stroke project kit

By Fierra Surrao July 2016

Stroke

A stroke is when the flow of blood to the brain is interrupted or blocked, damaging the brain.

There are two types of stroke. The first is when an artery becomes blocked. An artery is a tube that

takes blood to different parts of the body. The second is when a blood vessel bursts, causing

bleeding in the brain. A blood vessel is another tube that carries blood around the body.

What happens when someone has a stroke• Numb and weak in one side of the face, arms and legs

• Unable to talk, words will come out slurred

• Difficulty seeing in one or both eyes

• Feel dizzy

What to do to avoid getting a stroke Eat healthy, exercise, do not smoke or drink alcohol, and reduce stress. Stress can be reduced by

listening to calming music, practising deep breathing, and doing an activity that a person enjoys.


Assessment It is important to assess the person so you know what problems they have. Once you know what problem the person has, read the treatment part of this book for how you can help. After each part of the assessment (for example, once you have assessed their eyes) tell the person what you found out.

EyesThe person may have a problem with moving

their eyes or seeing properly after stroke. This is concerning as they may bump into things, and have difficulty finding objects, this can cause

anxiety.

Assessment

Diplopia (blurry vision) Ask the person if words or pictures are blurry. Or show a picture and ask if it is blurry.

Convergence (can both the eyes follow the pen-cil or does one or both eyes lose focus and look straight ahead instead of at the pen when the pen moves)

Sit facing in front of the person. Hold a pen 20cm away and ask the person to look at the tip of the pen. Slowly move the pen towards the persons nose then move it out again.

Tracking (whether the eyes can follow the pen left to right, up and down and diagonally or whether they lose focus i.e. can’t look upward)

Sit facing in front of the person. Tell the person to keep their head still and to follow your pen with their eyes. Hold the pen 20cm away in the centre of the persons face, move your pen slowly horizontally, vertic-ally and diagonally.


Hemianopia (how far out to the side the person can see with both eyes. The person should tell you that they can see your pen before it reaches the middle of their face)

Sit facing the person. Ask them to cover their good eye, starting from the side the eye is covered, hold the pen 20cm away on the upper (forehead) level and tell the person to say “NOW” when they see the pen. Slowly bring the pen to the middle of the persons face. Repeat this on the middle (eye) level and lower (chin) level. Once you have done this, start with the pen on the other side of the face, asking the person to still keep their good eye covered and repeat upper, middle and lower levels. After this, get the person to cover their other eye and repeat this whole process.

Visual inattention or neglect (do this if there is no hemianopia). The person has inattention if when you wiggle both your index fingers at the same time, they only point to one. This is con-cerning as they are neglecting one side of their body and environment. They may not comb or shave one side of their face, not eat food on one side of their plate and get lost during walking as they neglect one side of their path.

Sit facing the person. Hold up an index finger either side of the per-sons face 30cm away (hold your fingers just in front of their ear). Wiggle on finger at a time and then both fingers together randomly. Tell the person to point to the wiggling finger, or to both if both moved.


SensationThe person may have less or no feeling in their affected arm after stroke. This is dangerous as they cannot feel pain, heat or cold, meaning they can burn themselves or touch sharp objects such as a knife without realising. Please make sure you always assess sensation.

Assessment

Light touch (if the person cannot feel light touch, they can also not feel pain or hot and cold tem-peratures). If they do not point close to where you touched them they also have less feeling in their arm.

Sitting opposite client, ask them whether the feeling in their arm is dif-ferent after stroke (when dressing, or the temperature when shower-ing, or whether they know where their arm is when they are lying in bed). Ask person to close their eyes, test unaffected arm first, then affected. Brush cotton wool (or anything soft like a tissue or soft cloth) on an area of the persons skin and ask them to point to where you touched their skin. Start from shoulder through to finger tips, on the top and bottom of their arm and hand.

Deep pressure Use the eraser on the pencil to apply pressure to the skin, test on un-affected arm then affected. Tell person to point to where you are pushing down.


Temperature Have two tubes, one filled with hot water and another with cold (if not possible pour hot water over a spoon and cold water over another spoon for heat and cold). Explain you want to see if the person can tell the different between hot and cold, one tube is hot and the other is cold. Ask the person to close their eyes and press cold and hot tubes randomly on the persons skin for 1 second. Ask person to tell you if it was hot or cold. Test non-affected then affected arm.

Proprioception (whether there is feeling in the persons joints when they are still, if there is no proprioception the person also cannot feel pain or temperature)

Ask person whether they have found it hard to feel the position of their affected arm after stroke. Tell the person you want to see whether they can position their unaffected arm in the same as you position their affected arm with their eyes closed. Hold each position for 3 seconds then ask person to copy. Start with positioning the shoulder, then elbow, then wrist, then fingers.

Kinaesthesia (whether the person can feel which way the joints in their affected arm are moving)

Person closes eyes. Start with unaffected arm, bend or straighten the persons elbow and ask them to tell you which one you are doing. Then move the wrist up or down and then the fingers up or down. Do affected arm.


Stereognosis (this is how well the person can identify objects without looking for them, for ex-ample riel or U.S notes in their pocket)

Place a safety pin, spoon, riel note and pen into the persons hand one by one and check you call them by the same name. Ask person to close their eyes, place an object into the persons non-affected hand first, ask them to name it, remove it, then place the second. After all are done, test with affected hand. Tell them what you found.


Shoulder The person may have a subluxed shoulder. You may notice they lift their affected shoulder during activity and fix their arm against their body when doing an activity with their hand. They may be unable to move their shoulders up and down (when dressing) or forwards and backwards (reaching forwards).The person may feel a dull, aching pain because of subluxation in the shoulder joint and have headaches because of this.

