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LEARNING OBJECTIVES
Describe the epidemiology, etiology, pathophysiology, symptomatology, and sequelae of stroke.
Identify and describe the procedures used to examine and evaluate patients with stroke to establish a diagnosis, prognosis, and plan of care.
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.
Describe and practice clinical reasoning used to examine and evaluate client care, formulate realistic goals, and develop a plan of care for a clinical case study.
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Stroke (cerebrovascular accident [CVA]) is the sudden loss of neurological function caused by an interruption of blood flow to the brain. Ischemic stroke is the most common type, affecting about 80% of individuals with stroke, and can be the result of thrombosis, embolism, or hypoperfusion. A thrombus is a local occlusion of a blood vessel, and an embolus is material from a distant site that either blocks or impairs blood flow, depriving the brain of essential oxygen and nutrients. Lack of oxygen and nutrients results in tissue necrosis and penumbral area where the cells may be damaged but preserved.1 Hemorrhagic stroke occurs when blood vessels rupture, causing leakage of blood in or around the brain.
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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 hr. 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 etiologic categories (thrombosis, embolus, or hemorrhage), specific vascular territory (anterior cerebral artery syndrome, middle cerebral artery syndrome, etc.), and management categories (transient ischemic attack, minor stroke, major stroke, deteriorating stroke, young stroke).
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See Immersive Case C: A Patient With Stroke
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EPIDEMIOLOGY AND ETIOLOGY
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Stroke is the fifth leading cause of death and the leading cause of long-term disability among adults in the United States. An estimated 7.6 million 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 prevalence than men. However, this prevalence is reversed in older ages; women over 85 years ...