stroke presentation Flashcards
stroke signs and symptoms,
post stroke deficits
Headache, visual disturbance, photophobia, vomiting, cervical stiffness.
Loss of consciousness
Attention, concentration, memory issues
Motor deficits – loss of power, hemiplegia, facial droop
Sensory deficits – neglect, inattention
Speech problems
Visual disturbance
Visuo-spatial issues
Cognitive impairment
Other issues – nutrition, continence, breathing, circulation,
motor system
Hemiparesis Weakness Paralysis Loss of voluntary motor control Spasticity Increased reflexes
weakness ‘hemiparesis’
Upper limb 50% Lower limb 45% Both limbs Face 40% Trunk muscles Implications - immobility, ADL, functional mobility & weight transfer
hemiparesis/ hemiplegia
Hemiplegia is a paralysis that affects one side of the body. It’s often diagnosed as either the right or left hemiplegia, depending on which side of the body is affected.
abnormal tone
Initial - Cerebral shock – low tone, hypotonia.
Hypertonia – increased tone, spasticity (typical patterns).
Evaluate tone (Ashworth scale).
Use of positioning charts
Liaise with ward staff
Prevent - adaptive changes - deformity / contracture
sensory impairment. Hemiaesthesia
Lesion - sensory cortex / thalamus. Impaired sensation - hemisensory loss. Tests clinical & largely subjective. Course of recovery. Implications for management. Role for sensory re-education
balance
Loss of balance control Loss of automatic postural adjustments Posture - large base of support \+/- ataxia Increased risk of falls
Loss of consciousness
LOC/Coma – may or may not be present, may be terminal.
15% - first few days post stroke
Average coma – 1 hour
Cause of coma – cerebral shock
Eyes are deviated to side of lesion in comatose patient i.e. R side lesion, eyes to the R, L sided hemiplegia.
Prognostic variable
Haemorrhagic stroke, SAH, brainstem compression
Assessment – Glasgow Coma Scale (GCS)*
attention and concentration
Lesion prefrontal, posterior parietal, ventral temporal, thalamus, brainstem.
Impaired attention & concentration.
Implications for rehabilitation.
Neuropsychology input.
memory
Medial temporal lobe & thalamus.
Factor in natural decline in memory with age.
Other diseases/co-morbidities e.g. dementia.
Failure to register new information – how might this affect rehabilitation.
communication
Broca’s area Expressive/motor dysphasia Wernicke’s area Receptive/sensory dysphasia Aphasia motor+sensory dysphasia Reading & writing Numeracy
visual deficits
Receive, transmit & interpret visual information
Concomitant disease - visual acuity, glaucoma diabetic retinopathy, cataract
Stroke related
Homonymous hemianopia
Visual field defect
Visual inattention
visuospatial deficits
Damage non-dominant posterior parietal lobe.
Somatognosia
Lack of awareness of body structure and failure to recognise one’s parts and their relationship to one another.
Anosognosia
Severe form of neglect - patient fails to recognise paralysis or deficits
Unilateral neglect
Inability to integrate and use perceptions from one side of the body /environment. Ignores one half of body. Bumps into objects.
Right / left discrimination
Inability to understand concepts of right
and left.
Apraxia
Inability to perform skilled movements in the absence of loss of motor power, sensation or co-ordination
Agnosia
Lack of recognition of familiar objects.
Body image
Visual & mental memory image of one’s body.
Body scheme
The position of different parts of the body to each other.
visuospatial deficits: tests
Tests Clock drawing Line Bissection test Cancellation tasks Clinical psychology and OT
Implications in rehabilitation
swallow problems - dysphagia
45% acute stage.
Bedside swallow test in first 7hr, screening & NPO.
Formal SLT assessment first 24hr.
Risk of aspiration pneumonia.
Dehydration / malnutrition.
Video fluoroscopy Management Swallow technique Modify food consistency Nursing staff/nutritionist Positioning Involve carers
