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Glossary of Terms

Activities of daily living: The basic elements of personal care such as eating, washing and showering, grooming, walking, standing up from a chair and using the toilet.

Activity: The execution of a task or action by an individual. Activity limitations are difficulties that an individual may have in executing activities

Agnosia: The inability to recognize sounds, smells, objects or body parts (other people’s or one’s own) despite having no primary sensory deficits.

Alternate level of care: A patient receiving an alternate level of care is one who has finished the acute care phase of treatment but remains in an acute care bed, awaiting placement in an alternate care setting (chronic care unit, home for the aged, nursing home, home care program, etc.). This classification occurs when the patient is admitted as a patient’s physician gives an order to change the level of care from acute care and requests a transfer for the patient. Sometimes a patient is admitted as a patient requiring an alternate level of care because alternate care is not available (Canadian Institute for Health Information Discharge Abstract Antiplatelet agents: Agents that inhibit platelet aggregation. These agents are used in the prevention of ischemic stroke in high-risk patients.

Aphasia: Loss of the inability to produce or comprehend language as a result of injury to specialized areas in the brain related to these functions, affecting the ability to speak, understand, or read and write.

Apraxia: Impaired planning and sequencing of movement that is not due to weakness, incoordination or sensory loss.

Assistive technology: Technology designed to help a patient with limitations to perform daily activities and social roles.

Atrial fibrillation: Rapid, irregular beating of the heart.

Balance: Acquisition and maintenance of postural stability at rest or during activities.

Balance training: Sensory motor and cognitive intervention to promote postural stability.

Biofeedback: A technique monitoring physiological functions and providing extrinsic feedback, which may include somatosensory, visual and auditory input.

Canadian Institute for Health Information: An independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians. This organization tracks data in many areas, using information supplied by hospitals, regional health authorities, medical practitioners, governments and other sources.

Canadian Stroke Strategy: A joint initiative of the Canadian Stroke Network and the Heart and Stroke Foundation of Canada. It brings together a multitude of stakeholders and partners with the common vision that “All Canadians have optimal access to the integrated high quality, and efficient services in stroke prevention, treatment, rehabilitation and community reintegration”.

Cardio Respiratory Fitness: Related to the ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged periods. Improvements in cardiorespiratory fitness result in improvements of the heart to deliver oxygen to the working muscles and in the muscle`s ability to generate energy with oxygen and result in better endurance performance. (America College of Sports Medicine Guidelines, 2000)

Carotid endarterectomy: Surgical opening in one of the main neck arteries (the carotid arteries) performed when the artery is partially blocked by plaque (the buildup of fatty materials, calcium and scar tissue that narrows the artery). The procedure helps prevent a first stroke or reduces the risk of further strokes. It works best for people whose artery is narrowed but not completely blocked. (Heart and Stroke Foundation)

Cognitive: Relating to the ability to think, remember and solve problems.

Community-based rehabilitation therapy: Rehabilitation provided in the home or community-based organizations.

Community reintegration: A return to participation in desired and meaningful activities of daily living, community interests and life roles following a stroke event. The term encompasses the return to mainstream family and active community living and continuing to contribute to one’s social groups and family life. Community reintegration is a component in the continuum of care after stroke; rehabilitation helps clients identify meaningful goals for community reintegration and, though structured interventions, facilitates resumption of these activities to the best of their abilities. The stroke survivor, family, friends, stroke recovery associations, rehabilitation programs and the community at large are all integral to successful community reintegration.

Comorbid condition: Relates to the effect of all other diseases or conditions a patient may have in addition to the primary disease of interest

Compensatory therapy: Adaptive therapeutic interventions designed to enhance activity and participation (the focus is on function and not impairment).

Comprehensive stroke centres: Centres with specialized resources and personnel available at all times (24 hours a day, 365 days a year) to provide assessment and management of stroke patients. These facilities have established written protocols for emergency services, in-hospital care and rehabilitation; the ability to offer thrombolytic therapy to suitable ischemic stroke patients; timely neurovascular imaging and expert interpretation; and coordinated processes for patient transition to ongoing rehabilitation, secondary prevention and community reintegration services. Comprehensive stroke centres also include neurosurgical facilities and interventional radiology services. Comprehensive stroke centres have a leadership role in establishing partnerships with other local hospitals for supporting stroke care services. Comprehensive stroke centres should also have a performance measurement system in place to monitor the quality of stroke care and patient outcomes.

