Table 4: Effects of Stroke
Left Brain Damage (right side paralyzed)
Right Brain Damage (left side paralyzed) • Quick, impulsive, lack of insight. • Temper flare-ups, emotional. • Apathetic, lack of motivation or initiation. • Irritable, depressed, self-centered. • Memory deficits. • Short attention span. • Lack of awareness of effects of stroke.
Behavior
• Slow, cautious. • Disorganized. • Anxious. • Underestimates abilities.
Cognition
• Memory deficits. • Short attention span. • Lack of awareness of effects of stroke.
Communication • Expressive and receptive aphasia.
• Speaking and understanding usually not affected. • Difficulties starting conversation, taking turns in conversation, and can have rambling speech. • Difficulties with writing and spelling. • Paralysis or weakness on left side of body, poor balance, loss of ability to plan movements (apraxia), too much muscle tone (spasticity) or too little (flaccidity). • Impaired ability to judge distance, size, and position. • Impaired ability for self-care; left-sided neglect. • Can have swallowing difficulties (dysphagia).
• Unable to name objects but understands how to use them. • Repeats words or phrases (perseveration). • Speaking and understanding usually not affected. • Difficulties starting conversation, taking turns in conversation, and can have rambling speech. • Difficulties with writing and spelling. • Can have swallowing difficulties (dysphagia).
Movement
Other
Suggestions for interaction • Do not overestimate abilities; spatial deficits are easy to miss. • Approach patient from the left side. • Use verbal cues. • Break tasks into small steps. • Watch if patient can safely perform a task. • Minimize clutter in environment. • Avoid quick movements. • Highlight visual reference points. Note. Adapted from Buettner, L., & Fitzsimmons, S. (2009). NEST: Dementia practice guidelines for disturbing behaviors. State College: PA: Venture Publishing. INCONTINENCE • Do not underestimate ability to learn and communicate even if patient cannot speak. • Try other forms of communication such as pictures. • Keep messages simple and do not raise voice. • Divide tasks into simple steps. • Allow patient time to think and form thoughts. • Provide feedback and encouragement for progress.
The occurrence of urinary incontinence increases with age, but it is not a normal part of the aging process. It is associated with skin irritation, urinary tract infections, and falls. It can lead to embarrassment, withdrawal from social life, depression, and loss wof self-esteem. Doing activities outside the home, interacting with friends and family, and sexual activity may be restricted or avoided entirely. Urinary incontinence has significant physical, psychological, social, and economic consequences for older adults. Incontinence may occur for many reasons, some of which are temporary, such as from a urinary tract or vaginal infection, constipation, certain medications, or an extended respiratory Types of incontinence There are several different types of incontinence and it is important to know the type to treat it most effectively: ● Transient incontinence : Commonly caused by reversible problems, such as delirium, depression, infection, febrile states, fecal impaction, medications, or inflammation, the underlying problem needs to be treated quickly so it does not result in chronic incontinence. ● Stress incontinence : This type of incontinence involves small amounts of urine loss during activities that increase intra-abdominal pressure, such as coughing or sneezing; it is caused by weakness and laxity of pelvic floor, bladder outlet, or urethral sphincter. It is most common in women and also in men after prostate surgery. For some women, this begins after childbirth, for others, after menopause. ● Urge incontinence : Urge incontinence is an abrupt and strong desire to void with sudden loss of large amount of urine, usually on the way to the bathroom; it is caused by overactivity of the detrusor muscle, which causes bladder Management of incontinence Older adults may have a high quality of life despite urinary incontinence. Healthcare professionals can recommend the following techniques to control incontinence:
infection or cold with frequent coughing or sneezing. Some incidences of incontinence are the result of longer-lasting problems such as a weak bladder muscle, an overactive bladder, and nerve damage from diseases such as multiple sclerosis or mobility problems. Most incontinence can be treated and controlled and sometimes cured. Older adults with urinary incontinence should seek the help of a primary care provider who may perform a number of tests, including urine and blood tests and bladder emptying tests. A daily diary of urination and leakage may also be kept. contractions. This may be found in people with Alzheimer’s or Parkinson’s disease or a local bladder disorder such as stones or cancer. ● Mixed incontinence : Mixed incontinence is a combination of stress and urge incontinence. ● Overflow incontinence : Overflow incontinence is urine loss from obstruction or overdistended bladder with frequent or constant dribbling of urine; it is caused by medications, fecal impaction, diabetes, and spinal cord injury. It is found in men with prostate disorders and urethral strictures, in women with genital prolapse, and in people with diabetes and spinal cord injury. ● Functional incontinence : Functional incontinence is urine leakage associated with inability or unwillingness to use the toilet; this may be caused by pain, cognitive impairment, environmental barriers, impaired mobility, and/or unavailable caregivers.
● Use habit training or timed voiding for urge incontinence. This is done by first keeping a diary of when the urge to void
Page 34
Book Code: PTNY3622B
EliteLearning.com/Physical-Therapy
Powered by FlippingBook