Interdisciplinary roles in stroke care.

Care of the stroke patient presents a complex challenge to the interdisciplinary stroke team. The physical therapist, occupational therapist, and clinical social worker are important members of that team, each of whom contributes specialized knowledge and interventions in behalf of the patient. The physical therapist focuses on prevention of joint and tissue injury and retraining of lost motor skills. The occupational therapist considers the total patient in his or her environment and assists the patient in regaining or improving function in all areas of daily living. The clinical social worker concentrates on psychosocial assessment and intervention with the patient and family, aiding them in the adjustment process and planning for discharge. The nurse, in addition to playing a unique role in the delivery of nursing care to the stroke patient, is in a position to serve as coordinator of the interdisciplinary team. The nurse can facilitate the work of the physical and occupational therapists and the social worker by providing them with timely referrals, valuable assessment information and insights, and reinforcement of therapeutic activity while the patient is on the nursing unit. The keys to making the interdisciplinary team work for the maximal benefit of the patient are threefold: mutual respect and understanding among team members; ongoing coordination of efforts; and open communication between all team members, the patient, and the family. These elements are interrelated and essential if the interdisciplinary team is to be successful at meeting its ultimate goal: expert care of the total patient to achieve maximal independence.

Functional outcomes of children with sickle-cell disease affected by stroke.

The nature and degree of functional recovery after stroke in children with sickle-cell disease (SCD) has not been extensively investigated. The purpose of this study was to evaluate retrospectively the functional status of 14 SCD children who had had strokes and to compare them with age-matched and gender-matched SCD children who had not had strokes. By doing so, we would be able to quantify the eventual physical and cognitive functional outcomes of survivors of stroke secondary to SCD and assess the impact of stroke on these patients. These children (five boys and nine girls) with SCD and stroke(s) were 11.6 +/- 4.3 years of age (range five to 18 years). They experienced one to three strokes at a mean age of 6.1 +/- 5.2 years (range one to 17 years). A series of tests were administered to these subjects to evaluate physical and psychosocial functions. These tests were performed at least one year after the latest stroke. This study showed that all of the SCD-stroke children were physically independent. Only a few had impairments of hand functions and mild difficulties in self-care activities. However, most of these children demonstrated intellectual deficits ranging from borderline to moderate mental retardation, reduced language functions ranging from low normal to retarded range, and problems in adjustment. Intelligence quotient of the children with SCD-stroke(s) was significantly lower than those of age-matched and gender-matched nonstroke SCD children, suggesting that stroke caused an adverse effect on the cognitive functioning of these children. The results indicate that in the SCD-stroke children psychosocial deficits outweighed physical disabilities.(ABSTRACT TRUNCATED AT 250 WORDS)