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INTRODUCTION

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LEARNING OBJECTIVES

  1. Describe the epidemiology, etiology, pathophysiology, symptomatology, and sequelae of stroke.

  2. Identify and describe the examination procedures used to evaluate patients with stroke to establish a diagnosis, prognosis, and plan of care.

  3. Describe the role of the physical therapist in assisting the patient in recovery from stroke in terms of interventions, patient/client-related instruction, coordination, communication, and documentation.

  4. Identify and describe strategies of intervention during inpatient rehabilitation.

  5. Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.

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Stroke (cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Ischemic stroke is the most common type, affecting about 80% of individuals with stroke, and results when a clot blocks or impairs blood flow, depriving the brain of essential oxygen and nutrients. Hemorrhagic stroke occurs when blood vessels rupture, causing leakage of blood in or around the brain. Clinically, a variety of focal deficits are possible, including changes in the level of consciousness and impairments of sensory, motor, cognitive, perceptual, and language functions. To be classified as stroke, neurological deficits must persist for at least 24 hours. Motor deficits are characterized by paralysis (hemiplegia) or weakness (hemiparesis), typically on the side of the body opposite the side of the lesion. The term hemiplegia is often used generically to refer to the wide variety of motor problems that result from stroke. The location and extent of brain injury, the amount of collateral blood flow, and early acute care management determine the severity of neurological deficits in an individual patient. Impairments may resolve spontaneously as brain swelling subsides (reversible ischemic neurological deficit), generally within 3 weeks. Residual neurological impairments are those that persist longer than 3 weeks and may lead to lasting disability. Strokes are classified by etiological categories (thrombosis, embolus, or hemorrhage), specific vascular territory (anterior cerebral artery syndrome, middle cerebral artery syndrome, and so forth), and management categories (transient ischemic attack, minor stroke, major stroke, deteriorating stroke, young stroke).

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EPIDEMIOLOGY AND ETIOLOGY

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Stroke is the fourth leading cause of death and the leading cause of long-term disability among adults in the United States. An estimated 7,000,000 Americans older than 20 years of age have experienced a stroke. Each year approximately 795,000 individuals experience a stroke; approximately 610,000 are first attacks and 185,000 are recurrent strokes. Women have a lower age-adjusted stroke incidence than men. However, this is reversed in older ages; women over 85 years of age have an elevated risk compared to men. Compared to whites, African Americans have twice the risk of first-ever stroke; rates are also higher in Mexican Americans, American Indians, and Alaska Natives. The incidence of stroke increases dramatically with age, doubling in the decade after 65 years of age. Twenty-eight percent of strokes occur in individuals younger than 65 years of age. Between ...

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