Exam 3: Stroke Impairments Flashcards
What percentage of stroke patients experience some form of weakness?
80-90%
Are UE or LE more likely effected?
UE
20% of individuals with what type of stroke will fail to regain any functional use of their UE?
MCA stroke
Will distal or proximal muscles experience greater strength deficits?
Distal
What are the dominant synergies of the UE and LE?
UE flexion and LE extension
What are the non-dominant synergies of the UE and LE?
UE extension and LE flexion
What components are included in UE flexion synergy?
Scapular retraction and elevation
Shoulder abduction and ER
Elbow flexion
Forearm supination
Wrist flexion
Finger flexion
What is the strongest component of UE flexion synergy?
Elbow flexion
What components are included in UE extension synergy?
Scapular protraction
Shoulder adduction and IR
Elbow extension
Forearm pronation
Wrist flexion
Finger flexion
What is the strongest component of UE extension synergy?
Shoulder adduction
What components are included in LE flexion synergy?
Hip flexion, abduction, ER
Knee flexion
Ankle dorsiflexion, inversion
Toe dorsiflexion
What is the strongest component of LE flexion synergy?
Hip flexion
What components are included in LE extension synergy?
Hip extension, adduction, IR
Knee extension
Ankle plantarflexion, inversion
Toe plantarflexion
What is the strongest component of LE extension synergy?
Hip adduction, knee extension, and ankle plantarflexion
Describe Stage 1 of Motor Recovery
Period of flaccidity, no movement of the limbs can be elicited
Describe Stage 2 of Motor Recovery
Some facilitated movement, minimal voluntary movement responses. Spasticity begins to develop, particularly in muscles of dominant synergy
Describe Stage 3 of Motor Recovery
Both flexion and extension synergies present and elicited voluntarily. Active movement occurs within the synergy. Spasticity peaks
Describe Stage 4 of Motor Recovery
Some movement combinations that do not follow path of basic synergies are mastered. Spasticity begins to decline
Describe Stage 5 of Motor Recovery
Synergies lose their dominance. More difficulty out of synergy movement combinations are mastered. Spasticity continues to decline
Describe Stage 6 of Motor Recovery
Individual joint movements. Improving coordination
Describe Stage 7 of Motor Recovery
Normal function
When will a patient with a stroke experience hypotonicity?
Immediately following a stroke due to cerebral shock
When will hyperreflexia emerge?
With the development of spasticity and synergy
When will a patient with a stroke present with hyporeflexia?
Initially following the stroke during the period of flaccidity
Describe the prevalence and general characteristics of hypertonicity?
Present in 90% of cases. Affects antigravity muscles, and can lead to contractures
Describe coordination deficits in a patient with stroke
Difficulty with timing and sequencing and limited ability to adapt to task demands
How will a patient present with a cerebellar stroke in terms of coordination?
Ataxia
How will a patient present with a stroke affecting the basal ganglia in terms of coordination?
Slow movement (bradykinesia), involuntary movements including chorea or hemiballismus
What is apraxia?
Difficulty planning and executing movements that can not be accounted for by another reason (strength, coordination, or cognition)
Where are lesions located that cause apraxia?
Premotor frontal cortex, left parietal lobe, corpus callosum
What is ideational apraxia?
Inability to produce movement on command or automatically due to breakdown in conceptualization of the complete task
What is ideomotor apraxia?
Inability to produce movement on command or imitation, but may produce automatically
What ROMs may be limited due to contractures?
Shoulder flexion, abduction, ER
Elbow extension
Forearm supination
Wrist and finger extension
What causes joint malalignment at the wrist and shoulder?
Edema at the wrist and shoulder subluxation
What two factors result in shoulder subluxation in stroke patients?
Muscle inactivity and biomechanical alignment
What impaired muscle activation contributes to GH instability?
Deltoid and rotator cuff
How is the scapula positioned in stroke patients at risk of shoulder subluxation?
Scapula is abducted, elevated, and downwardly rotated
What other factors contribute to shoulder subluxation besides muscle inactivation and scapular position?
Poor posture with asymmetry and a flexed trunk, humeral head not supported by labrum resulting in gravity pulling down the humerus and stretching the capsule and ligaments
Where will a patient with a cortical lesion experience somatosensation deficits?
Localized contralateral deficits
Where will a patient with a deep lesion experience somatosensation deficits?
Diffuse involvement contralateral
Where will a patient with a brainstem lesion experience somatosensation deficits?
Ipsilateral face and contralateral trunk and limb
What are patients with deficits in somatosensation at risk for?
Neglect, learned nonuse, and increased risk of injury
What does CPSP stand for?
Central Post-Stroke Pain
What is CPSP?
Lesions to the somatosensory pathway, especially the thalamus
Describe the characteristics of CPSP?
