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PHTY3140 > L5: Movement and impairment abnormalities after stroke > Flashcards

L5: Movement and impairment abnormalities after stroke Flashcards

1
Q

What are the 4 types of strokes?

A
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2
Q

What are the outcomes post stroke? Best and worse?

A
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3
Q

What are 5 stages (processes) of a stroke?

A
  1. Lesions of cortical motor areas and their projections
  2. Decreased descending input to spinal motor neurons
  3. Reduced activation of motor units
  4. Impaired muscle activation in timing, number, fatigability
  5. Weakness and loss of dexterity (Nerves unable to repolarise)

Neurological illness

  • Central and motor fatigue
  • Constantly trying to reset
  • Possible disuse
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4
Q

What are 8 functional tasks of daily living (movement difficulties) that are affected after a stroke?

A
  1. Rolling
  2. Sitting up
  3. Speaking
  4. Reaching
  5. Walking
  6. Running
  7. Jumping
  8. Standing up
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5
Q

Which impairments should be assessed first?

A

Functional then primary

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6
Q

What are 7 primary impairments after a stroke?

A
  1. Hemiplegia or hemiparesis (weakness)
    • Biggest impact (eg. spasticity does not impact on function as much)
  2. Spasticity – later lecture for detail
  3. Sensory
  4. Visual
  5. Perceptual
  6. Emotive
  7. Cognitive
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7
Q

What is hemiplegia or hemiparesis (primary impairment) after a stroke?

A

Unilateral paralysis/paresis on the side of the body contralateral to the brain lesion

  • Eg. Right CVA –> left hemiplegia
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8
Q

What are 2 symptoms of hemiplegia or hemiparesis (primary impairment) after a stroke?

A
  1. loss of movement varies with size and site of lesion
  2. range from total paralysis to loss of selectivity of distal movements

Quite flaccid at the start –> activation will improve slowly

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9
Q

What is cerebral diathesis?

A

Cerebral diathesis –> whole brain begins to die

  • Use it or lose it
  • Brain reliant on the balance of inhibition and excitation –> lose this balance –> Knock on effect –> brain shuts down its use –> secondary disuse
  • Early rehab is key to prevent secondary decay
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10
Q

What are the primary abnormalities in hemiplegia or hemiparesis after a stroke?

A
  • There may also be weakness on the side of the body ipsilateral to the brain lesion
  • Strength was 65% to 89% of normal on the ipsilateral side
  • “weaker and stronger sides” vs
  • “affected and unaffected sides”
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11
Q

What are the 2 primary abnormalities (motor decificit with certain lesions) in hemiplegia or hemiparesis after a stroke?

A
  1. Ataxia
    • Cerebella, sensory, vestibular, motor
  2. Slowness of movement
    • Motor unit recruitment, somatosensory loss.
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12
Q

What is a primary abnormality (lacunar infarcts) in hemiplegia or hemiparesis after a stroke?

A

Lacunar infarcts in internal capsule - discrete motor lesions

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13
Q

What is a primary abnormality (lacunar infarcts) in hemiplegia or hemiparesis after a stroke?

A

Lacunar infarcts in internal capsule - discrete motor lesions

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14
Q

What is a primary abnormality (MCA) in hemiplegia or hemiparesis after a stroke?

A

MCA - movement worse in UL than LL

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15
Q

What is a primary abnormality (ACA) in hemiplegia or hemiparesis after a stroke?

A

ACA - movement worse in LL than UL

  • Eg. Anterior cerebral artery problem –> loss at legs vs arms
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16
Q

What are primary abnormalities for stroke of the posterior cerebral artery?

A

significant speech issues

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17
Q

What are the primary abnormalities for the arterial territory of stroke?

A
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18
Q

What are 4 types of lesions (in terms of arteries)?

A
  1. Middle Cerebral Artery
  2. Anterior Cerebral Artery
  3. Posterior Cerebral Artery
  4. Posterior Inferior Cerebellar Artery
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19
Q

What are the 2 prominent motor abnormalities following stroke?

A
  1. Weakness
  2. Loss of dexterity/ fractionation of movement
    • Not coordination (as it ties in with cerebellar damage)
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20
Q

What are the 3 prominent motor abnormalities (loss of fractionation of movement) following stroke?

A
  1. Ability to isolate movement to a single muscle, joint or limb
  2. “Isolated movement” / “selective movement”
  3. Impaired ability to co-ordinate muscle activation - timing
    • Not getting the impulses provided to the muscle
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21
Q

What are the 4 motor abnormalities (motor control errors) following stroke?

