Rehab Flashcards
What are the effects of an ACA stroke?
- contralateral LL motor and sensory loss
- personality change
What are the effects of an MCA stroke?
- UL motor signs (LL if severe) in contralateral
- dysphagia (usually left sided rarely right side (left handed?))
- facial weakness
- neglect
- if temporal (finger agnosia, L/R disorientation, agraphia, apraxia)
What are the effects of a PCA stroke?
- visual hemianopia
- ST memory loss
- Anton syndrome (cortically blind)
What occurs in a Basilar stroke?
- cranial nerves - fluctuating conciousness (RAS) - cerebellar signs (dysdiadochokinesia, dysmetria, diplopia, nystagmus, vertigo) - limb weakness
How would you assess someone who has had a stroke?
medical issues - comorbidities - medications - stable Impairment - vision - hemiparesis - dysphagia - dysphasia - incontinence - cognition Activity limitation - mobility - ADLs
What is the Treatment for Stroke?
1) specialist stroke unit 2) acutely - prophylaxis (RFs - BP, cholestrol, smoking, diet, DM) - swallowing - continence - DVT/PE - infections 3) Rehab goals - Swallowing (speech pathologist and dietician) - assist with communication - mobility/falls (physio exercise regimes, OT walking aids) - continence (aids e.g. diapers, timed voids, fluid intake anti-SLUD) management, tx UTIs, oxybutynin (confusion or beta3 blocker) - movement (spasticity/contractures) - splinting - ROM exercises - compensatory techniques - medication (baclofen) or if isolated botulinum toxin injection - functional (SW and OT) - ADLS - Driving - sexuality - job
What is the prognosis for someone post-stroke?
rapid within the first 3 months.
Is it true or false that a left homonymous hemianopia may be caused by the following lesions?
- A lesion of the optic chiasm
- A lesion of the right occipital lobe
- An attack of migraine
- Occlusion of both the anterior and middle cerebral arteries
- Right optic Neuritis
- F
- T
- T
- T
- F
- homonymous hemianopia means loss of vision on the same side in both eyes.
- left would be right occuputal lobe or complete lesion of the right optic radiation. A partial lesion would cause quadrantopia.
- migraine can as it can originate in the striate cortex.
- Both MCA and ACA can cause ischaemia to the optic radiation and can cause this.
- Optic chiasm is bitemporal hemianopia.
- optic neuritis is often central scotoma.
A 76 year old women presents with a two week history of right-sided weakness, which has more or less resolved. CT of head confirms cerebral infarction. Her pulse is irregularly irregular, but her heart sounds normal. She is not on any medicaiton. What do you give her?
Non-rheumatic AF increases stroke 5x, Warfarin has risk reduction and is much more effective than aspirin. Would also consider a NOAC but considering recent ischaemia warfarin might be better ST.
A 67 year old man has been admitted into hospital for the last week with dense left hemiparesis. He has been kept nil-by-mouth as its unsafe for him to swallow. What is your management?
Patients should recieve nutrition within a few days of being kept NBM, initially by NG tube. A PEG tube should be arranged within 2-4 weeks to reduce aspiration pneumonia risk and help in patient comfort.
Which one of the following is caused by temporal lobe lesions?
- apraxia
- astereognosis
- primitive reflexes
- visuospatial neglect
- Wernicke’s aphasia
- frontal lobe lesions involve executive function and sequencing.
- expressive aphasia (receptive are temporal)
- primitive reflexes
- perseveration
- anosmia
- changes in personality
- parietal lobe
- apraxia
- neglect
- astereognosis (unable to recognise object)
- visual field defects
- alcalculia (inability to perform mental arithmetic)
- temporal lobe
- visual field defects (homoymous superior quadrantanopia)
- Wernicke’s aphasia
- auditory agnosia
- memory impairment
- Occipital lobe
- cortical blindness (anton’s)
- homonymous hemianopia
- visual agnosia (seeing but not perceiving - not neglect - can be followed buy cannot be named).
Rehab Principles?
- allied health professionals roles
- physio (mobility)
- OT (ADLs, equipment)
- Speech path (swallowing techniques)
- social worker
- patient suitability
- medically stable
- reasonable cognitive ability or expectation
- motivation to attend
- expectation therapy program will result in gains
- availability of support if residual impairment
- Impairment, Diability, Handicap (organ, individual, societal)
- Disability - functional activity limited because of the impairment
- Impairment - organ or system function (neuro impairment)
- Handicap - reflection of what the patient is unable to acheive in society at a greater level due to impairment.
