Stroke

Question 1

Prognosis after a stroke to walk

Answer 1

98% chance if, in the first 72hours post-stroke patient is able to:
- independently sit for 30seconds
- muscular contraction visible
27% chance if cannot do

Question 1

Prognosis after a stroke to have upper limb function

Answer 1

98% chance if, in the first 72 hours post-stroke patient is able to:
- some sort of finger extension
- shoulder abduction
25% chance if cannot do

Question 2

Neurophysiological - adaptive plasticity

Answer 2

Good plasticity
Increased neural and functional ability to perform tasks

Question 3

Neurophysiological - maladaptive plasticity

Answer 3

Bad plasticity
Nerves have created negative responses decreasing function, the ability to learn and impaired ability to perform tasks

Question 4

8 factors that influence neuroplasticity

Answer 4

1. Neuroplasticity must be dependent and specific
2. neuroplasticity is time sensitive
3. Neuroplasticity is influenced by intensity
4. Neuroplasticity is influenced by patient characteristics
5. neuroplasticity is influenced by the environment
6. neuroplasticity is influenced by adjunct treatment
7. neuroplasticity is influenced by pharmacological intervention (Gabba agonist = bad)
8. Neuroplasticity is influenced by task importance, motivation, attention and feedback

Question 5

Use-dependent plasticity

Answer 5

Use it or lose it principle
cortical reorganisation as a result of motor practice where the person already knows how to do the task –> may need to do in different ways

Question 6

Learning Dependent Plasticity

Answer 6

Cortical reorganisation as a result of skill acquisition
this takes time –> task-specific training, goal setting and active problem solving

Question 7

Medical Management for acute Stroke

Answer 7

tpA (thrombolysis)
Endovascular thrombolysis
Craniectomy

Question 8

Thrombolysis

Answer 8

–> dissolves the blood clot and reconstitutes blood flow and O2 to the brain
Must be administered within 0-4.5hrs of the stroke patient coming to the emergency
Treatment has risk of ICH but benefits out weight risk with decrease life disability

Question 9

Endovascular Thrombolysis

Answer 9

Mechanical Retrieval of the clot
candidate 0-24hrs of seeing patient (generally starts from 6hrs) –> mismatch between ischemic core and penumbra (want to preserve and reverse the brain tissue damage)
2.8-3.6 Intention to treat one 1 person to a non-independent disability = very effective

Question 10

Craniectomy

Answer 10

It takes a part of the skull out to relieve intracranial pressure and improve perfusion. Usually from Ischaemic cerebral haemorrhage.
done within 48hours or before clinical deterioration
It helps to prevent further damage from occurring - but cannot reverse the damage as the period is too long.

Question 11

Low contextual interference for exercising

Answer 11

More beginner –> greater performance but poor retention
this is when use serial repetitions of block trials

Question 12

High Contextual interference for exercising

Answer 12

Experts
Better retention and transfer but poorer performance
Random order of trials of all task variants –> high function and random practice

Question 13

Evidence for STS training and standing balance

Answer 13

SB - Training during various activities –> positive effects for basic ADLs and balance
SB - significant improvement for postural sway in the chronic phase only –> no significant effects for ADL, function

Question 14

Three factors affecting goal-directed movement UL

Answer 14

Object position in space
Object characteristics
what to do with the Object

Question 15

2 phases affecting goal-directed movement UL

Answer 15

transportation of the object
manipulation of the object

Question 16

Inclusion Criteria for CMIT

Answer 16

10ºOf wrist extension
10º of thumb abduction
10ºof finger extension
Must have mild/cognitive perceptual deficits