Care and mobility considerations (Upper)
It is important to bear in mind that damage to specific parts or functions of the brain (which may be physically small) may cause disproportionate, and devastating disability. Some examples of this are dysphasia (difficulty with expressing and understanding language), hemianopia, and the inability to recognize faces. It is especially true of language loss, which may occur in isolation. A person with aphasia would not be able to speak, read, manage mathematical calculations etc.
Spinal cord strokes may well affect bowel and bladder control.
There may be other effects such as:
- Speech disorders, such as:
- Dysarthria (poorly articulated speech, caused by problems in muscle control)
- Aphasia (disorder of the language content of speech, a defect or loss of the ability to comprehend or express words)
- Anomia (inability to produce the correct word)
- Dysphonia (hoarse or whispered speech)
- Hemianopia (loss of half of the visual field)
- Cognitive function – effect on thinking, awareness of surroundings, attention, learning, judgement and memory)
- Hemianaesthesia (loss of sensation of the affected part)
- Perceptual problems (lack of awareness of the affected part of the body)
- Mood disturbances or depression
- Ataxia (problems with co-ordination, unsteadiness)
- Vertigo (balance disturbance)
- Problems controlling movements of the eyes
- Problems with swallowing
- Problems with bowel and bladder control
Vision guidance is available in addition where appropriate.
Upper limb condition - Mild Functional Restriction
| Category | Description |
|---|---|
| Disabling Effects | People with this level of restriction would normally have reasonable grip, manual dexterity, and muscle power in the affected arm, and would not be likely to experience spasticity. |
| Mobility | A person with mild upper limb stroke would normally have no physical difficulty in getting around and would not require guidance or supervision. |
| Care | People with mild upper limb stroke would normally be able to safely manage all aspects of their personal care. People with this condition would normally be able to safely manage all aspects of their personal care, as they would normally have reasonable grip, manual dexterity, and muscle power in the hands/ arms. They would normally be able to prepare and cook a main meal and would have little functional restriction on a day-to-day basis. |
Upper Limb condition - Moderate Functional Restriction
| Category | Description |
|---|---|
| Disabling Effects | People with this level of restriction may have some restriction of hand function and manual dexterity, as well as weakness of the muscles, and spasticity of the affected upper limb. |
| Mobility | Walking aids may help with mobility, but upper limb difficulties may preclude their use. |
| Care | A person with this level of restriction would normally have difficulties coping with many activities of daily life. Reduced manual dexterity may lead to difficulty with dressing, including small buttons and fastenings, feeding, washing, shaving, toileting, administering medication, medical treatment, and peeling vegetables, which requires good bimanual dexterity. Due to reduced muscle power, though the person would normally be able to turn a sink tap, or control knobs on a cooker, he/she would normally have difficulty handling hot pans. The person would not normally need supervision or watching over. |
Upper Limb Condition - Severe Functional Restriction
| Category | Description |
|---|---|
| Disabling Effects | In a person with this level of restriction manual dexterity and muscle power would normally be severely affected, as well as there being the presence of significant spasticity, of the affected upper limb. |
| Mobility | Walking aids are unlikely to be of any use as this person would be likely to have great difficulty in gripping, holding and using any prescribed mobility aids. |
| Care | A person with this level of restriction would normally have great difficulty in coping with most activities of daily life. They may have difficulty getting out of bed. They would normally have significant difficulty with or inability to: feed, wash, shave, get in or out of a bath, dress, manage buttons and fastenings, attend to toilet needs, and administer medicines or medical treatment. They would normally have difficulty with or inability to cut up food. Because of severe restriction of manual dexterity, and severe loss of muscle power, the preparation of a main meal would not normally be possible. Due to muscle weakness or spasticity, the people may not be able to help themselves up after a fall. |
Where there is upper limb and lower limb and cognitive involvement while each is considered separately when assessing functional restriction it must be borne in mind that the combined effects on a persons ability to self care and get around may be greater than the individual components.
