Care Home Training

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Care Home Training

• A workshop on Stroke

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To be clear about what a stroke TIA are, what
causes them and the range of effects

• Learning Objectives
• To be clear what a stroke and TIA are
• To know about the physical effects of stroke
• To know how stroke affects swallowing and the
  importance of oral care
• To have an understanding of the effects on
  communication and vision following a stroke
• To have an awareness of the cognitive and
  psychological impact

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A guide to stroke

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What is a stroke?

• Damage to part of the brain
• Caused by a problem with its blood supply
• Blood is supplied through arteries
• There is a blockage or burst
• Usually happens quickly and strikes suddenly-
  brain attack

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How does this happen?

• Ischaemic (69 - 80)
• Death of tissue (infarction) because of blockage
  by
• Thrombosis a solid clot of blood in artery
  supplying brain or
• Embolism a clot or other substance (fat,
  cholesterol, blood platelets) carried from
  elsewhere in circulation

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How does this happen?

• Haemorrhage (15 - 20)
• Bleeding in the brain
• Burst blood vessel e.g. artery
• High blood pressure can weaken artery
• Bursts and damages tissue
• Brain damage is the result

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Transient Ischaemic Attack

• Occurs when the brains blood supply is briefly
  interrupted
• Classification effects last no longer than
  24hours from onset or the symptoms start to
  resolve within 120 minutes
• Very rarely, symptoms of a TIA are due to
  bleeding (haemorrhage) in the brain
• The FAST test helps people to quickly recognise
  the key symptoms of a TIA or stroke

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Act FAST
.Facial weakness C Arm weakness Can the person
raise Speech problems Can the person speak
say Time to call 999 Stroke is a medical
emergency.   If you see any one of these signs,
seek immediate medical attention

• Other symptoms include
• Sudden weakness or numbness on one side of the
  body
• Sudden confusion
• Sudden dizziness or unsteadiness
• Sudden visual problem
• Severe headache

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Hypertension
Hormonal Contraception HRT
Smoking
Obesity
Heart Disease
Family History or Ethnicity
Inactivity
Binge Drinking Substance Misuse
Diabetes
Previous Stroke TIA
Age
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Stroke Facts

• Every year, approximately 152,000 people have a
  stroke in the United Kingdom
• That is more than one every five minutes
• In 2008, stroke was the fourth largest cause of
  death in the UK after heart disease, cancer and
  respiratory disease
• Stroke is the largest cause of complex disability
  in adults

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Body talk

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• Parietal Lobe
• Taste, temperature, pain
• Understanding language
• Auditory visual memory
• Calculations
• Reading writing
• Spatial awareness

The brain

• Frontal Lobe
• Planning actions
• Learning New tasks
• Motivation
• Behaviour regulation

• Occipital Lobe
• Visual Perception
• Colour
• recognition

• Temporal Lobe
• Memory functions
• Word based memory
• (dominant)
• Visual Memory
• (non-domination)

• Brain Stem
• Breathing
• Blood Pressure
• Digestion
• Heart Rate
• Other Autonomic Functions

• Cerebellum
• Coordination
• Balance
• Equilibrium
• Muscle tone

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What happens in the brain?

• RIGHT BRAIN controls
• Left side of body
• Movement
• Vision
• Hearing
• Memory
• Art
• Music
• Spatial awareness

• LEFT BRAIN controls
• Right side of body
• Movement
• Vision
• Hearing
• Memory
• Reading
• Writing
• Speaking
• Understanding
• Mathematics

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Exercise
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Neuroplasticity

• Neuroplasticity The brain's ability to
  reorganise itself by forming new neural
  connections throughout life. Neuroplasticity
  allows the neurons (nerve cells) in the brain to
  compensate for injury and disease and to adjust
  their activities in response to new situations or
  to changes in their environment

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Normal muscle tone?

• The amount of contraction in a group of
  muscles which enables smooth voluntary movement
  to take place

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How stroke affects tone

• Low tone muscles tend to be loose and weak,
  hanging limply.
• Flaccidity
• High tone tightening of muscles, tendons and
  ligaments that prevents normal movement.
• Spasticity

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What can help

• Good positioning
• Support and stabilise limbs
• Symmetrical
• Medication
• Baclofen
• Botox
• Encourage use
• Move in normal patterns

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Down the wrong way
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The swallow process

• There are four stages to a swallow
• Preparation/anticipation
• Mouth
• Throat
• Throat to stomach
• Stroke can affect any stage - Dysphagia

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Aspiration

• Epiglottis fails to close off windpipe
• Fluid/food goes into the lungs
• Chest infection/pneumonia
• Life and death matter

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Warning signs of Dysphagia

• Recurrent chest infections
• Weight loss
• Inability to maintain posture
• Poor dentition
• Aphonic / weak voice
• Weak, ineffective cough reflex

• Coughing / choking pre/post swallow
• Wet, gargly voice quality
• Change in respiratory status
• Change in colour

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Speech and Language Therapists may advise

• Thickening drinks and soups
• Food supplements
• Soft diet
• Pureed diet
• Enteral feeding (NG / PEG)

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Tips for safe swallowing
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Tips for safe swallowing
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Tips for safe swallowing
Ensure carers and family members understand the
stroke survivors swallowing problems
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Oral Care Importance of a healthy mouth
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Daily Mouth Care
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Making sense of the world

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What did you have for breakfast?
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How do we communicate?
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When we talk...

• 55 is communicated via body language
• 38 is communicated via tone of voice
• 7 is communicated by actual words

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Types of aphasia

• Receptive aphasia
• Unable to understand words

• Expressive aphasia
• Unable to find words or sentences

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Stroke and communication

• DYSPRAXIA
• Difficulties sequencing speech
• Co-ordinating movements
• jumbled-up unintelligible speech, can be
  repetitive

• DYSARTHRIA
• Weak muscular activity
• Difficulty articulating speech
• Slurred, unclear speech

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Visual problems after stroke

• High proportion of people who have had a stroke
  have some form of visual dysfunction as a result
  - 62 - 71
• Visual Field loss
• Visual Inattention Neglect
• Eye movement problems
• Perception problems
• Focussing and reading problems

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Cognitive effects

• Memory
• Language
• Attention
• Concentration
• Vision and perception
• Reasoning and problem solving

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How are you feeling?

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Psychological effects

• Anxiety/fear
• Frustration
• Anger
• Apathy
• Depression
• Emotional lability

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