Stroke – PREP Algorithm Poor Prognosis — SCE Neurology MCQ

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HardNeurorehabilitationStroke – PREP Algorithm Poor PrognosisSCE Neurology

Six months after stroke, a patient has no voluntary finger extension and severe shoulder weakness in the affected arm. How should rehabilitation planning use this poor prognostic sign?

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Correct answer: E — Comfort, independence and meaningful task-practice rehabilitation goals

The best answer is “Comfort, independence and meaningful task-practice rehabilitation goals”. Very limited distal voluntary movement predicts low probability of useful dexterity, but prognosis should guide honest, person-centred goals rather than therapeutic abandonment; positioning, range, pain prevention, compensatory skill and selected restorative practice remain relevant. “High-intensity exercise with an expectation of full distal recovery” is less appropriate because recovery cannot be guaranteed from intensity alone “Withdrawal of affected-arm positioning and assisted movement” is less appropriate because neglecting the arm promotes pain, contracture and care difficulty “Motivation-focused counselling as the principal recovery intervention” is less appropriate because biological injury and tract integrity strongly affect recovery “Constraint-induced therapy at the current profound weakness level” is less appropriate because constraint-induced therapy requires some active movement and can be inappropriate in profound paresis

Reference: NICE NG236: Stroke rehabilitation in adults. https://www.nice.org.uk/guidance/ng236/chapter/Recommendations