Computed tomography scan: Radiographic images of the head, appearing as a series of thin slices showing details of the brain`s anatomy. In some cases, a contrast dye may be injected to better define tissues and blood vessels and enhance the images. These images can show whether a stroke was due to a blood clot (an ischemic stroke) or uncontrolled bleeding (a hemorrhagic stroke). This is often one of the first tests scheduled for someone who has had a stroke.

Constraint induced therapy: Intervention designed to enhance recovery of function or a body part by restraining a less affected function or body part.

Continuing Care Reporting System: Contains standardized clinical and administrative information on continuing care in Canada, which includes detailed clinical, functional and service information (e.g., residents` preferences, needs and strengths) and provides a snapshot of the services they use. Two types of facilities are included: hospitals that have beds designated and funded as continuing care beds, commonly known as extended, auxiliary, chronic or complex beds; and residential care facilities, commonly known as nursing homes, personal care homes or long-term care facilities. The data are collected using the Resident Assessment Instrument (RAI) Minimum Data Set (MDS 2.0).

Conventional therapy: The usual care offered in a particular setting and must be defined in terms of their intensity, frequency, and duration.

Day hospital: A defined geographic outpatient unit dedicated to interdisciplinary care and rehabilitation of an individual.

Deep vein thrombosis: Thrombosis (a clot of blood) in the deep veins of the leg, arm or abdomen.

Disability: A defect in performing a normal activity or action (e.g., inability to dress or walk).

Discharge Abstract Database: Database of information related to acute care hospital discharges across Canada. The database is maintained by the Canadian Institute for Health Information, which receives data directly from all hospitals in every province and territory except Quebec. The database contains demographic, administrative and clinical data for hospital discharges (inpatient acute, chronic, rehabilitation) and day surgeries in Canada.

Discharge disposition: A patient`s destination following a visit to the emergency department or following a stay in hospital. A patient`s discharge disposition may or may not be the same location as before their visit to hospital.

Dysarthria: Impaired ability to produce clear speech due to the impaired function of the speech muscles

Dysphagia: An impairment of swallowing that may occur following a stroke.

Early supported discharge: Early supported discharge services aim to move forward the time of discharge from hospital, as well as to provide a more continuous process of rehabilitation spanning both the period in hospital and the first few weeks at home. In these two ways, early supported discharge alters the conventional pathway of care to ensure more amenable services for patients undertaking rehabilitation.

Emergency department: A hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.

Emergency medical services: Provide out-of-hospital acute care and transport to definitive care for patients with illnesses and injuries that the patient believes constitute a medical emergency. The most common and recognized type of emergency medical service is an ambulance or paramedic organization.

Enteral tube: Delivery of nutrients directly into the digestive system via a tube.

Executive function: Cognitive functions usually associated with the frontal lobes, including planning, reasoning, time perception, complex goal-directed behaviour, decision-making and working memory.

Exercise therapy: Intervention directed towards optimizing physical capacity.

Functional independence measure: An 18-item, 7-level ordinal scale. It is the product of an effort to resolve the long-standing problem of lack of uniform measurement and data on disability and rehabilitation outcomes.

Gait: The pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.

Hemiparesis: Weakness involving one side of the body (of mild, moderate or severe degree) that may be caused by stroke, and can be accompanied by sensory or other neurological deficits.

Hemiplegia: Refers to a complete paralysis. Complete loss of motor function on one side of body that may be caused by stroke localized to the cerebral hemisphere opposite to the side of weakness.

Hemorrhagic stroke: A stroke caused by the rupture of a blood vessel within the brain, usually an artery.

Hyperacute period: The time frame from the initial onset of stroke symptoms and engagement of emergency medical services though interaction with paramedics and within the emergency departments of acute care hospitals.

Hypertension: High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 ⁄ 90 mm HG. Hypertension is a risk factor for stroke or transient ischemic attack and is managed with regular aerobic exercise, weight reduction (if overweight), salt reduction and medications.

Hypertonia: Abnormal increase in resistance while externally imposing movement about a joint.

Impairment: A problem in the structure of the body (e.g., loss of a limb) or the way the body of a body part functions (e.g., hemiplegia).

Infarction: Death of cells in an organ (e.g., the brain or heart) due to lack of blood.

Integration: An integrated health system would result in coordinated health services that both improve accessibility and allow people to move more easily through the care and treatment continuum of the care health system and would provide appropriate, effective and efficient health services.

Intensity: The level of effort demanded or required of the individual in relation to their current capacity (physical and mental)

Interdisciplinary stroke team: A comprehensive team of healthcare professionals who are dedicated to the care of stroke patients within a unit. An interdisciplinary stroke team may include persons who have experienced a stroke, family and caregivers, neurologists and other physicians with expertise in stroke management, physiatrists, nurses, primary care practitioners, physical therapists, occupational therapists, speech language pathologists, social workers, dieticians, pharmacists, psychologists, rehabilitation assistants and pastoral care workers.

