How Stroke Presents: Seating & Mobility Considerations

two older peopleWhen laypeople think of cerebrovascular accident (CVA) or stroke, they probably envision weakness or paralysis on one side of the body — clinically known as hemiparesis or hemiplegia.

But there are other possible effects of stroke that can impact the mobility systems that clinicians and ATPs choose.

The Impact of Stroke

Linda Bollinger, DPT, PT, ATP, is Clinical Education Manager at Sunrise Medical.

“The effects of stroke are quite significant,” she said. “A CVA will not only affect cognition, but also movement in one or all extremities due to paralysis and/or spasticity, vision, communication, apraxia, to name a few. All of these effects will impact independent mobility. These effects are what make the assessment process more difficult and lengthy. You cannot just order a standard wheelchair and expect that the individual will be independent.”

Stroke clients could also need help with pressure relief.

“They may have loss of sensation on their affected side,” she explained. “In addition, the neurological damage may result in orthopaedic asymmetries causing unequal weight bearing. This may require the need for reminders to weight shift (i.e., leaning forward or standing up).

“Passive weight shifts using a tilt/recline wheelchair is also an option; however, this will impact independent mobility. Therefore, weight shifting may also be a justification for a power wheelchair. Assessing for power requires a separate evaluation process with considerations of the effects of a stroke, but also with accessibility.”

Neurological Changes

Curt Prewitt, MS, PT, ATP, is Director of Education for Ki Mobility.

“Some of the things you’ll see from people who’ve had a stroke is one side of their body is affected,” he said. “You can have weakness or paralysis on one side. You might have cognitive neglect of that side, an important effect to be aware of.”

With cognitive neglect, a stroke client might be unaware of what’s happening on the affected side. Such a client might, for example, fail to look to his left before turning his wheelchair.

“A lot of that [impact] might tie into their communications abilities,” Prewitt added. “They might have expressive or receptive problems with communication. But just because they can’t communicate or understand communications doesn’t necessarily mean they’re not intact otherwise to make appropriate decisions.”

Prewitt said some clients with cognitive neglect can learn to pay special attention to the impacted side of their visual field, while others cannot. Still, he said it’s important not to assume that stroke renders all clients completely incapable.

“Just because they’ve got [cognitive effects], don’t think they’ve lost the ability to make safe decisions,” he said. “The therapist and physicians should be reasonably exploring those possibilities and allowing that person to fulfill as much potential as they’ve got left, rather than assuming they can’t do it.”

This article originally appeared in the February 2019 issue of Mobility Management.

In Support of Upper-Extremity Positioning