A
  1. Tendency to activate incorrect muscle for particular motor task
  2. Too strong a muscle contraction for the needs of the movement in compensation for poor control
  3. Tendency to move the intact side instead of the affected side
  4. Correct activation of muscles but incorrect spatial and temporal relationship between muscles
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22
Q

What are the 5 motor abnormalities (Overactivity / Excessive Muscle Activity) following stroke?

A
  1. Use of too much effort in trying to carry out a task can produce abnormal patterns
  2. Sometimes called “effort tone”
    • Eg. stick tongue out when writing (when concentrating)
  3. Excessive muscle activity is seen when usual synergists are weak
  4. Seen in muscles capable of strongest activation
  5. Often occurs on intact side as the person uses maximum effort to perform a task
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23
Q

What does the combination of ‘weakness’, ‘fractional difficulties’, ‘motor control errors’, ‘overactivity’ lead to?

A
  1. Tendency to develop abnormal patterns when attempting voluntary movement
    • Becomes easier but incorrect pattern (compensating) –> bad movements
  2. Often described as “flexor and extensor synergies” – FALSE TERM BUT GOOD WAY TO COMMENCE DISCUSSIONS.
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24
Q

What are 4 common patterns of abnormal movements of the upper limb flexors following a stroke?

A
  1. scapular elevation and retraction
  2. shoulder flexion and abduction
  3. elbow flexion
  4. forearm supination
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25
Q

What are 4 common patterns of abnormal movements of the upper limb extensors following a stroke?

A
  1. scapular protraction
  2. shoulder adduction and internal rotation
  3. elbow extension
  4. forearm pronation
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26
Q

What are 3 common patterns of abnormal movements of the lower limb flexors following a stroke?

A
  1. hip flexion and external rotation
  2. knee flexion
  3. ankle dorsiflexion and inversion
27
Q

What are 3 common patterns of abnormal movements of the lower limb extensors following a stroke?

A
  1. hip extension, adduction and internal rotation
  2. knee extension
  3. ankle plantarflexion and
  4. inversion
28
Q

What are 3 overactivities/excessive muscle activity following a stroke?

A
  1. Prominent feature of movement post stroke
  2. Blocks / limits return of normal movement
  3. With correct training and the return of normal movement control these patterns should disappear
29
Q

What are 4 factors influencing goal setting and discharge planning?

A
  1. Ability to predict outcome
  2. Knowledge of recovery of movement
  3. Location of treatment
  4. Stage of recovery
30
Q

What are 3 charcateristicsof hyperreflexia?

A
  1. Spasticity: Velocity dependent stretch hyperreflexia
    • If go from flaccid –> spasticity after stroke –> signs of UMN
  2. May become evident after 4-6 weeks (Flaccid initially following stroke)
  3. Increases over time – may be an adaptive response
    • Spasticity is managed through central reinhibition
    • Eg. spasticity, regain motor control to tricpes –> inhibit spasticity of biceps
31
Q

What are 5 characteristics of flexor spastic pattern (upper limb) hyperreflexia following a stroke?

A
  1. scapula depression and retraction
  2. shoulder flexion, adduction and internal rotation
  3. elbow flexion
  4. forearm pronation
  5. wrist and finger flexion
32
Q

What are 3 characteristics of extensor spastic pattern (lower limb) hyperreflexia following a stroke?

A
  1. hip extension, adduction and internal rotation
  2. knee extension
  3. ankle plantarflexion and inversion
33
Q

What is hypertonia?

A

Increased resistance felt on passive movement

34
Q

What is the combination (2) of hypertonia following a stroke?

A
  1. Hyperreflexia +
  2. Adaptive increases in muscle stiffness, changes in muscle length and connective tissue changes
35
Q

What is dysarthria?

A

difficulty with articulation

36
Q

What is Dysphagia?

A

difficulty with swallowing

37
Q

What are the 2 primary sensory abnormalities following a stroke?

A

Sensory loss – non dermatomal

  1. Usually unilateral
  2. Usually on side of body contralateral to brain lesion
38
Q

What are the 3 primary sensory tactile abnormalities following a stroke?

A
  1. light touch localisation *
  2. pressure
  3. texture
39
Q

What are the 3 primary sensory proprioception abnormalities following a stroke?

A
  1. joint position sense *
  2. passive movement sense *
  3. vibration
40
Q

What are the 3 primary sensory abnormalities (types) following a stroke?

A
  1. Tactile *
  2. Proprioception *
  3. Pain
  4. Temperature
41
Q

What are the 4 primary visual abnormalities (deficits) following a stroke?