International normalized ratio: Used to evaluate the ability of blood to clot properly, this ratio can be used to assess both bleeding and clotting tendencies. One common use is to monitor the effectiveness of anticoagulants such as warfarin.

Ischemia: An inadequate flow of blood to part of the body because of blockage or constriction of the arteries that supply it.

Last seen normal: The date and time a patient was last known to be normal before the onset of symptoms of stroke or transient ischemic attack.

Lack of stay: A measure of the duration of a single hospitalization.

Length of stay: A measure of the duration of a single hospitalization.

Long-term care home: A facility that provides rehabilitative, restorative or ongoing skilled nursing care to residents in need of assistance with activities of daily living.

Low-density lipoprotein: A compound that regulates cholesterol synthesis from the liver to the peripheral tissues. Sometimes referred to as “bad cholesterol,“ LDL may put an individual at risk for cerebrovascular disease if it occurs at high levels.

Mean: Simple average, equal to the sum of all values divided by the number of values.

Median: The value that has 50 percent of the data points above it and 50 percent below it.

Medical redirect bypass: Following predefined medical criteria and a written agreement between physicians, hospitals, dispatch and ambulance service, a closer hospital may be bypassed for medical reasons to redirect the person exhibiting signs and symptoms of stroke to a stroke centre that can provide expert timely assessment and treatment

Muscular endurance: Ability of a muscle or muscle group to perform repeated muscle contractions over a period of sufficient to cause muscular fatigue, or to maintain a specific percentage of the maximum voluntary contraction for a prolonged period of time (ACSM, 2001)

Muscle strength: Maximal force that can be generated by a specific muscle or muscle group. (ACSM, 2000)

National Ambulatory Care Reporting System: Includes data for all hospital-based ambulatory care provided departments. Client visit data are collected at the time of service in participating facilities. Currently, data submission to the National Ambulatory Care Reporting System has been mandated in Ontario for emergency departments, day surgery units, dialysis units, cardiac catheterization suites and oncology units (including all regional caner centres). Data elements include demographic data, clinical data, administrative data, financial data and service-specific data elements for day surgery and emergency.

National Rehabilitation Reporting System: Includes client data collected from participating adult inpatient rehabilitation facilities and programs across Canada. Data are collected at time of admission and discharge by service providers in participating facilities. There is also an optional postdischarge follow-up data collection process. The National Rehabilitation Reporting System data elements are organized under the following categories: socio-demographic information, administrative data (e.g., referral, admission and discharge), health characteristics, activities and participation (e.g., activities of daily living, communication, social interaction), interventions. These elements are used to calculate a variety of indicators including wait times and client outcomes.

Neglect: The failure to attend or respond to or make movements toward one side of the environment.Outpatient rehabilitation:  Includes day hospital, outpatient ambulatory care and home-based rehabilitation. Outpatient therapy in the subacute phase of stroke (4 to 8 weeks after stroke) is often prescribed following discharge from inpatient stroke rehabilitation units. (Evidence-Based Review of Stroke Rehabilitation, 10th edition)

Outpatient Therapy: In the subacute phases of stroke (4-8 weeks after stroke) outpatient rehabilitation therapy in an outpatient clinic affiliated with an acute care or inpatient rehabilitation facility may be prescribed upon discharge from acute inpatient care or inpatient rehabilitation.

Percutaneous endoscopic gastrostomy: A form of enteral feeding in which nutrition is delivered via a tube that has been surgically inserted into the stomach through the skin.

Performance measure: A quantifiable measure of outcomes, outputs, efficiency, access and other dimensions of quality of care.

Pulmonary embolism: Blockage of the pulmonary artery (which carries blood from the heart to the lungs) with a solid material, usually a blood clot or fat, that has travelled there via the circulatory system.

Rankin Scale (modified): An outcomes scale used to measure disability or dependence in activities of daily living in stroke victims.

Recovery: The process whereby the person regains body structure, function, activity and participation. (Not time limited)

Registry of the Canadian Stroke Network: A clinical database that collects data from prehospital stroke onset to discharge from acute care, following a stroke or transient ischemic attack. Information is collected on risk factors, presentation, acute investigations and interventions, inpatient management, complication, discharge disposition, length of stay and mortality. Note:  During the data collection period for the 2006 report of the Stroke Evaluation Advisory Committee, only 10 regional stroke centres were participating in the Registry of the Canadian Stroke Network (Central South ⁄ Royal Victoria Hospital was not yet part of the network). Data collection began July 1, 2003, so the fiscal year 2003-04 included only 9 months of data, which means that volumes and counts are underestimated for that year.

