stroke-clinical features and clinical management

Question 1

hemiplegia and hemiparesis

Answer 1

paralysis of 1 side of the body, Rt CVA= left hemiplegia, hemiparesis- slight weakness/ loss of function

Question 2

clinical features of stroke

Answer 2

motor symptoms, sensory symptoms, speech symptoms, cognitive symtoms

Question 3

motor pathways

Answer 3

motor information originates from motor cortex in frontal lobe, the main descending pathway is corticospinal tract, in the medulla 80% fibres cross, at the spinal cord, synapses with alpha motor neuron, the peripheral motor nerve/ lower motor neuron takes messages to neurons

Question 4

motor symptoms

Answer 4

alterations in tonem low tone (flaccidity), high tone (spasticity), ataxia, weakness, asymmetry, loss of normal movement patterns- to make movements easier, loss of postural adjustment- loss of balance, compensation- to counterbalance

Question 5

typical patterns- flexion pattern in upper limb

Answer 5

shoulder elevation and retraction, internal rotation and adduction, elbow flexion and pronation, wrist and finger flexion

Question 6

typical patterns- extensor pattern in lower limb

Answer 6

hip retraction/ flexion and extension, knee extension,ankle plantarflexion and inversion

Question 7

sensory pathways

Answer 7

sensory messages are initiated in sensory receptors, sensory messages are transferred to the spinal cord via sensory peripheral nerves- FON, they are transferred to the cortex via specific tracts, they synapse at the thalamus before going to cortex, the sensory messages are perceived in the sensory cortex in the front of parietal lobe

Question 8

sensory symptoms- sensory impairment

Answer 8

impaired cutaneous sensation, stereognosis, proprioceptive impairment,

Question 9

sensory symptoms-visual problems

Answer 9

visual field loss, homonymous hemianopia

Question 10

speech symptoms- speech problems

Answer 10

dysphasia/ aphasia (complete lack of speech), global aphasia, dysarthria

Question 11

speech symptoms- expressive dysphasia and receptive

Answer 11

damage to broca’s area, usually associated with Rt hemiplegia, lose ability to produce speech
receptive- damage to wernicke’s area in temporal lobe, lose ability to understand speech

Question 12

what are cognitive problems related to

Answer 12

parietal lobe

Question 13

cognitive problems- perceptual problems- agonisa

Answer 13

inability to recognise objects when using a specific sense, astereognosis- cant recognise objects without seeing it, visual agnosia- cant recognise what an object is ,auditory agnosia- patients dont recognise peoples voices, can be dangerous- dont recognise alarms- safety issues

Question 14

cognitive problems- other

Answer 14

depth perception- driving?, apraxia- put things out of order, anosognosia- not recognising you’ve had a stroke

Question 15

cognitive problems- inattention/ neglect

Answer 15

more common with left hemiplegia, patients fails to attend stimuli from left side, poor prognosis if persist, results in many functional problems- self care, eating, dressing, walking

Question 16

other related problems

Answer 16

disorders of emotion, dysphasia- delay/absent swallow reflex- cant swallow- nutrition/ hydration, incontinence- no signals getting into bladder and bowel, secondary MSK problems- sublux shoulder, prone to damage to GHK, balance/ gait problems, functional difficulties, social problems

Question 17

physiotherapy treatment

Answer 17

primary goals are to prevent complications, minimise impairments and to maximise function- assessment, identification of problems, clinical reasoning, goal setting, objective outcome, choice of Rx method

Question 18

factors affecting recovery- condition

Answer 18

extent and nature of lesion, integrity of collateral circulation, pre-morbid status, age, capacity of nervous system to re-organise, environment,

Question 19

national stroke strategy

Answer 19

treat stroke as medical emergency, effective assessment and treatment of vascular risk factors, TIAs assessed and scanned within 24 hrs, suspected stroke transferred to specialist stroke unit with MDT treatment and assessment, range of services available locally to support long term needs, opportunity to return to work

Question 20

factors affecting recovery- patient

Answer 20

motivation and attitude of patient, patient participation, patient experience, co-existing conditions, nutrition/ hydrations