Risk
- Cerebrovascular accident (CVA) is the medical term for Stroke.
- A stroke is a life-threatening and debilitating event where the blood supply to part of the brain is blocked by a clot (ischaemic stroke) or where a blood vessel ruptures causing a bleed (haemorrhagic stroke).
- The main signs of a NEW stroke (i.e. these are different from the person’s original presentation) can be remembered by the acronym FAST:
- Facial weakness: Can the person smile with both sides of their face?
- Arm weakness: Can the person raise both arms?
- Speech problems: Can the person understand what you say and can they speak back coherently?
- Time: Call 999 immediately if you notice any of these new signs.
Reason
- Individuals who have had a stroke may experience hemiplegia (one-sided weakness), which is often accompanied by a loss of sensation on that side of their body, as well as a loss of awareness of their midline.
- They may also have a footdrop, meaning that they are unable to bend up the ankle as is needed when we lift our foot to place the heel on the floor to take a step.
- They may also have a cognitive or behavioural impairment.
- All of these factors can potentially impair the individual’s balance, putting them at an increased risk of falling.
Intervention
- Refer to a Community Neurological Physiotherapist, who can prescribe an appropriate exercise/activity/postural management plan. Make sure your referral states the specific problem/s that a person is presenting with, and ensure that you highlight any concerns you have about the risks to them (e.g. risk of falling because they are unsteady on their feet when they mobilise with a member of staff and a walking stick, or their posture in sitting is worsening and they are at increased risk of pressure sores or falling from their chair or becoming ‘unseatable’). Highlighting specific risks will make it more likely that you receive Physiotherapy support.
- Ensure that any strengthening exercises are not just focussed on the ‘stronger’ side of the body, as this may actually worsen any weakness and midline awareness.
- Always encourage the correct use of any mobility aids or equipment and refer to a Community Physiotherapist regarding any difficulties with a prescribed/existing mobility aid.
- For professional advice on seating, refer to Hertfordshire Wheelchair Services.
- Refer to an Occupational Therapist for such things as equipment to assist with Activities of Daily Living, and for splints e.g. hand and wrist splints.
Considerations
- It is important that the individual’s capacity to make decisions around each specific area is considered and documented.
- Individuals who have capacity regarding these decisions can make choices about what they want to do and about which strategies they do, or do not, wish to be implemented. You need to document their ability to make this decision, as well as what they chose every time is it relevant.
- You may need to inform them of the benefits and risks, if they are not aware, or you may need to remind them if they have difficulty remembering things.
- If the individual is assessed as not having capacity regarding a decision, this needs to be documented appropriately and interventions need to be implemented and documented as part of a Best Interests Decision, using appropriate paperwork.