A cerebrovascular accident (CVA or 'stroke') is a sudden attack of weakness affecting one side of the body, resulting from an interruption to the flow of blood to the brain (by thrombosis, embolus, or ruptured aneurysm). A stroke can vary in severity from a weakness in a limb with some perceptual problems to a profound paralysis and considerable perceptual impairment. 'Prognosis' infers an assessment of the future course and outcome of the stroke.
Chapter 1 introduces the area of stroke rehabilitation in occupational therapy by describing in detail the causes of a stroke and the way in which it is managed by occupational therapists. Discussion is made of the three stages of rehabilitation, namely: assessment, treatment and prognosis, identifying where they are subjective and how an objective method could improve them.
Chapter 2 examines the use of biofeedback in the rehabilitation of stroke patients with emphasis being placed on the use of a combination of techniques for treatment and with proposals for using electromyography (EMG), visual and acoustic biofeedback for the assessment of stroke patients.
The use of a microcomputer-electromyograph link is proposed, with a discussion of the design of a computerised assessment battery in Chapter 3. The main findings from the use of the battery with a cross-section of adult stroke patients are discussed so that some recommendations can be made for future use of the assessment battery and a new theory of stroke recovery can be proposed.
Chapter 4 considers current probability models in rehabilitation and discusses how knowledge was acquired for the stochastic model. Data from a national stroke survey also conducted is statistically analysed together with the electromyographical and reaction time score data from patients; the probability of occurrence of each stroke factor and each performance score with a 'poor' or 'good' prognosis is then calculated and collated to produce the stochastic model of stroke prognosis which is tested in Chapter 5.
The findings of these testing trials are discussed and used to produce modifications to the model. An introduction to expert systems is also given in Chapter 5 and a brief discussion of how expert system models and expert systems themselves can be validated. Finally, some proposals for a stroke prognostic expert system are given.