Stroke Flashcards

Question

Principle 3 of neuroplasticity

Answer 1

The intact hemisphere can take over some motor control • There are ipsilateral corticospinal neural pathways (weak in humans) • These pathways innervate many more proximal than distal muscles • The transcollosal connections provide another possible role of the intact hemisphere • fMRI studies demonstrate that the damaged hemisphere has increased blood flow when bilateral movements are made

Answer 2

Neuroplastic mechanisms can be facilitated • Physiotherapists can influence cortical reorganisation after stroke with: • Rehabilitative techniques • Sensory stimulation • Environmental enrichment

Answer 3

- Neurological deficit of presumed vascular origin lasting less than 24 hours • Typically last less than 10 minutes • Suggestions to change definition to <1hour • Relatively benign in terms of immediate consequences as symptoms resolve • ‘Warning Stroke’ more appropriate than ‘Mini Stroke’ as it is a direct sign that a stroke may potentially occur • Important to have investigated

Answer 4

- process of stroke injury at cellular level - irreversible damage begins immediately at the core - the penumbra may viable for up to 6 hrs - rapidly initiated within seconds to minutes after the loss of blood flow to a region of the brain - comprises a series of subsequent biochemical events that lead to disintegration of cell membranes and neuronal death at the core of the infarction - severe focal hypoperfusion leads to excitotoxicity and oxidative damage which in turn causes microvascular injury, BBB dysfunction and initiate inflammation - exacerbates initial injury and can lead to permanent cerebral damage - amount of permanent damage dependent on : degree and duration of ischaemia and brain's capability to recover

Answer 5

``` Hypertension • Acute Hypertension • Alcohol • Amphetamines etc Arterial Disease • Vascular Malformations Diasthesis (Bleeding Disorders) • Anticoagulants • Antiplatelets • Thrombolytic therapy Trauma ```

Answer 6

* Intracerebral haemorrhage activates a nuclear factor which then perpetuates inflammation * Inflammation along with oxidative stress leads to secondary brain damage * Induction of antioxidative defence components and inhibition of the nuclear factor protect affected area of the brain * Phagocytosis-mediated haematoma clean up also stimulated, facilitating removal of the haematoma (source of toxicity and inflammation)

Answer 7

language skilled motor formulation (Praxis) arithmetic sequential and analytical calculating skills musical ability : sequential and analyticla skills in trained musicians sense of direction : following a set of written directions in sequence

Answer 8

prosody (emotion conveyed by tone of voice) visual spatial analysis and spatial attention arithmetic : ability to estimate quantity and to correctly line up columns of numbers on the page musical ability : in untrained musicians, and for complex musical pieces in trained musicians sense of direction : finding one's way by overall sense of spatial orientation

Answer 9

``` general prognosis 25% well recovered 25% moderately impaired 25% dependant 25% deceased ``` mortality rate 10% infarction 50% haemorrhage

Answer 10

* Prevent secondary complications * Optimise cardiorespiratory function * Optimise motor performance * Increase physical fitness and strength * Inspire interest and motivation * Promote mental and physical vigour

Answer 11

evidence shows that more is better • Type of practice is equality important to amount • Task-specific/ task-related • Functional practice • Context specific • Must practice in different task and environmental contexts • Practice ++++++++++ • Learning is directly related to the amount of practice undertaken • Repetition ++++++++++ • In both strength training and skill development, repetition is an important aspect of practice • Let fatigue and quality of movement guide you as to the intensity of the exercise and the number of repetitions to be completed maximise practice time

Answer 12

• Prevention of complications (e.g. contracture, subluxation, swelling of extremities, pressure ulcers, falls) • Management of complications (e.g. fatigue, loss of cardiorespiratory fitness) • Improved patient positioning and handling by health professionals and family/ carer • Overcoming learned non-use or compensations through positive movement experiences • Management of impairments (e.g. weakness, sensory loss, flexibility, tone, spasticity) • Functional retraining/ restoration of movement • Teaching new adaptive skills • Ensuring appropriate aids are issued and used correctly • Walking aids should not be used in the early stages of management unless they were used prior to the stroke Positive attitude of patients • Physiotherapy associated with functional improvement • Valued by patients because physiotherapy perceived to “keep you moving, keep you going and keep you busy” • Physiotherapy programs provide structure to day • Physiotherapists considered as a source of advice, information, faith and hope

Answer 13

* Rehabilitation should be structured to provide as much practice as possible within the first six months after stroke * As much physical therapy (PT and OT) should be provided as possible with a minimum of one hour active practice/ day at least five days per week * Task specific circuit class training or video self modelling should be use to increase the amount of practice * Patients should be encouraged to practice skills learnt in therapy throughout the remainder of the day

