Right-Side Cerebrovascular Accident

1. Right-Side Cerebrovascular Accident By: Ciera Jackson

2. 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

3. 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%

4. 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

5. 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

6. COURSE AND PROGNOSIS Recovery depends on the location, type and severity of a stroke • one month • one year • 20-plus years

7. PRECAUTIONS Practitioners working with Right CVA pts should be precautious of: • Warning signs of stroke • Deep vein thrombosis (DVT) • Subluxation • Muscle weakness

8. DEMOGRAPHICS OF DIAGNOSIS

10. TREATMENT TEAM

11. 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

12. 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

13. 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

14. 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)

15. EVALUATION METHODS Standardized 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. • 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)

16. OCCUPATIONAL PERFORMANCE IMPACT Occupational Profile: Joana

17. 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.

18. Occupations Impacted

20. Client Factors

21. ASSETS • Determination/Motivation • Full function of right side • Useful habits (eating healthy, regular exercise)

22. PROBLEMS REQUIRING OT • Weakness of left-side, • Limited ROM to complete ADL’s iADL’s • Decreased attention span • Adjustment to disability

23. TREATMENT PLAN

24. FUNCTIONAL PROBLEMInability to prepare full course meals due to left side paresis causing limited ROM and strength STG 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. • 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.

25. FUNCTIONAL PROBLEMClient suffers from decreased attention span that limits her from being able to tutor. STG 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. • 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.

26. 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

27. 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).