs for stroke;
large muscle exercise
1° and 2° prevention
Increase functional capacity for walking and ADL's
Reduce motor impairment
Improve cognition
40%-70% peak O2 uptake or RPE 11-14
, 3-5 d/wk
20-60 min/session (or multiple 10 min sessions)
Complement with pedometer to increase lifestyle physical activity
options in acute, ICU, early IPR - obtained by arm/leg cycling, NuStep,
seated stepper, walking, repeated transfers (be creative - just get HR up
and keep it up)
other tests
Give this one a try later!
management - acute exam; these are highly recommended for acute care;
6 minute walk
10 meter walk
Functional Reach
Postural Assessment Scale for Stroke Patients (PASS) - lab, in postures and
moving in/out of them
Timed Up and Go
Specific to acute care - in addition to orpington and core set
diagnosis
Give this one a try later!
PT management;
Medical Diagnosis
◦Stroke
PT Diagnosis
◦Look up ICD-10 codes
Typically receive physician referral that has the med dx or the pt says I have
a stroke
We can look up the ICD stroke codes - not many helpful options for what
we address because we don't address the stroke and we have to say what
we are helping in their body problems not the stroke
