# 003 Geriatric Stroke Impairment & Complications Rehabilitation

Fast Facts and Concepts #003 PDF

Authors: Steve Denson, MD, Catherine Tsufis, John McGuire, MD, Judith Kosasih, MD, Bambi Wessel

Objective:

1. Define common impairments and complications of stroke.
2. Identify three functional and/or negative predictors of outcome

Context: Geriatric Patient Visit

Action: Implement an effective post-stroke rehabilitation program to reduce morbidity and mortality associated with stroke.

Incidence/Prevalence: Two thirds of stroke patients are over 65, and stroke is the fourth leading cause of death and the second leading cause of disability in the United States¹ . Eighty percent of stroke patients survive, and there are currently more than six million survivors in the United States, with varying levels of disability² 

Underlying Science: 90% of strokes are ischemic, caused by either embolic or thrombotic clots to the central nervous system.  10% are hemorrhagic, manifesting as either intracerebral or subarachnoid bleeds.  Most common causes of ischemic strokes are atheromatous diseases in medium and large vessels, cardioembolic conditions such as atrial fibrillation, and small vessel ischemic disease.  Other diseases that damage blood vessels (hypertension, diabetes, dyslipidemia) and lifestyle issues (tobacco use, cocaine, heroin, or amphetamine use) are also implicated.  The location of the stroke subsequently defines the types of deficits a person will experience.

Impairments in Stroke:

Complications in Acute Stroke:

Recovery: Most motor recovery occurs within the first 3 months, Cognitive function improves mainly in the first 3 months.  Language function and visual-spatial function recovers in the first 12 months.  Recovery is possible beyond this, and is typically seen in the setting of a motivated patient, focused intervention, and intact support system³.

Functional predictors of outcome: NIHSS (NIH Stroke Scale) at 1 week⁴, 1 week post stroke sitting balance, bowel and bladder control, and motor strength.

Reference: http://www.nihstrokescale.org

Negative Predictors of Outcome: Negative predictors include: older age, history of previous stroke, urinary or bowel incontinence, visuospatial deficits, cognitive impairment, speech impairment, depression, coronary artery disease, and absence of a supportive caregiver⁵.

REFERENCES:

1. Roger VL. Go AS. Lloyd-Jones DM. Benjamin EJ. Berry JD. Borden WB. Bravata DM. Dai S. Ford ES. Fox CS. Fullerton HJ. Gillespie C. Hailpern SM. Heit JA. Howard VJ. Kissela BM. Kittner SJ. Lackland DT. Lichtman JH. Lisabeth LD. Makuc DM. Marcus GM. Marelli A. Matchar DB. Moy CS. Mozaffarian D. Mussolino ME. Nichol G. Paynter NP. Soliman EZ. Sorlie PD. Sotoodehnia N. Turan TN. Virani SS. Wong ND. Woo D. Turner MB. American Heart Association Statistics Committee and Stroke Statistics Subcommittee.(2012) Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 125(1):188-97.

2. McGuire JR. (2011) Stroke. Topics in Stroke Rehabilitation. 18(3).

3. Brown AW, Schultz BA. (2010) Recovery and rehabilitation after stroke. Semin Neuro. 30(5): 511-7.

4. Johnston SC. (2002) Transient Ischemic Attack. NEJM. v347, 1687-92.

5. Jongbloed L.(1986) Prediction of function after stroke: A Critical review. Stroke. 17(4):765-76.

Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.

Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Copyright/Referencing Information: Users are free to download and distribute Geriatric Fast Facts for educational purposes only. Citation:  Catherine Tsufis, Steven Denson MD, John McGuire MD, Judith Kosasih MD, Bambi Wessel - Fast Fact #3: Geriatric Stroke Impairment & Complications Rehabilitation. September 2012, Geriatric Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

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