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Clinical Practice Guidelines for Stroke

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Angela Dempski

on 13 September 2011

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Transcript of Clinical Practice Guidelines for Stroke

Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline Pamela W. Duncan, et al. & Barbara Bates, et al.
Presented by Angela Dempski, SPT Where did the CPGs come from? Best efforts of a joint task force to provide evidence-based medical care for patients in need of stroke rehabilitation Department of Veterans Affairs
+ US Department of Defense
----------------------------------------------- Assist facilities to put in place processes of care that are evidence-based and designed to achieve maximum functionality and independence and improve patient/family quality of life
What are the CPGs? Evidence Supporting the Use of CPGs Duncan et al.
“Greater adherence to post–acute stroke rehabilitation guidelines was associated with improved patient outcomes”
Cochrane Database
Stroke unit care or organized inpatient multidisciplinary rehabilitation showed improved outcome compared with "standard" care
Primary Goals of Rehab Prevent complications
Minimize impairments
Maximize fucntion DVT
Pressure Ulcers
Bowel and Bladder Dysfunction
Dysphagia Secondary Stroke Prevention Strategies Hypertension treatment
Warfarin use (atrial fibrillation)
Antiplatelet therapy use (cerebral ischemia) Early Initiation of Rehab Should be... provided as soon as medically tolerated
Should include... Range-of-motion exercises
Frequent changes of bed position on the day of admission
Progressive increase in the level of activity Standardized
Assessment
Tools FIM:
Assesses a patient’s ability to return to ADLs and functional activities NIHSS:
Used to assess the medical prognosis of a patient following stroke
> 16 = high probability of death or severe disability (poor prognosis)
< 6 = good recovery
Evidence-Based Interventions Strengthening

Positive relationship between muscle strength, function, and prevention of falls
Treadmill training (partial body weight support):

Mild-to-moderate dysfunction --> impaired gait
Recommended for patients who are not walking 3 months post acute stroke CI Therapy

20 degrees of wrist extension
10 degrees of finger extension
No sensory and cognitive deficits
Only demonstrated benefit—individuals who received 6 to 8 hours of daily training for ≥ 2 weeks
FES
Generally used during the first several weeks after acute stroke
Used in gait training
Recommended for patients who have shoulder subluxation
NDT

Insufficient evidence to recommend for or against using NDT in comparisson to other tx Shoulder pain:

Results from sensorimotor dysfunction
72% of stroke patients will experience at least 1 episode of shoulder pain during the first year after the stroke

Suggested interventions:

E-stim
Steroid injections/medications
Exercise
Shoulder positioning protocols
Strapping involved UE
Ice, heat, STM, mobs
Multidisciplinary Team Family/Caregiver Stressors:
Cognitive loss
Urinary incontinence
Personality changes
Address availability of community resources
Minimize caregiver distress by advising regular reviews of psychosocial and support needs Educational interventions may assist patients and caregivers in making effective decisions about treatments
Your Experience with Patients with Stroke...
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