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Stroke and transient ischaemic attack - Management
Neurological problems
- Balance impairment:
- Balance training and walking aids should be considered for people with balance impairment.
- Many people have impaired balance after a stroke. This is due to a combination of:
- Reduced limb and trunk motor control.
- Altered sensation on one side.
- Altered representation in the brain of the body and posture, often associated with left visual and spacial neglect.
- Reduced movement, weakness, clumsiness (motor control impairment):
- People with impaired motor control should be referred to a physiotherapist with experience in neurodisability.
- Weakness on one side (hemiparesis) is probably the single most disabling factor after a stroke.
- Impaired tone — spasticity and spasms:
- Anyone with motor weakness after a stroke should be assessed for spasticity.
- There is considerable debate on the definition, physiology, and importance of spasticity.
- For clinical purposes, consider spasticity to be a problem if there is increased tone, abnormal posturing, or involuntary spasms, and if this causes discomfort or limited activity for the person or difficulty for the carer.
- Spasticity can be treated by:
- Exercise and stretching — refer to a physiotherapist.
- Intramuscular botulinum toxin (for focal spasticity affecting one or two joints) — refer to specialist stroke service.
- Antispastic drugs (for generalized spasticity). First try baclofen, gabapentin, or tizanidine.
- If adequate control cannot be achieved with one of these drugs, refer to a specialist with expertise in managing spasticity who can consider trying combinations of these drugs or other treatments.
- Impaired sensation:
- People with marked sensory loss but good motor function should be taught how to take care of the limb and avoid accidental injury.
- Touch, position sense, pain and other sensations may be impaired after a stroke. Its severity is probably associated with the extent of motor loss.
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