Stroke teaching guide

Stroke

Right Hemiplegia increased tone

1: Has the person had an acute stroke within last 24 hours? Any of these present: face droop, slurred speech, one sided numbness?? No = go 2

2: Has the patient been cleared by a medical team for assessment? Yes = go 3

3: Can the patient move their right leg and arm without issues? No = go 4

4: Is the right leg or arm stiff to move in one direction? Yes = Right Hemiplegia increased tone

Right Hemiplegia increased tone treatment

Stroke

Right Hemiplegia low tone

1: Has the person had an acute stroke within last 24 hours? Any of these present: face droop, slurred speech, one sided numbness?? No = go 2

2: Has the patient been cleared by a medical team for assessment? Yes = go 3

3: Can the patient move their right leg and arm without issues? No = go 4

4: Is the right leg or arm stiff to move in one direction? No = go 5

5: Is the right leg or arm heavy and floppy? Yes = Right Hemiplegia low tone

Right Hemiplegia low tone treatment

Stroke

Left Hemiplegia increased tone

1: Has the person had an acute stroke within last 24 hours? Any of these present: face droop, slurred speech, one sided numbness?? No = go 2

2: Has the patient been cleared by a medical team for assessment? Yes = go 3

3: Can the patient move their right leg and arm without issues? Yes = go 6

6: Can the patient move their left leg and arm without issues? No = go 7

7: Is their left leg or arm stiff to move in one direction? Yes = Left Hemiplegia increased tone

Left Hemiplegia increased tone treatment

Stroke

Left Hemiplegia low tone

1: Has the person had an acute stroke within last 24 hours? Any of these present: face droop, slurred speech, one sided numbness? No = go 2

2: Has the patient been cleared by a medical team for assessment? Yes = go 3

3: Can the patient move their right leg and arm without issues? Yes = go 6

6: Can the patient move their left leg and arm without issues? No = go 7

7: Is their left leg or arm stiff to move in one direction? No = go 8

8: Is their left leg or arm heavy and floppy? Yes = Left Hemiplegia low tone

Left Hemiplegia low tone treatment

Stroke

Poor sitting balance

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? No = Poor sitting balance

Poor sitting balance treatment

Stroke

Reduced proprioception

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? No = Reduced proprioception

Reduced proprioception treatment

Stroke

Reduced sensation

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? No = Reduced sensation

Reduced sensation treatment

Stroke

Reduced range of movement

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? No = Reduced range of movement

Reduced range of movement treatment

Stroke

Shoulder subluxation

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? Yes = Shoulder subluxation

Shoulder subluxation treatment

Stroke

Shoulder pain

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? Yes = Shoulder pain

Shoulder pain treatment

Stroke

Elbow contracture

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? No = Elbow contracture

Elbow contracture treatment

Stroke

Wrist contracture

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? No = Wrist contracture

Wrist contracture treatment

Stroke

Hand flexion contracture

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? No = Hand flexion contracture

Hand flexion contracture treatment

Stroke

Hip contracture

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? No = Hip contracture

Hip contracture treatment

Stroke

Knee contracture

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Is the upper or lower limb stiff to move in one direction? Yes = go 19

19: Can the knee be moved fully through range? No = Knee contracture

Knee contracture treatment

Stroke

Ankle contracture

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? No = Ankle contracture

Ankle contracture treatment

Stroke

Poor rolling ability

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? No = Poor rolling ability

Poor rolling ability treatment

Stroke

Poor pelvic tilting

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? No = Poor pelvic tilting

Poor pelvic tilting treatment

Stroke

A.O.1 Bed transfers

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? No = go 24

24: Can the patient move from lying to sitting with assistance from one person? Yes = A.O.1 Bed transfers

A.O.1 Bed transfers treatment

Stroke

A.O.2 Bed transfers

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? No = go 24

24: Can the patient move from lying to sitting with assistance from one person? No = go 25

25: Can the patient move from lying to sitting with assistance of 2 people? No = Assistance of 2 with bed hoist

Assistance of 2 with bed hoist treatment

Stroke

A.O.1 Sit to stand

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? No = go 24

24: Can the patient move from lying to sitting with assistance from one person? No = go 25