A
  1. Homonymous visual field loss
    • loss of visual field on one half of each eye on the side of the hemiplegia
  2. Quadrantanopia (Loss of quadrant)
    • Can be dangerous –> unable to drive
  3. Loss of conjugate gaze (muscle control) – review assessment from second year Lifespane 1
  4. Visual inattention / extinction
    • Ignore a side of their body when input on both sides
    • Eg. can touch left side and can touch right side
    • But when touch both sides –> only recognises one side and ignores the other side
42
Q

What are the different fields of vision loss?

43
Q

What are 4 primary abnormalities of language function (communication)?

A
  1. Dysphasia: difficulty with the spoken word
  2. Dyslexia: difficulty with reading
  3. Dysgraphia: difficulty with writing
  4. Dyscalculia: difficulty with calculations
44
Q

What is Dysphasia?

A

difficulty with the spoken word

45
Q

What is Dyslexia?

A

difficulty with reading

46
Q

What is Dysgraphia?

A

difficulty with writing

47
Q

What is Dyscalculia?

A

difficulty with calculations

48
Q

What are characteristics of paients with expessive concerns?

49
Q

What are 4 abnormalites of higher cortical function (perceptual deficits) following a stroke?

A
  1. Dyspraxia / Apraxia
  2. Inattention – sensory and visual
  3. figure ground
  4. Body awareness
50
Q

What are 4 abnormalites of higher cortical function (cognitive deficits) following a stroke?

A
  1. General intellectual function
  2. Memory
  3. Attentional deficits
  4. Impairments of executive functions
    1. problem solving
    2. motivation
    3. planning
    4. organisation
51
Q

What is the effect of the right CVA?

A

Right CVA –> attention, awareness –> left hemiplegia

52
Q

What is the effect of the left CVA?

A

Left CVA –> communication –> right hemiplegia

53
Q

What are 3 abnormalites of higher cortical function (emotional disturbances) following a stroke?

A
  1. lability
  2. depression
  3. anxiety
54
Q

What are 4 abnormalites of higher cortical function (behavioural disturbances) following a stroke?

A
  1. impulsivity
  2. disinhibition (Not social appropriate)
  3. personality changes
    • aggressive or passive behaviour
  4. insight
    • unrealistic goals
    • failure to see relevance of therapy
55
Q

What are 7 secondary abnormalites (adaptive changes) following a stroke?

A
  1. Changes to muscle:
    • Disuse weakness
    • Length changes (Muscles because shorter (don’t move))
    • Atrophy
    • Increased muscle stiffness
  2. Adaptive motor patterns (overactivity)
  3. Changes in joint mobility (stiffness) & ↓neural length
  4. Decreased bone density associated with ↓ WB / load
  5. Decreased cardiorespiratory endurance
  6. Pain
  7. Learned non use (Within 24 hrs of a stroke –> will stop using their arm (a bit longer in the leg))
56
Q

What is the differences between Left & Right CVA?

A
  1. Left hemisphere
    • mainly responsible for language and analytical activity/Problem solving and motor planning = Right hemiplegia
  2. Right hemisphere
    • mainly responsible for visuospatial functions and attention = Left hemiplegia
  • Hemispheres interact to produce functions
57
Q

What is affected in a left CVA (left hemisphere)?

A

Left hemisphere

  • mainly responsible for language and analytical activity/Problem solving and motor planning = Right hemiplegia
58
Q

What is affected in a right CVA (right hemisphere)?

A

Right hemisphere

  • mainly responsible for visuospatial functions and attention = Left hemiplegia
59
Q

What are 5 symptoms of a left CVA- right hemiplegic?

A
  1. aphasia
  2. dysgraphia
  3. dyscalculia
  4. apraxia
    • ideomotor
    • ideational
  5. constructional
  6. perseveration (motor and speech)
60
Q

What are 7 symptoms of a right CVA- left hemiplegic?

A
  1. unilateral neglect
  2. inattention/extinction
  3. agnosias
  4. body image deficits (Unaware of body (eg. arm))
  5. other disorders of visuospatial awareness
  6. apraxia : constructional and dressing
  7. motor impersistence
61
Q

What are the differences between concentration, movement time, performance, carryover effect, attitude and mood between a left and right CVA?

62
Q

What is the concentration, movement time, performance, carryover effect, attitude and mood for a left CVA?

63
Q

What is the concentration, movement time, performance, carryover effect, attitude and mood for a right CVA?

PHTY3140 (28 decks)

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