Stroke

Question 1

Definition

Answer 1

Acute neurologic dysfunction of vascular origin

Sudden or rapid occurence of symptoms and signs corresponding to involvement of focal areas of the brain

Question 2

General Stats

Answer 2

3rd leading cause of death in US

Leading cause of death over age 75

19% higher incidence in men than women

Incidence increases with age, 95% of strokes occur > age 45

Question 3

Types

Answer 3

Hemorrhagic (15%) - bleed

Ischemic (85%) - clot

Question 4

Motor Control and Strength Impairments

Answer 4

Hemiplegia

Initially flaccid

As voluntary movement returns, increase tone and synergy patterns

Question 5

Synergy patterns

Answer 5

Upper limb - Flexor Synergy

Lower limb - Extensor Synergy

Question 6

Coordination and Balance Impairments

Answer 6

Trunk Control

Coordination and movement patterns

Balance

Spasticity

Decreased joint flexibility, joint pain, contracture

Difficulty positioning for comfort and hygiene

Question 7

Sensation Impaired

Answer 7

Pain

Temperature

Joint positional sense

Stereognosis- recognize object with touch

Question 8

Language and communication

Answer 8

Aphasia- disturbance in comprehension and formulation of language

Naming, reading and writing

Prosody- rhythm, stress, intonation of speech

Question 9

Apraxia

Answer 9

Disorders of skilled movement

In the absence of motor, sensory, or cognitive impairment

Question 10

Neglect Syndrome

Answer 10

Failure to report, respond, or orient to novel or meaningful stimuli presented to side opposite of brain lesion

Question 11

Other Symptoms

Answer 11

Dysphagia- difficulty swallowing

Bowel and bladder dysfunction

Deconditioning - complex process of physiological change following period of inactivity

Question 12

Shoulder pain, Contracture

Answer 12

Glenohumeral subluxation

Impingement syndromes, rotator cuff tears

Frozen shoulder- stiffness and pain

Complex regional pain syndrome - severe pain, swelling, changes in skin

Question 13

Stroke Treatment

Answer 13

Treatment of acute stroke

Secondary prevention

Natural recovery

Compensatory techniques

PT, OT, SLP, Orthotist

Question 14

Strokes occurring at the middle cerebral artery, the most commonly effected artery, presents in what way? What about anterior cerebral artery?

Answer 14

Middle cerebral artery- Contralateral upper limb paralysis and sensory loss. Considerably less for the lower limb.

Anterior cerebral artery- Contralateral lower limb paralysis and sensory loss. Considerably lower for the upper limb.

Question 15

Most neurological recovery happens within what time frame?

Answer 15

6 months neurologically. Although functional improvement may continue as a result of further sensorimotor reeducation as patient learns to cope with disability.

Question 16

If patient presents with ankle equines and spasticity of the ankle (with positive clonus test), what type of AFO is indicated?

Answer 16

Solid Ankle AFO.

Question 17

T/F when sitting and standing the patient has increased tone of the extensor muscles of the lower extremity. For this reason ROM, should be tested in the supine position, while spasticity should be tested in the upright position.

Answer 17

True

Question 18

In what instances is a KAFO indicated for a patient with stroke/tbi than a AFO.

Answer 18

Quad weakness, Hamstring spasticity.

Question 19

What type of AFO is most appropriate in the acute phase of stroke/TBI recovery

Answer 19

Articulated AFO allows for adjustment in the posterior and anterior channels as function and impairments improve.

Question 20

T/F the buckle should be placed on the uninvolved side to allow the patient to pull the strap toward the involved side.

Answer 20

F the buckle should be placed on the involved side to allow for the patient to pull towards the uninvolved side.