Chapter 1: Introduction to stroke

Question 1

what is the definition of a stroke?

Answer 1

a focal dysfunction of the brain, retina and spinal cord lasting longer than 24hours, with evidence of focal infarction on imaging

Question 2

what is the definition of a Transient Ishcemic Attack (TIA)?

Answer 2

a focal dysfunction of the brain not lasting more than 24hours, without evidence of focal infarction on imaging

Question 3

What are some classifications of stroke

Answer 3

By location - OSCP classification
By cause - TOAST classification
By pathology - Ischemic vs hemorrhagic

Question 4

What are some medical interventions for ischemic stroke?

Answer 4

1) Medications - aspirin, anti-platelets, anti-coagulants, thrombolytic therapy (tPA), anti-hypertensives, lipid modification drugs
2) Surgical Thrombectomy - Cardiac Endarterectomy, Cardiac stenting

Question 5

What are some medical interventions for hemorrhagic stroke?

Answer 5

1) surgical - coiling, surgical removal of aneurysm, decompressive craniectomy, stereotactic radiosurgery

Question 6

what are some physiotherapy precautions to take when treating a stroke patient?

Answer 6

1) first admission - await for doctor to review and wait for clearance
2) look out for complications post stroke - eg haemorrhagic transformation post tPA, recurrent stroke post thrombectomy
3) always check vitals before seeing the patient

Question 7

what is the role of a physiotherapist in treatment of a stroke patient?

Answer 7

1) chest PT
2) target rehab to address problems after stroke. help patient regain independence
3) discharge planning
4) determine rehab potential
5) liase with medical, nurses and other allied health professionals

Question 8

What are the primary motor impairments for stroke patients?

Answer 8

reduced muscle strength
reduced coordination
spasticity

Question 9

What are the primary non-motor impairments for stroke patients?

Answer 9

reduced sensation 
reduced proprioception 
reduced vision 
reduced perceptual-cognition 
reduced speech and language 
reduced vestibular function 
behavioral

Question 10

What are the secondary motor impairments for stroke patients?

Answer 10

decreased muscle length 
compensatory movements
swelling 
shoulder subluxation 
decreased CVS fitness

Question 11

What are the secondary non-motor impairments for stroke patients?

Answer 11

pain
fatigue
mood disturbances

Question 12

what are the motor learning principles?

Answer 12

intensity, specificity and variability of practice

Question 13

1) Define neuroplasticity

2) what neuronal changes occur with neuroplasticity

Answer 13

1) lifelong ability of the brain to change based on new experiences and learning
2) increase synapse in the infarct cortex, increased size of cortical representation in damaged motor cortex
3) functional re-organization of damaged cortex adjacent to the damaged area

Question 14

What are the common causes of haemorrhagic and ischaemic stroke?

Answer 14

Haemorrhagic: hypertension, bleeding disorders, anticoagulation, vascular malformation, artery dissection

Ischemic: artherosclerosis, small vessel disease
cardiac, AF

Question 15

what are the clinical features of TACS?

Answer 15

hemiparesis OR
higher cortical dysfunction AND
homonymous hemianopia

Question 16

What are the clinical features of LACS

Answer 16

pure motor OR 
pure somatosensory OR 
mixed of motor and somatosensory OR 
ataxic hemiparesis OR 
clumsy hands & dysarthria

Question 17

What are the clinical features of PACS?

Answer 17

higher cortical dysfunction OR

ANY TWO: hemiparesis, higher cortical dysfunction, hemianopia

Question 18

What are the clinical features of POCS?

Answer 18

ANY ONE: hemianopia, brainstem or cerebellar syndrome