Cerebrovascular accident, CVA, or more commonly known as stroke, is the 3rd most common cause of death in the United States. Studies have shown that of every 100 stroke survivors, 10% return to work, 40% have residual disability, 40% need special services and 10% need institutional care.
70% of strokes are due to cerebral infarction, or disruption of blood vessels in the brain, 20% are due to hemorrage, bleeding in the brain, and 10% are unspecified. The main movement impairments associated with stroke are hemiplegia, weakness of the side of the body opposite the damage to the brain, and; flaccidity, low or absent muscle tone which may be transient or permanent. In some cases, the involved limbs may be hypertonic or rigid with difficulty moving.
The most commonly involved artery in a stroke is the middle cerebral artery. This type of stroke may present with opposite side weakness in the upper and lower extremities and trunk; impaired sensation, speech, swallowing, balance/proprioception; neglect often the same side as the side of weakness; and in some cases, a visual field cut.
Individuals who have suffered from a stroke can receive multidisciplinary skilled care with a prescription from their Physician. Occupational, Physical and Speech therapies may be appropriate pending consultation with a Physician. Occupational therapy can assist a patient with increasing independence with activities of daily living such as bathing, feeding, grooming and return to work. Physical therapy involves education regarding transfers (i.e. in/out of bed, sit to stand, bed to wheelchair), gait (walking) with and/or without a device, and functional mobility (job or home specific tasks). Speech therapy can evaluate an individual's swallowing ability as well as address problems with cognition and communication. Other healthcare members such as nurse case managers/social workers and psychologists may further assist patient in their needs for assistance at home, to better coordinate their care, and to address issues such as depression.
Each individual who has had a stroke has different needs pending their past medical history, prior level of function and support at home. For example, if the patient had a stroke, fell and broke a hip, the techniques for transferring will be different than those listed below. The techniques below are typically used with patients with one sided upper and lower body weakness. The best way to learn how to help a patient is to have hands on training with a therapist under the direction of the patient's Physician.
Generally it is easier to roll onto the strong side. In the picture the affected arm and leg are darkened indicating R sided weakness. Depending on the level of weakness, patient may need assistance gently bending up both legs and keeping affected arm at his/her side. Often times the patient is too weak to move the arm/leg independently and sometimes if neglect is involved, he/she loses awareness of that side of the body.
Bend knees. Make sure affected arm is close to body so that is it not left behind.
Assist patient rolling onto his/her strong side using gentle hands at the trunk (shoulder/pelvis, do not pull on limbs). Stay close to the patient so he/she does not feel as if they will fall out of bed.
Supine (lying on back) to Sitting up:
After completing rolling. Gently help lower the patient's legs off the edge of the bed.
As the legs are lowered, the pelvis tends to tilt on its own with momentum to assist the sitting up motion. With your hands on the affected hip and on the opposite shoulder (do not pull on the head/neck), gently assist the patient from sidelying to sitting.
Stay close to the patient. Some may have poor trunk control in sitting and may need assistance with sitting balance to avoid sliding off the chair/bed.
Sitting to Lying down:
Make sure the patient is positioned on the bed with adequate space to lie down. It is usually easier to scoot in sitting than have to adjust up/down in bed in a lying position.
Generally it is easier to lower patient into sidelying on the strong side. Have the patient assist sit to sidelying with their strong arm (pressure through the strong side forearm) to slowly lower themselves into the bed.
Patient may need assistance carrying the weaker leg onto the bed or they can use their strong leg hooked under the weak leg to help him/herself transfer.
Assist patient rolling onto his/her back and position appropriately for comfort.
Sit to stand: Patients who have a stroke often times have difficulty with tasks that once seemed "automatic", such as getting up out of a chair. This sequencing can be helpful to better initiate the movement and encourage use and weightbearing through the weaker leg.
Have patient scoot their hips forward in the chair by slightly leaning back, or by scooting one hip at a time. Patient may need assistance at the pelvis to scoot the weaker limb forward.
Feet should be position flat on the floor. Make sure feet, hips and knees are aligned properly and that the arms are position where the patient can use them for balance. It is easier to stand if the knees are bent such that the knees are over the toes.
Patient should lean forward to better use momentum to initiate the sit to stand transfer, almost like a gentle rocking motion. It is difficult to stand straight up without leaning forward and patients tend to fall backward.
Patient should be encouraged to use both legs equally to stand. Patient may use arms on the chair/bed for balance, but not for pushing off.
Again, learning the appropriate way to best help a patient is with a therapist in person to demonstrate and practice the technique(s). Assisting a patient with walking, transferring bed to wheel chair and getting off the floor will be discussed in next month's article.
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These technics work well for back injuries as well.