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  • wikipedia:International classification of function
  • This patient's frontal and parietal primary motor/sensory and speech areas (Lt side) due to atrial fibrillation with heart thrombi that embolise to the MCA to occlude the artery
    • Needs warfarin with AF for the rest of her life unless contraindicated


  • 2 roles
    • ensure medical care of stroke patient and any underlying issues
    • leading and coordinating of the multi-disciplinary team
      • takes ultimate responsibility
  • "When can he go home?" - the doctor needs to combine all the information from the therapists and from knowledge of their ADLs and home living situation in order to be able to answer this question.


  • Use a wellness model – focus on abilities rather than disabilities
    • Centre around patient’s goals
  • Roles:
    • Administering/monitoring interventions
    • Bowel and bladder
    • Skinprotection
    • 7days/week, 24hours/day
    • emotional health


Try to come up with a method of independent mobility (even though people don't get 100% better completely after a big stroke, we're trying to get people independent quickly. So although we're trying to get them better, we also want to get them independent).

  • Movement
    • See what people can do
    • Teach them to do it again
  • Focus on:
    • Strength
    • Balance
    • Coordination
  • Equipment – tilt table, hoist?

4 levels:

  1. Underlying pathology
  2. Restore structure/function
  3. Restore independence even with the level of impairment
  4. Restore ability to return to ADLs with disability

Occupational therapist

  • Maximise independence
    • Self, domestic, community
  • Activities of daily living
    • Showering, changing etc
    • Support at home
  • Rehabilitation
    • Evaluation of self-care status
    • Fine-motor skills + upper limb skills
    • Assessment of homes
    • Prescription of equipment
  • Hand splints, devices to assist with toileting, dressing etc, ramps for wheelchairs
  • Very practical: all about solving the problem of getting the person as they operate now to achieve their functions (in their specific house!)

Diversion therapist

  • Leisure options – in-patient + later rehab
    • Engage them to try by leisure - show them that they can do the things that they like
  • Need leisure education for people who don't know what leisure is (work too hard etc)
    • Need leisure activities when you've had a major health crisis - stroke patients are at an increased risk of depression/suicide
    • Good way to motivate patients
  • A lot of people define themselves not by their work but instead through things like playing music etc. These leisure activities are their purpose for living
    • Aids for leisure activities e.g. needle threaders
  • Practicality of achieving many of your goals seems to drop off
    • You need major adjustments to try to achieve these things

Speech pathologist

  • Swallowing
    • Posture
    • Cognition
    • Dentition
    • Chest status – aspiration risk (in the past, a great cause of death)
    • Assess cranial nerves
  • Speech
    • Impairment – which part of the brain
    • Disability – needs to be able to properly express in order to function
    • Participation – roles in life, can they return to ‘normal’ life?
  • Practice normal conversations, hearing and understanding
  • Tailored to specific needs
  • Speech pathologist = dysphagia + dysphasia
  • Circumlocution is a skill that's taught to allow people who can't find the right word to say, and they instead describe what the thing so the other person can understand
    • For CALD - you need interpreters for speech pathologist (this is harder for assessing how good the person's speech/understanding is). Sometimes grammar doesn't translate over to the other language
    • With interpreters - don't want the
  • Phonemic cues e.g. say "ch- ch-" to hint them to chair.
  • People who have a stroke will often lose the language that they learned most recently.


  • Nutrition
  • Weight reduction
    • Education, weight loss diet, follow-up
    • Inpatient dietary control is easy - but it's hard to make sure they change their diet long term
  • Malnourishment – renourishment

Social worker

  • Lessening impact of illness/disability
    • Maximising social functioning etc
  • Assessment of:
    • caring responsibilities o financial matters
    • discharge needs
      • support at home/nursing home

Clinical psychologist

  • Emotional support
  • Grief and loss
  • Issues:
    • Altered levels of functioning/independence
    • Dealing with identity/self-efficacy loss