Stroke 2 Flashcards
What is central post-stroke pain?
Also known as thalamic syndrome
Neurological disorder that develops when the CNS, the brain and spinal cord is damaged, occurs when a stroke injures the thalamus or parietal lobe (parts of the brain that process sensory stimuli like heat, cold and touch)
Spontaneous pain and painful overreaction to objective stimulation resulting from lesions confined to the substance of the CNS including dysaesthesia of a disagreeable kind
Occurs in 8% of stroke patients- most common <2 months after, but up to 6 years post-ictus
What sensory disturbances occur in central post-stroke pain?
o Reduced pain or temp sensation
o Poor pain localisation on affected side
o Hyperaesthesia or allodynia
o Intermittent or persisting pain- cold & poorly localised
How is central post-stroke pain treated?
o Opiated morphine or tramadol
o Anti-depressants- Amitriptyline 10-25mg and titrate to 50mg
o Anti-convulsants- Gabapentin 300-600mg TDS (sedation) or Pregabalin 75mg OD
o Deep brain stimulation
What are the roles of the physiotherapist?
Posture and balance
Seating for patient on ward
Advise MDT for transferring of patient (chair to toilet)
Treatment of movement problems following stroke
Appropriate discharge plan
Stroke Team Assistant facilitates 24-hour approach to moving, handling and positioning of patients
Advice to family and carers on appropriate exercises to facilitate patient’s recovery
appropriate referral is made for physiotherapy follow up following discharge
What are the requirements of normal movement?
Muscle tone- postural tone is adaptable and varies throughout different parts of the body in response to a desired motor goal, there is a range of normal, it needs to be sufficient to withstand gravity but adaptable to allow free movement e.g. picking up a cup without using the whole body
Reciprocal innervation- this is the modulation of excitation and inhibition within the CNS allowing smooth working of one muscle group with another this produces selective movement i.e. the movement of one body part whilst keeping another part still
Sensory integration and proprioceptive control- sensory feedback is necessary to give information to the brain about the success or failure of a movement or task
What is the bobath concept?
Uses facilitation to address disturbances of movement and balance- facilitation is the use of specific handling skills to give the patient the experience of more normal movement through active alignment of particular body parts this improve the patient’s proprioceptive awareness and thus quality of movement in practice the aim is to re-educate more normal movement patterns as opposed to increasing use of compensatory movements that in the longer term limit movement potential
What is neuroplasticity?
The potential of the nervous system to adapt and change it allows us to learn & re-learn new skills and explains our potential for recovery after stroke, factors that influence it include the environment, positioning and movement of patients it is important to consider how someone moves, as well as if they can
What are outcome measures used in physiotherapy?
Trunk control test- monitors rolling to either side, sitting up from lying and sitting balance (max score is 100) 9 hole peg test- test of upper limb dexterity and function- timed trial of placement and removal of 9 pegs into and out of a shallow container Berg balance (BBS)- 14 item scale which measures balance balance is measured based on an ability to maintain positions of increasing difficulty due to a diminishing base of support and ability to change position- max score 5 Timed up and go- times a patient rising from a chair, walking 3m, turning, walking back to the chair and sitting back down the score given is the time taken in seconds to complete the test
What dyspraxia may patients exhibit?
Ideomotor- difficulty imitating gestures or performing purposeful motor tasks on command, although the concept is fully understood
Ideational- difficulty carrying out an activity automatically or on command due to difficulty in understanding the concept or sequencing the activity
Why should suspected stroke patients be admitted directly to specialist acute units?
o Early recognition and treatment of complications
o MDT working
o Co-ordinated and organised in-patient care with weekly MDT meetings
o Programmes of education and training for staff, patients, carers
o Involvement of carers in rehabilitation
o Staff interest and expertise
patients are more like to receive measures to reduce aspiration, early nutrition, shorter length of stay, less like to die and more likely to discharge independent
What are the types of dysphasia?
Expressive- understands language, but cannot find the write words,recognises incorrect language, reading and writing may be affected
Receptive- inability to understand language, does not recognise error in speech reading & writing affected. (lesion in Wernicke’s area). often a combination of expressive and receptive dysphasia
What are the symptoms of stroke?
Hemianopia
Expressive aphasia- Inability to express language despite intact comprehension
Receptive aphasia- Inability to understand commands and the world around them. May have fluent speech but meaningless
Apraxia- Difficulty in performing tasks despite intact motor function
Asterognosis- Inability to identify objects in both hands by touch alone despite intact sensation
Inattention (neglect)- Inability to attend to stimuli bilaterally despite intact sensation
What is dysarthria?
- Dysarthria is a motor disturbance of speech individuals know what they want to say, but cannot get the words out correctly, because of weakness to the tongue or facial muscles
- It can be complete, in which case it is difficult to distinguish from aphasia however, in dysarthria, comprehension, reading and writing should not be affected
- The person may sound slurred, get easily out of breath and have a flat-sounding voice
What is dyspraxia?
affects the person’s ability to respond voluntarily in conversation, but they may be able to do things
automatically
• For example, they may greet you normally and then be unable to answer any questions
• Typically, the person is unable to repeat things and seems to grope for words and sounds
• However, it can difficult to differentiate dyspraxia from aphasia
What does managing dysphagia require?
Speech & Language Therapist (SALT) assess the patient further to check the risks for oral intake
The physiotherapist will assess appropriate positioning for swallowing eg sitting balance, head control
OT will assess seating for eating and drinking to ensure optimum positioning they will also look at hand-mouth coordination and adaptations to aid eating and drinking
The Dietician will assess and monitor intake to ensure nutritional requirements are met
The Kitchen provides meals in a modified format to enable patients to have different textured foods according to their needs