Rehabilitation: Restoration of a disabled person t optimal physical and psychological functional independence.

Restorative (remedial) therapy: Therapeutic interventions designed to restore body structure and function by targeting the underlying impairment to enhance recovery.

Risk factor: A characteristic of a person (or group of people) that is positively associated with a particular disease of condition.

Spasticity: Velocity-dependent increase in muscle tone that often occurs in stroke.

Stroke: Rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.

Stroke prevention clinic: A clinic providing comprehensive stroke prevention services to patients who are not admitted to the hospital at the time of their emergency department visit. Prevention clinics offer an interdisciplinary team approach and are typically funded for an advanced practice nurse, a medical secretary and a behavioural psychologist or occupational therapist.

Stroke unit: A specialized, geographically located hospital unit with a dedicated stroke team and stroke resources (e.g., care pathway, educational material, monitored beds). The unit does not need to have all of these resources, nor does it have to be exclusive for stroke patients, but it must be in one location.

Subarachnoid hemorrhage: Occurs when a blood vessel just outside the bran ruptures and blood fills the subarachnoid space surrounding the brain,  Symptoms may include a sudden, intense headache, neck pain, and nausea or vomiting,

Task-specific training: Training that involves repetition of a functional task or part of the task.

Telemedicine/telestroke: Use of electronic communication to exchange medical information from one site to another to educate the patient or the healthcare provider, and to improve patient care and health.

Thrombolytics: An agent (medication) that dissolves or splits up a blood clot.

Tissue plasminogen activator: A clot-busting drug used to treat heart attack and ischemic stroke.

Tone: Resistance to passive stretch while the patient is attempting to maintain a relaxed state of muscle activity.

Transient Ischemic attack: An episode of temporary and focal cerebral dysfunction of vascular origin, variable in duration, commonly lasting from 2 to 15 minutes, but occasionally lasting as long as a day (24 hours), which leaves no persistent neurological deficit.

Vascular cognitive impairment: A common form of dementia that is due to cerebrovascular disease. Symptoms include confusion, memory problems, loss of bladder or bowel control (incontinence), emotional problems such as inappropriate laughing or crying, difficulty following instructions and problems with daily activities such as handling money.


Abbreviations

AAC Augmentative and alternative communication

ADL Activities of daily living

AF Atrialfibrillation

ASA AcetylsalicylicAcid (aspirin)

CEA Carotidendarterectomy

CEMRA Contrast enhanced magnetic resonance angiography

CHEP Canadian Hypertension Education Program

CSN Canadian Stroke Network

CSS Canadian Stroke Strategy

CT Computed tomography

DBP Diastolic Blood Pressure

DM Diabetes Mellitus

DVT Deep vein thrombosis

EBRSR Evidence-Based Review of Stroke Rehabilitation

ED Emergency Department

ECG/EKG Electrocardiogram

EMS Emergency Medical Services

ESD Early supported discharge

EWG Expert Working Group

GP General Practitioner

ICH Intracranial hemorrhage

ICU Intensive care unit

INR International normalized ratio

IPC Intermittent pneumatic compression

IV Intravenous

LDL Low-density Lipoprotein

LMWH Low molecular weight heparin

MCA Middle cerebral artery

MI Myocardial Infarction

MR-DWI Magnetic resonance diffusion weighted imaging

MRI Magnetic Resonance Imaging

NINDS National Institute of Neurological Disorders and Stroke

NNT Numbers needed to treat

OBS Observational study

OT Occupational therapist

PE Pulmonary embolism

PEG Percutaneous endoscopic gastrostomy

PT Physical therapist or Physiotherapy

RCT Randomized controlled trial

rFVIIa recombinant activated factor VII

rt-PA Recombinant tissue plasminogen activator

RN Registered nurse

RRR Relative risk reduction

SAH Subarachnoid Hemorrhage

SCORE Stroke Canada Optimization of Rehabilitation through Evidence

SBP Systolic Blood Pressure

SLP Speech Language Pathologist

SR Systematic review

STAIR Stroke transition after inpatient care

STEP Stroke Therapy Evaluation Program

SU Stroke Unit

SW Social work or Social worker

TIA Transient ischemic attack

tPA Tissue plasminogen activator

TTE Transthoracic echocardiography

TEE Transesophageal echocardiography

UK United Kingdom

UFH Unfractionated heparin

VTE Venous Thrombus Embolism