Neuro - Week 2 - Stroke

Front 1

What is a stroke?

Back 1

The rapidly developing clinical signs of focal or global disturbance of cerebral function lasting more than 24 hours, or leading to death with no apparent cause other than vascular.

Front 2

What is a transient ischemic attack?

Back 2

Clinical syndrome characterised by an acute loss of focal cerebral function or monocular function with symptoms lasting less than 24 hours and which is thought to be due to inadequate cerebral/ocular blood supply due to arterial thrombosis/embolism associated with arterial, cardiac or haematological disease. TIA patients have increased risk of stroke.

Front 3

What is the main clinical features of stroke and TIA?

Back 3

Loss of focal neurological function of sudden onset which is maximum at onset, due to inadequate blood supply of haemorrhage.

Front 4

What are the primary impairments of stroke?

Back 4

• Hemiplegia or hemiparesis
(weakness)
• Spasticity
•Sensory
o Tactile
o Pain
o Proprioceptive
o Temperature
Visual
o Homonymous hemianopsia
o Quadrantanopia (homonymous)
o Loss of conjugate gaze
o Visual inattention/extinction
o Monocular blindness (one eye)

Front 5

What are secondary impairments of stroke?

Back 5

- Adaptive motor patterns
- Stiffness and decreased neural length
- Decreased bone density with decreased WB
- Decreased CV
- Pain
- Learned non-use

Front 6

What are some motor symptoms of stroke?

Back 6

o Weakness (hemiparesis) on side
o Simultaneous bilateral weakness
o Difficulty swallowing (dysphagia)
o Ataxia and imbalance

Front 7

What are some speech symptoms of stroke?

Back 7

o Difficulty understanding/expressing spoken language (dysphasia)
• May be expressive or receptive
o Difficulty reading or writing (dyslexia/dysgraphia)
o Difficulty calculating (dyscalculia)
o Slurred speech (dysarthria)

Front 8

What are some behavioural changes that may arise after a stroke?

Back 8

o Difficulty with ADL
o Forgetfulness
o Visuospatialperspective dysfunction.
o General higher cognitive deficits
• Problem solving, motivation, planning, organisation
o Emotional distress
• Lability, depression, anxiety
o Behavioural disturbances
• Impulsivity
• Disinhibition
• Personality changes
• Become overly aggressive or passive
• Lack of insight
• Unrealistic goals
• Failure to see relevance of therapy

Front 9

What are some perceptual changes that may arise after a stroke?

Back 9

o Inattention
o Body awareness
o Neglect
o Pushing behaviour

Front 10

How does a LCVA differ to a RCVA

Back 10

Left Hemisphere
- Language and analytical activity
Left CVA
- aphasia
- dysgraphia
- dyscalculia
- apraxia
- perseveration
Right Hemisphere
- Visuospatial and attention
Right CVA
- Unilateral neglect
- Inattention/agnosias
- Body Image Deficits
- Other disorders of visuospatial awareness
- Apraxia
o Constructional and dressing
- Motor impersistence

Front 11

How does the side of the lesion affect rehab?

Back 11

Left CVA Right CVA
Concentration Good Poor
Movement time Slow Fast
Performance Correct Erratic
Carryover effect Good Poor
Attitude Realistic Unrealistic
Mood Depressed
Anxious
Frustrated
Labile Unmotivated
Labile

Front 12

What is UL flexor synergy?

Back 12

- Scapular elevation and retraction
- Shoulder flexion and abduction
- Elbow flexion
- Forarm supination

Front 13

What is UL extensor synergy?

Back 13

- Scapular protraction
- Shoulder adduction and internal rotation
- Elbow extension
- Forearm pronation

Front 14

What is LL flexor synergy?

Back 14

- Hip flexion and external rotation
- Knee flexion
- Ankle dorsiflexion and inversion

Front 15

What is LL extensor synergy?

Back 15

Hip extension, adduction and internal rotation
Knee extension
Ankle plantarflexion and inversion

Front 16

What is hyperreflexia and spasticity? What is the spasticity flexor and extensor tone?

Back 16

Hyperreflexia is defined as overactive or over responsive reflexes.
Spasticity is velocity dependent stretch hyperreflexia, which may become evident after 4-6 weeks. It generally increases over time.
Flexor Spastic Pattern (UL)
o Scapula depression and retraction
o Shoulder flexion, adduction and internal rotation
o Elbow flexion
o Forearm pronation
o Wrist and finger flexion
Extensor Spastic Pattern (LL) is
Hip extension, adduction and internal rotation
Knee extension
Ankle plantarflexion and inversion

Front 17

What is hypertonia?

Back 17

- Increased resistance felt on passive movement
- Viewed as hyperreflexia in addition to adaptive increases in muscle stiffness, changes in muscle length and connective tissue changes.

Front 18

What are the Key Aspects of the Physiotherapy Management Program (for every PHTY session)

Back 18

1. Prevent and manage secondary impairments
a. Actively manage pain, joint stiffness, neural length changes, muscle length changes, disuse weakness
2. Elicit selective movement recovery
a. Facilitation of muscle activity through handling
b. Augmented feedback
c. ES
3. Retrain movement and increase strength in context of functional tasks
a. Improve control of movement
b. Increase muscle strength
c. Reptitive practive with feedback
d. Bed mobility
e. Sitting balance
f. Sit to stand/stand to sit
g. Standing balance
h. Walking
i. Upper limb reaching
j. Reduce overactivity
4. Address all stroke-related primary impairments
a. Sensory training
b. Perceptual training
5. Redevelop optimal MS and CV endurance
a. Increase number of repitions, distance walked ect.