Transient Ischemic Attack: Management

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Top Contributors - Mary Akinwola  

Overview

Transient ischemic attack is clinically defined as an acute episode of temporary neurologic dysfunction resulting from a focal cerebral ischemia and is not associated with sudden tissue ischemia. Although the classical definition of TIA included symptoms lasting and resolving in 24 hours, the American Stroke Association certifies a new definition based on tissue rather than time. It focuses on focal ischemia rather than acute infarction. Therefore, because of the peculiarities of TIA, it is often neglected because symptoms tend to dissipate.

TIAs are often early warning signs for ischemic stroke, so, in addition to the management of symptoms, there is a need for interventions to prevent permanent stroke and the accompanying disability.

Physiotherapy

Following an acute management of TIA, physiotherapy is important in the management of symptoms accompanying TIA. A clinical protocol was developed to provide physiotherapists with a general guide for management of TIA. With this protocol, the progression of treatment should be individualized and based on the patient's needs.

Precaution and Contraindications

During management, it is important to closely monitor the symptoms that will indicate a repeat stroke. if the following signs are observed during treatment, the patient should be taken to the ER for acute care.

1. Change in alertness
2. Confusion or memory loss
3. Slurred speech
4. Decreased bowel and bladder control
5. Difficulty walking
6. Unilateral numbness or tingling.

It is also important to monitor the pre and post exercise hemodynamics, specifically, blood pressure and heart rate. To prevent re occurrence, risk factors should be screened for.

PHASE I

This is the immediate phase of care which spans Week 1-Week 4 following the event.

The goals of this phase include:

• Monitoring hemodynamics throughout physiotherapy sessions
• Increase cardiovascular exercise to five times a week
• Addressing modifiable risk factors by commencing a weight loss program to manage obesity for example
• Addressing coordination or balance deficits

Physiotherapy Interventions such as :

1. Neurological Facilitation Techniques such as joint loading, tapping if residual deficits are noticed
2. Resisted PNF
3. Perturbations during balance training
4. Static and Dynamic balance training
5. Closed-chain strengthening exercises
6. Gait training

Phase II

This intermediate phase of the protocol spans Week 5-Week8

Goals include:

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