Severe burning, aching, intermittent stabbing, shooting pains, exaggerated response to touch, pressure or thermal stimuli
When does CPSP develop?
First few months following a stroke
Do patients recover from CPSP?
Recovery is rare and it limited rehab participation
What visual deficits are common following stroke?
Homonymous hemianopsia and visual inattention or perceptual neglect
Where would a lesion causing perception deficits likely be located?
Right parietal cortex
What perceptual deficits are common with stroke?
Body image disorders (neglect), spatial relation syndromes, agnosia
What are spatial relation syndromes?
Difficulty perceiving the relationship between self and environment
What is the common postural alignment of the trunk in sitting?
PPT/sacral sitting with a flat lumbar curve, asymmetry in the frontal plane
Presentation will vary depending on location of COM
What is the common postural alignment of the limbs in sitting?
Involved limbs fall into alignment with gravity, can vary due to tone and COM
What is the common postural alignment of the head in sitting?
Secondary cervical hyperextension, may rotate away from the affected side
What contributes to impaired postural control in sitting?
Visual, perceptual, and sensory impairments and the reduced ability to recruit, modulate, and control the trunk and limb muscles
What is the effect of the lack of activation of leg muscles during postural control in sitting?
Decreased support and balance during reaching activities
Describe postural alignment in standing from the frontal plane
Decreased activation on the involved side and unequal weight distribution
Describe the postural alignment of the trunk in standing
Inactive thoracic extensors and abdominals
Describe the postural alignment at the hip and pelvis in standing
Inactive hip extensors and abductors resulting in hip flexion and adduction. Pelvis will be retracted and elevated
Describe the postural alignment at the knee in standing
GRF is anterior and medial to the knee, resulting in hyperextension
Describe the postural alignment at the ankle and foot in standing
Relative plantarflexion and inversion
Describe hemiparesis in terms of postural control
Uneven weight distribution, increased postural sway in standing, disorganization of normal postural synergies, and frequent loss of balance
What type of ataxia will result with a midline cerebellar lesion?
Truncal ataxia
What type of ataxia will result with a lateral cerebellar lesion?
Ipsilateral limb symptoms
Describe common symptoms of cerebellar ataxia
Gait and balance abnormalities, may occur with vestibular symptoms if there is brainstem involvement
What is sensory ataxia?
Disrupted proprioceptive input to the CNS resulting in gait and balance abnormalities
What compensation can aid with sensory ataxia?
Reliance on vision, will see increased symptoms with eyes closed
What three ways can ataxia affect postural control?
Inability to sustain coactivation
Inability to grade and time trunk muscle coactivation with limb movement resulting in poor anticipatory postural adjustment
Inability to grade and time agonist vs antagonist muscles in limbs resulting in decreased coordination
What are common hemiparetic gait deviations during stance phase?
Asymmetrical weight distribution, inadequate weight shift onto involve LE, hip flexion and trendelenburg, knee hyperextension, short step with involved limb, lack of trailing limb during terminal stance, decreased sensory input and kinesthetic awareness
What are common hemiparetic gait deviations during swing phase?
Difficulty initiating swing, extensor tone, decreased hip and knee flexion, circumduction or hike of pelvis, decreased dorsiflexion and foot clearance, lack of heel strike
What sided lesion will result in speech or language deficits?
Dominant
What is dysarthria?
Difficulty with speech production due to impaired motor function. Can also affect respiration, articulation, phonation, resonance, or sensory feedback
What are common problems with dysphagia?
Delayed swallowing reflex, reduced pharyngeal peristalsis, reduced lingual control
What are risks associated with dysphagia?
Risk of aspiration, dehydration, and compromised nutrition
What type of stroke will result in dysphagia?
Brainstem stroke
What cognitive effects are associated with stroke?
Deficits in attention, orientation, short-term memory impairment, executive function, dementia
What emotional effects are associated with stroke?
Emotional changes, pseudobulbar affect, apathy, euphoria, depression
Where are lesions likely located that result in emotional changes?
Frontal lobe, hypothalamus, limbic system
What changes in urinary function can result due to stroke?
Incontinence related to hyperreflexia, hyporeflexia, disturbed sphincter control, sensory loss
What are causes of functional incontinence in stroke patients?
Inattention, mental status, or immobility
What changes in bowel function can occur in stroke patients?
Incontinence, diarrhea, constipation, impaction
Why is cardiovascular and pulmonary dysfunction relevant in stroke patients?
Underlying vascular disease and coronary artery disease. Leads to decreased vital capacity. May limit exercise tolerance
When are stroke patients at risk for DVT or a pulmonary embolism?
High risk during the acute phase
When does the majority of recovery from a stroke occur?
First few weeks or months
At what point does a stroke patient tend to plateau in terms of recovery?
6 months
