Physical Therapy for the Stroke Patient: Early Stage Rehabilitation

by Jan Mehrholz

Overview

A manual of proven physical therapy techniques for the early, acute phase after stroke

Clinical evidence clearly demonstrates that physical therapeutic measures begun as soon as possible after a stroke, often within 24 to 48 hours, greatly increase everyday competence and quality of life. Physical Therapy for the Stroke Patient: Early Stage Rehabilitation covers all the issues that physical therapists must deal with in this critical period: assessment of patients' abilities; care during the acute phase; early mobilization; effects of medication; risk factors; ethical questions; and much more. It provides complete guidelines on how to examine and treat the patient, the "dosage" of physical therapy required, and the key differences between early and late stage rehabilitation after stroke.

Special Features:

• Information-packed chapter on "Optimizing Functional Motor Recovery after Stroke," written by J. Carr and R. Shepherd, pioneers in the field and the first to correlate motor learning and stroke recovery
• Case studies throughout the book offering direct, hands-on examples of evaluation and treatment methods
• Nearly 150 color photographs demonstrating step-by-step physical therapy techniques used in actual practice
• Hundreds of references to the literature that support the evidence-based approach presented in the book

This book is an invaluable resource for all physical and occupational therapists who must answer the question, "How much therapy will help my patient?" Not only will it increase your therapeutic skills and confidence, but it will also expand your knowledge of the medical issues and long-term outcomes for the post-stroke patients in your care.

Product Details

ISBN-13:	9783131547217
Publisher:	Thieme
Publication date:	05/23/2012
Pages:	206
Product dimensions:	6.90(w) x 9.70(h) x 0.40(d)

About the Author

PhD

Table of Contents

1 Background Information on Stroke-Incidence, Risks, Survival Rates and Chances, Causes, and Related Disorders Marcus Pohl Jan Mehrholz 1

Definition 1

Incidence and Distribution 4

Incidence of Stroke 4

Prevalence of Stroke 4

Survival 4

Risks and Causes 5

Nonmodifiable Risk Factors 5

Modifiable Risk Factors 5

Disorders and Their Consequences 7

Motor Convalescence and Rehabilitation Following Stroke 8

Course of Illness Following Stroke 9

Prognosis 9

Everyday Competence and Ability to Walk Following Stroke 12

Quality of Life Following Stroke 15

Summary 16

2 Emergency and Acute Preclinical Management of Stroke Gert Grellmann 17

Introduction 17

Symptoms of Stroke: Differential Diagnostics 19

Measures Taken at the Scene of the Emergency 20

Patient's Medical History 20

Clinical Examination 21

Basic Measures to be Taken by Paramedic 21

Summary 24

3 Acute Therapy of Stroke Ralf Schlosser 25

Therapy of Ischemic Stroke 25

General Information 25

In the Emergency Department 26

Special Diagnostics 27

Therapy 29

Specific Therapy 33

Therapy of Complications 38

Special Cases 40

Outlook 41

Summary 41

Therapy of Hemorrhagic Stroke 42

Intracerebral or Parenchymatous Hemorrhage 42

Subarachnoid Hemorrhage 45

Summary 47

4 Early Mobilization: Opportunity or Risk? Jan Mehrholz 48

5 Optimizing Functional Motor Recovery after Stroke Janet H. Carr Roberta B. Shepherd 51

Introduction 51

Acute Stage after Stroke 51

Impairments and Adaptations 54

Weakness 55

Loss of Motor Control 57

Spasticity 58

Adaptive Changes 59

Interrelationships between Motor Learning, Brain Plasticity, and Environments 62

Motor Learning 62

Focusing Attention 63

Goal Setting 65

Practice 66

Delivery of Physical Therapy-Providing Opportunities for Practice 67

Effects of Skill Training and the Environment on Neuroplasticity 70

The Rehabilitation Environment 73

Task-Oriented Training to Increase Skill and Motor Control 74

The Lower Limbs in Support, Propulsion, and Balance 75

Task-Oriented Training 78

Functional Weightbearing Exercises 78

Nonweightbearing Exercises 81

Active Muscle Stretching 82

Maximizing Muscle Endurance and Physical Fitness 83

Training Guidelines: Balance 85

Training Guidelines: Standing Up and Sitting Down 99

Training Guidelines: Walking 110

Training Guidelines: Reaching and Manipulation 120

Conclusion 133

Appendix 133

6 Care of Stroke Patients Claudia Flaemig 136

Care and Treatment Plan 136

Stroke Unit 136

Nursing Care during the Acute Phase 137

Monitoring and Securing of Vital Functions 137

Patient Care History and Care Planning 138

Prevention and Early Detection of Cardiovascular Complications 138

Surveillance and Safety Aspects of Medical Treatment 138

Implementation of Prophylactic Measures 139

The Rehabilitation Phase 142

Communication Assistance 143

Assistance with Washing and Dressing 144

Assistance in Performing Bodily Functions 145

Hemiplegic Shoulder 146

Swollen Hand 146

Dealing with Neglect 147

Guidance for Family Members 147

7 Ethical Questions Relating to the Care of Stroke Patients Frank Oehmichen 148

What is at Issue? 148

Legal Justification of Treatment 149

Medical Treatment Options 150

Decisions Made on the Basis of the Medical Indication 152

Meaning of the Term "Indication" 152

Meaning of the Term "Prognosis" 154

The Dying Process as a Specific Prognostic Responsibility 155

Decision-Making Based on the Patient's Own Wishes 157

Communicative Determination of the Individual Indication and Individual Wishes of the Patient 159

Internal Formation of Decisions 160

External Influences on Decision-Making 161

Discussion 163

Summary 165

References 167

Index 187