Neuroscience/Stroke rehabilitation
From IKE
Key Point #1: The brain has specialized centers which perform different functions which communicate with each other in an integrated network. Damage to one of these centers will affect primarily the function it serves but will also have an impact on the entire network.
Key Point #2: Best practice in stroke rehabilitation involves the use of specialized (stroke-specific) interdisciplinary teams of doctor(s), nurses, therapists and social workers who work in a highly coordinated fashion to produce optimal results. Stroke rehabilitation appears to work best for moderately severe stroke patients.
Key Point #3: The hemiplegic posture results in forced extension of the plegic knee and hip which then allows the stroke patient to weight-bear (and potentially learn to walk) even in the absence of significant neurological recovery. Most neurological recovery occurs within the first 3 months post-stroke.
Key Point #4: Hemiplegic shoulder pain is common and can be prevented in some cases by ensuring the flaccid hemiplegic arm is adequately supported and aggressive range of motion exercises avoided. The most likely cause of later hemiplegic shoulder pain is a hypertonic subscapularis muscle (characterized by limited and painful external rotation) which can be treated with Bo-Tox.
Key Point #5. Visual-perceptual difficulties arising from parietal cortical lesions (most commonly right hemisphere involvement) are often characterized by left sided neglect and substantial problems with ADLs. Task-specific visual scanning and other therapies do result in improvements in both neglect and function.
Key Point #6: Intensive language therapy is necessary to improve language outcomes in aphasia post-stroke.
Key Point #7: Dysphagia is a common problem post-stroke and may lead to aspiration and pneumonia. It is best treated with special dysphagia diets and in more severe cases an external feeding tube.
Key Point #8: A well-functioning and supportive family and limiting the impact of depression result in better overall rehabilitation and functional outcomes.
