Acute Stroke Rehabilitation: The Emergency Considerations By Auwal Abdullahi BSc PT (BUK), MSc Neurol Rehab (Plymouth), Fellow in Clinical Neurology Sciences (London Academy of Sports and Health Sciences) http://www.konferencjaratownictwo.pl/

Introduction Stroke is a cerebrovascular condition resulting in focal or global neurological deficits that lasts for over 24 hours It affects millions of people around the world annually It is one of the leading causes of long term disability especial in activities of daily living (ADL) (WHO, 2002; Strong et al., 2007)

Consequences of Stroke Impairments of the motor function Impairment of sensory/perceptual function Impairment of cognitive function Impairment of autonomic function (Fisher et al., 2010)

When is Stroke Considered Acute? It is usually the first few weeks post-stroke It is the period when there is much opportunity for functional and structural reorganization of the brain Thromboembolism, respiratory complication, infection, pressure sores and delirium are significant causes of morbidity during this period (Bernheisel et al., 2011)

Special Considerations during Acute Stroke Rehabilitation Detailed Physical Assessment and Examination Chest Physiotherapy Early mobilization (including limb mobility and transfer, and limb rehabilitation) Improving sensory and motor functions Improving cognitive function

Detailed Physical Assessment Detailed assessment in motor, sensory/ perceptual and cognitive functions are needed early post-stroke to alleviate disability in self-care (Bernspång et al., 1987) Assessment of motor function- Wolf motor function test (WMFT), Action research arm test (ARAT), Fugl-Meyer motor assessment (Lower and upper limb).

Detailed Physical Assessment (continued) Assessment of sensory/ perceptual function- Fugl-Meyer motor assessment (Lower and upper limb), Nottingham sensory assessment, Assessment of cognitive function- Addenbrookes cognitive assessment, mini-mental examination Assessment of activities of daily living (ADL)- Functional independence level (FIM), Modified Barthel Index

Detailed Physical Assessment (continued) Measurement of Self-efficacy- Stroke self-efficacy questionnaire, Upper limb self-efficacy test. (Jones & Riazi, 2011)

Special considerations Respiratory care - Chest Physiotherapy To dislodge secretions To prevent atelectasis To prevent infection focus

Special considerations (continued) Mobility (including transfer from bed to chair and vice-versa, limb mobility, turning) Prevent pressure sores Prevent thromboembolism Elastic stockings to prevent thromboembolism

Recovery of Limb Function Severe motor impairment Mental Practice and Motor Imagery Mirror Therapy Impairment oriented training such as Bobath and PNF Robotic Rehabilitation

Recovery of Limb Function (continued) Mild to moderate impairment Hybrid therapy Task specific training (Constraint induced movement therapy) (Dromerick et al., 2000)

Things to note in stroke rehabilitation

Recovery of Sensory Function Thermal stimulation Sensorimotor stimulation (Chen et al., 2005; de Diego et al., 2013)

Conclusion It is important to start early mobilization, chest physiotherapy, elastic stockings, turning and therapy for improving sensori-motor function early post-stroke.

Thank you for Listening

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