25: Can the patient move from lying to sitting with assistance of 2 people? No = A.O.1 Sit to stand

A.O.1 Sit to stand treatment

Stroke

A.O.1 Sit to stand

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? No = go 27

27: Can the patient move from sit to stand with assistance of 1 person? For a stroke patient, sitting to standing is best achieved slowly with two people to begin with, as blood pressure needs monitoring Yes = A.O.1 Sit to stand

A.O.1 Sit to stand treatment

Stroke

A.O.2 Sit to stand

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? No = go 27

27: Can the patient move from sit to stand with assistance of 1 person? For a stroke patient, sitting to standing is best achieved slowly with two people to begin with, as blood pressure needs monitoring No = go 28

28: Can the patient move from sit to stand with assistance of 2 people Yes = A.O.2 Sit to stand

A.O.2 Sit to stand treatment

Stroke

Standing hoist transfer

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? No = go 27

27: Can the patient move from sit to stand with assistance of 1 person? For a stroke patient, sitting to standing is best achieved slowly with two people to begin with, as blood pressure needs monitoring No = go 28

28: Can the patient move from sit to stand with assistance of 2 people? No = Standing hoist transfer

Standing hoist transfer treatment

Stroke

Poor standing balance

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? Yes = go 29

29: Can the patient stand and lean in all directions independently? No = Poor standing balance

Poor standing balance treatment

Stroke

Supervised mobility

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? Yes = go 29

29: Can the patient stand and lean in all directions independently? Yes = go 30

30: Can the patient walk unaided? No = go 31

31: Can the patient walk with a stick/zimmer frame unaided? No = go 32

32: Can the patient walk with assistance of one or two people? Yes = Supervised mobility

Supervised mobility treatment

Stroke

Wheelchair mobility

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? No = go 29

29: Can the patient stand and lean in all directions independently? No = go 30

30: Can the patient walk unaided? No = go 31

31: Can the patient walk with a stick/zimmer frame unaided? No = go 32

32: Can the patient walk with assistance of one or two people? No = Wheelchair mobility

Wheelchair mobility treatment

Stroke

Poor stepping ability

9: Can they sit unaided and lean in all directions (sideways/backwards/forwards) without problem? Yes = go 10

10: With their eyes closed can they feel the impaired limb being moved passively by another person? Yes = go 11

11: With eyes closed, can they feel impaired limb being touched? Yes = go 12

12: Can the affected shoulder be moved fully by another person? Yes = go 13

13: Does the shoulder look out of place? No = go 14

14: Is the shoulder painful? No = go 15

15: Can the affected elbow be fully straightened? Yes = go 16

16: Can the affected wrist be moved through full range? Yes = go 17

17: Can the hand/fingers be fully opened? Yes = go 18

18: Can the affected hip be moved fully through range? Yes = go 19

19: Can the knee be moved fully through range? Yes = go 20

20: Can the ankle be moved fully through range? Yes = go 21

21: Can the patient roll to the left and right on a bed? Yes = go 22

22: Can the patient lie on their back and lift their bottom? Yes = go 23

23: Can the patient move from lying to sitting unaided? Yes = go 26

26: Can the patient move from sit to stand unaided? Yes = go 29

29: Can the patient stand and lean in all directions independently? Yes = go 30

30: Can the patient walk unaided? Yes = go 33

33: Do they have an altered walking pattern (abnormal gait)? Yes = go 34

34: Can they stand on affected leg and step with other leg? No = Poor stepping ability

Poor stepping ability treatment

Clinical reasoning

Right Hemiplegia increased tone

Right Hemiplegia low tone

Left Hemiplegia increased tone

Left Hemiplegia low tone

Poor sitting balance

Reduced proprioception

Reduced sensation

Reduced range of movement

Shoulder subluxation

Shoulder pain

Elbow contracture

Wrist contracture

Hand flexion contracture

Hip contracture

Knee contracture

Ankle contracture

Poor rolling ability

Poor pelvic tilting

A.O.1 Bed transfers

A.O.2 Bed transfers

A.O.1 Sit to stand

A.O.1 Sit to stand

A.O.2 Sit to stand

Standing hoist transfer

Poor standing balance

Supervised mobility

Wheelchair mobility

Poor stepping ability