Previous Section
Approaches to Stroke Rehabilitation
Prevention and Treatment of Secondary Complications in Stroke Rehabilitation
For more information regarding aerobic exercise training in stroke survivors, please click on the following link:
Confusion
Confusion after stroke occurs in up to 25% of patients older than 40 years of age. It is also more common in patients with cognitive impairment prior to the stroke, patients with metabolic diseases (such as diabetes), and patients with infectious diseases. Confusion in stroke patients may also be related to medications such as benzodiazepines, anticonvulsants, or antidepressants. It is generally associated with poorer functional outcome at 6 months post- stroke.
Pressure Sores
Pressure sores, also called decubitus ulcers result from both extrinsic (pressure, shear forces, friction, moisture) and intrinsic (anemia, contraction of muscles, spasticity, diabetes, malnutrition, edema, obesity) etiologies. General measures to prevent pressure sores include adequate nutrition and hydration, as well as proper incontinence care. While in bed, stroke survivors should be turned regularly. Generally, the affected upper extremity should be elevated on a pillow to decrease distal edema and promote awareness. In a side lying position, the affected upper extremity should be positioned with flexion at the shoulder, extension at the elbow, and the wrist in a neutral position. A pillow should be placed between the knees with the affected hip in extension, knee in slight flexion and the ankle in dorsiflexion (ankle bent with foot pointed upward). Assessment of the skin should be performed frequently by caregivers if the stroke survivor has sensory deficits, neglect or a loss in any part of their visual field (visual field cut). In a wheelchair, the stroke survivor should have an appropriate seating system and cushion for maximal skin protection. They or their caregivers should learn pressure relief techniques.
Bladder Dysfunction
Approximately 45-75% of stroke survivors experience urinary incontinence immediately after stroke and most cases resolve within 8 weeks without any treatment. It may persist in up to 10% of patients at 2 years after the stroke. Incontinence appears to increase with the severity of the stroke, age of patient, patients who suffer from aphasia, dysphagia, visual field deficits, and motor weakness. It has a significant impact on the quality of life of the patient since it affects their self image and can interfere with their involvement in social activities. Urinary incontinence may be attributable to physiological changes caused by the stroke that effect many dimensions of daily life (such as communication, mobility, loss of function); or to neurophysiological changes that take place in the centers of the brain that regulate urinary function namely urine retention and urgency/frequency of urination. In addition, the majority of the stroke population is elderly and many may have preexisting urinary or bladder conditions such as urinary incontinence and bladder outlet obstruction (e.g., enlarged prostate).
Reversible causes of incontinence, such as urinary tract infection, fecal impaction, and reduced mobility, should be evaluated and treated. Post-void residuals should be measured to assess for urinary retention. Symptoms of urinary incontinence, frequency, and urgency should be noted. Patients with voiding dysfunction should be referred for urodynamic studies to characterize the voiding disorders and to determine appropriate intervention.
