Alex Philips - Stroke Flashcards
List THREE risk factors for stroke.
- High blood pressure
- Smoking
- Obesity
List TWO primary impairments and TWO secondary impairments that can occur following a stroke.
- Primary: Muscle weakness & reduced dexterity (coordination)
- Secondary: Contracture & swelling
Weakness is a common impairment after stroke. Explain the causes of weakness following a stroke.
- Lack of signal transmission from the motor cortex which generates the movement impulse to the spinal cord which executes the movement via signals to the muscles
- Due to the reduction of movement within the muscle, muscles can reduce in cross-sectional area and strength which can further increase muscle weakness
- Learned non-use: Individuals who have had a stroke may not use their affected side in which overtime the non-use becomes habitual which will also contribute to muscle weakness.
Using language that Mr Phillips would understand, explain why strength exercises are important following a stroke. Your answer should show your understanding of the exercise dosage required for recovery.
Following a stroke, some parts of your body might feel weaker or harder to move due to a distraction of the brain sending a strong enough signal to the muscles to move. Incorporating strength exercises into your treatment will help make your muscles stronger and more coordinated. It will also helps to activate the neurological pathways from our brain to our muscles. As a result it makes it easier for you to do everyday tasks like walking or picking things up.
To ensure that we are giving the best opportunities for these pathways to be activated and for your muscles to practice certain movements to increase strength and to ease movement ability and coordination, we will need to practice performing exercises for multiple repetitions everyday. These repetitions can occur hundreds of times
Define aphasia. Explain the implications of the patient having aphasia on your physiotherapy assessment and treatment.
- Aphasia is a language disorder which affects how one communicates, although an individual’s intellect is not affected. Features include naming or word finding difficulty, difficulty understanding, reading and writing.
- Implications include the patient being unable to communicate effectively to physiotherapist. Due to this the patient may not be able to communicate about any concerns or questions about the treatment plan. It also makes it difficult for the physiotherapist to explain assessments and treatments to the patients as they may not understand. Therefore, poorer outcomes related to functional recovery and activities of daily living may be present.
Tips for physio
- short simple sentences
- using gestures while speaking
- visual supports
Identify ONE upper limb muscle and ONE lower limb muscle at risk of contracture following a stroke.
- Upper limb muscle: posterior deltoid (shoulder extensor)
- Lower limb muscle: iliopsoas (hip flexor)
List THREE interventions to manage contracture.
- Low load prolonged stretch
- Positioning through the day
- Active training with muscles in lengthened position
Mr Phillips has [ONE missing component relating to an activity selected by the examiner]. Identify the muscle group that is paralysed/very weak that may contribute to the missing component.
Choose ONE strength exercise that you would use for Mr Phillips to strengthen this paralysed/very weak muscle group.
Bed Mobility
Supine to side lying
- Missing component: Hip and knee flexion
- ONE affected muscle group: knee flexion
- Strengthening exercise: Knee flexion strengthening using a slide board and pad
Side lying to SOEOB
- Missing component: Legs lifted and lowered over side of bed → reduced hip and knee flexion
- ONE affected muscle group: Hip flexion
- Strengthening exercise: Hip flexion strengthening using a slide sheet and pad
Mr Phillips has [ONE missing component relating to an activity selected by the examiner]. Identify the muscle group that is paralysed/very weak that may contribute to the missing component.
Choose ONE strength exercise that you would use for Mr Phillips to strengthen this paralysed/very weak muscle group.
Sitting Balance
- Missing component: Weight evenly distributed → Weight predominantly on R side, falls to L
- ONE affected muscle group: Left sided abdominal muscles
- Strengthening exercise: Sitting forward**
Mr Phillips has [ONE missing component relating to an activity selected by the examiner]. Identify the muscle group that is paralysed/very weak that may contribute to the missing component.
Choose ONE strength exercise that you would use for Mr Phillips to strengthen this paralysed/very weak muscle group.
Standing Balance
- Missing component: Weight evenly distributed (weight mainly on right side)
- Affected muscle group: Left sided lower limb weakness (especially hip extensors)
- Strengthening exercise: Hip extensor strengthening using a slide sheet and pad OR lifting the leg sideways onto a block
Mr Phillips has [ONE missing component relating to an activity selected by the examiner]. Identify
the muscle group that is paralysed/very weak that may contribute to the missing component.
Choose ONE strength exercise that you would use for Mr Phillips to strengthen this paralysed/very
weak muscle group.
Walking
Stance
- Missing Component: Extension of the hip throughout
- Affected muscle group: weak hip extensors or contracture of hip flexors
- Strength exercise: Hip extensor strengthening using a slide sheet and pad (100 reps)
Swing
- Missing Component: Dorsiflexion of ankle
- Affected muscle group: Ankle dorsiflexors
- Strength exercise: Ankle dorsiflexors strengthening in side lying with slide board
Would you prescribe a mobility aid for Mr Philips? Justify your answer
- No, I would want to encourage independence to my patient and try to replicate movement patterns and components which align with their pre stroke ability or movements in which individuals without a stroke complete. In addition, it would be beneficial for patient who have had a stroke to regain their balance without the use of a mobility aid. Use of a mobility aid can cause fear of movement when unable to use it.
- hinder recovery