Assessment

Shoulder subluxation (if it is present, the index finger will move into a gap)

Person sits with hands in laps. Stand behind the person with the hands on their shoulders and move hands laterally along the bony surface of the shoulder and sliding 5cm down the upper arm.

Passive Range of Motion in shoulder (if there is too little tone the shoulder will feel very heavy when moved, if there is too much tone the shoulder will resist being moved)

Have the person lie down on their unaffected side. Place one hand on the persons apex and the other on the medial border of the scap-ula, move the persons shoulder up and down, forward and back-wards and in an upwards and downward rotation.

Arm The person may have paralysis and increased muscle tone in one arm. Completing everyday activities with this injured arm leads to fatigue that doesn’t improve with sleep.

Assessment


Active Range of Motion in Arm (how well the person can move their arm on their own)

Ask person to lie down. Test unaffected arm first, then affected. Ask person to lift arm as much as they can and back down, behind their head, out to the side, hand facing up like a stop sign then over head touch shoulders on same side, arm out in front, shrug shoulders both together, bring shoulders forward and relax, shoulders back and re-lax.

Hand The person may have less movement in the wrist and finger after stroke, making it difficult to grasp objects.

Assessment

Hand function (the person may not be able to make a fist, do a hook grasp - seen when holding shopping bags, open hand wide to let go of ob-jects, grasp between thumb and side of index fin-ger or hold a pen, cup or ball.

Before starting assessment, stretch out hand by pulling the thumb out of the palm with the palm face up and the forearm resting on a sur-face.Wrist flexion and extension - hand resting on the side, and then re-peat with palm face down Wrist radial and ulnar deviation - palm down on tableMass grasp - person to make a fist Cylindrical grasp - person to hold a cup Lateral prehension and release - person holds a piece of paper between thumb and side of index finger and releases by lifting their thumb (release is important)Palmar prehension - person picks up and holds a pencilFlexion and extension - of each fingerSpherical - person holds and releases a ball Opposition - person brings the pad of thumb and index finger to-gether


Stroke Therapy Once you know what problems the person is having, you can help them. For example, if the person has problems with their eyes, look at the eyes section below to see what you can do.


Symptom Therapy

Eyes (difficulty seeing) • Tell the person to feel objects with their hands to identify it

• Tidy and organise their rooms at home

• Tell the person to walk and move slowly around their home and farm

• If they have hemianopia, which is difficulty seeing to one side, for ex-ample the left side, tell the person to turn their whole head to the left to see the left side when walking and doing activities like farming, cooking and fishing.

• If they have neglect on their left side, use the red tape in the kit to stick it vertically to the left of any surface at home, such as the left side of the table where they eat food, or the table where they cook food, tell them that they know when they are looking to the left when they see the red tape. This helps the person be aware of the side that has been injured.


Sensation (loss of feeling in one arm) • It is important that the hand and arm without sensation is always touch-ing something to increase the feeling in that hand or arm. For example, tell the person to use their weak hand to keep their plate still while eating or keep their toothbrush still on the table when putting toothpaste on it like the picture here (the grey arm is the weak arm)

• Tell the person to hold their weaker arm with their good arm by the wrist and guide it in activities. For example, guide it to pick up a water bottle or a spoon. The picture below shows a person guiding his weak arm (grey) to hold a cloth and wash his face.


Shoulder (difficulty moving their shoulder. The person lifts up their shoulders when dressing or cooking and presses their weak arm to their body when doing activities)

• After stroke, the shoulder may be stuck and the person may find it hard to reach their arm forward. It is important to help the person move their shoulder and arm forward. Encourage the person to bend over to put on their socks and shoes like this picture

• Tell the person to put their good hand over their weak hand on a table and straighten their arms like the picture below, and lean to their weak side before sitting back straight again.

•Tell the person to pull their weak arm across their body using their good arm to stretch their shoulder.

•If the person has aching pain, tell them to still use their arm so that their shoulder is always moving which helps with pain.


Arm (the person may find it hard to move their arm as it is weak and stiff)

Encourage the person to use their weak arm every day during activities. They can use their weak arm to:

• Hold their plate still while eating, hold a potato still when cutting it and hold their shirt at the bottom when buttoning it.

• Carry a piece of clothing under their arm, help to get in and out of bed, hold a bowl that is being washed, hold a glass when pouring water in it.

• Wash parts of their body, eat with a spoon, helps to button shirt and put pants and shoes on.

• Hold their weaker arm with their good arm by the wrist and guide it in activities (brushing teeth, picking up food with their fingers to eat). Please look at sensation which has a picture on this.

• In the pictures below the grey arm is the weak one.

• The person may feel very tired because they have to work harder to move their weak arm. Tell the person to take short breaks during activit-ies. For example cut a potato, then rest for one minute, then cut another vegetable. This way they can do more things and feel less tired.


Hand (the person will find it difficult to use their hand because it is stiff)

• If the hand is swollen, put a glove made out of tubigrip on it, an example is in the stroke box.

• Before and after doing any activity, tell the person to stretch out their hand. Rest their weak hand on a table or their lap, with their palm facing up. It is good if their elbow is straight. Take the thumb out of their palm with your thumb to straighten it and open the webspace, use your index finger and knuckles to straighten the fingers in the picture below. Hold this for at least 1 minute. Tell the person to stretch out their hand.

• If there is little feeling in the hand, tell the person to fill a bowl with un-cooked rice or stones (in the stroke box there is uncooked rice as an ex-ample) and to pick up, scrunch and release this. This is good for feeling in the hand.

• Encourage the person to use their hand to hold riel and U.S dollar notes and button their shirt.

Crying A person who has had stroke may feel sad and upset, they have been through a hard time that has changed their life. If the person cries, say “You have been through so much and it has been really hard. You are do-ing so well”

stroke project kit

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