Answer 14

* Patients should be mobilised as early and as frequently as possible * Upper limb training should commence early * Acutely, commence as soon as possible with frequent short sessions out of bed

Answer 15

* The earlier that rehabilitation is commenced, the better the outcome for the patient * Principles of rehabilitation should be applied in acute and post-acute settings * As much physical therapy (PT and OT) should be provided as possible with a minimum of one hour active practice/ day at least five days per week * Patients should be mobilised as early and as frequently as possible * Physiotherapy for patients with weakness should include progressive exercises and/ or electrical stimulation and/or EMG feedback with conventional therapy * Sensory specific training can be provided to stroke survivors who have sensory loss * If a visual field deficit is found, refer for comprehensive assessment by relevant health professionals * Practising reaching beyond arm’s length, integrated into a functional task, while sitting with supervision/ assistance should be undertaken by people who have difficulty sitting * Repetitive task specific training should be undertaken by people who have difficulty in standing up from a chair * Task-specific standing practice with feedback can be provided for people who have difficulty standing * People with difficulty walking should be given the opportunity to undertake tailored, repetitive practice of walking (or components of walking) as much as possible * People with difficulty using their upper limb(s) should be given the opportunity to undertake as much tailored practice of upper limb activity (or components) as possible * For people with confirmed apraxia, tailored interventions (e.g. strategy training) can be used to improve ADLs * The presence of agnosia should be assessed by appropriately trained personnel and communicated to the stroke team * Neglect has deleterious effects on all aspects of ADLs, is a predictor of functional outcome and must be managed * Treatment plans must be individualised, problem based and comprehensive * Key aspects of treatment plans include functional retraining, strengthening, flexibility, cardiorespiratory fitness and specific impairments

Answer 16

• Acute Care: focus on rapid thorough assessment and early management • Principles of rehabilitation should be applied in acute and post-acute settings•

Answer 17

Rehabilitation: aim is to improve function and/or prevent deterioration of function, and to bring about the highest possible level of independence – physically, psychologically, socially and financially • Proactive, person-centred and goal-oriented process that should begin the first day after stroke • Physical recovery + reintegration into community

Answer 18

Intravenous thrombolytic agents (e.g. alteplase (r-tPA), streptokinase, recombinant pro-urokinase and urokinase) promote thrombolysis, degrading clots to relieve ischaemia • Irreversible damage begins immediately at the ischaemic core, however the penumbra may be viable for up to six hours - early correction of ischaemia may minimise or even prevent any damage to the penumbra • Recommended as leading treatment for ischaemic stroke • Evidence that tPA reduces disability, increases recovery rates and independence is unequivocal • Must be administered within 4.5 hours of symptom onset • Specific inclusion and exclusion criteria must be satisfied • Access to t-PA is low (~7% in Australia) and has stalled In Australia, only 26% of appropriate patients received thrombolysis within 60 minutes of hospital admission (USA 43%, UK 56%) • Requires appropriate infrastructure (MDT with expert knowledge, pathways and protocols, immediate access to imaging facilities)

Answer 19

lecture 3-2

Answer 20

* L hemiplegia; upper limb affected more than lower limb * L hemianaesthesia * L hemianopia / quadrantopia * Gaze palsy * Dysarthria * Unilateral neglect / inattention * Agnosognosia * Autopagnosia * Motor impersistence * Disinterest / poor motivation / apathy * Impulsiveness * Dyspraxia – constructional / dressing * Impaired ability to judge distance * Astereognosis * Verticality problems * Coma – depending on extent of lesion

Answer 21

* R hemiplegia; upper limb affected more than lower limb * R hemianaesthesis * R hemianopia / quadrantopia * Dysphasia – receptive and/or expressive * Anomia * Dyspraxia – ideomotor / ideational * Gerstmann’s syndrome: R/L confusion, finger agnosia, acalculia, dysgraphia * Coma – depending on extent of lesion

Answer 22

* Contralateral hemiplegia – lower limb affected more than upper limb * Cortical sensory loss to leg and foot * Urinary incontinence * Dyspraxia of left limbs * Abulia * Slow to respond to commands; decreased mental quickness * Flat affect, lack of spontaneity, apathy * Distractible * Perseveration of movement * Notable reduction in speech output * Facial/ tongue weakness * Grasp/ sucking reflex may be apparent

Answer 23

* Homonymous hemianopia (cortical blindness if bilateral lesions) * Colour blindness * Hemianaesthesia (mild to severe) * Verbal dyslexia * Memory defects * Poor orientation in space * Gerstmann’s syndrome: R/L confusion, finger agnosia, acalculia, dysgraphia