Week 2 Acute Stroke Management and Perceptual Deficits

Question 1

A medical complication during post-acute rehab for stroke patients which affetcs 2/3 of patients, increases risk of death by 3x, Increase LOS (length of stay), and increase NH placement.

Answer 1

Chest Infeciton

Question 2

Another medical complication which affects 1/3 of patients. Something to be aware of especially with swallowing.

Answer 2

Aspiration Pneumonia

Question 3

This is a salvageable part of the brain when someone has a stroke, it is located near the core and time is of the essence.

Answer 3

Ischemic penumbra

Question 4

This is a helpful acronym if someone is having or is currently experiencing stroke.

Answer 4

FAST
F - face (drooping?)
A - arms (can the lift both)
S - speech (slurred? and can they understand you?)
T - time

Question 5

This is given to stroke patients to re-canalise blocked vessels, restore blood supply to the region within the therapeutic time frame (<5 hours), rescue ischaemic but retrievable penumbral tissues, and this is not given when there is bleeding (haemorrhage).

Answer 5

Thrombolysis
- Licensed: tPA - tissue plasminogen activator
- on trial - tenectoplase and desmotoplase

Question 6

What is the primary exclusion criteria for tPA?

Answer 6

• previous head trauma or stroke in the previous 3 months
• history of haemorrhage, intracranial neoplasm, AVM or aneurysm
• High BP (Systolic > 185, and diastolic >110)
• had seizure
• uncontrolled blood glycaemia
• > 85 yrs old
• Pregnancy
• recent major surgery

Question 7

A hemisphere in the brain which controls R sided voluntary movements and is responsible for the verbal-analytical activities. (also when you are right handed)

Answer 7

Left Hemisphere (Dominant hemisphere)

Question 8

A hemisphere in the brain which controls the L sided voluntary movements and the visuo-spatial functions. (also when you are left handed)

Answer 8

Right Hemisphere (Non-dominant)

Question 9

It is the failure to respond, report, or orient to stimuli presented to the contralesional side of the body or space and this failure can not be attributed to either sensory or motor defects.

Answer 9

Unilateral Spatial Neglect

Question 10

Type of Unilateral Neglect wherein there is unawareness of sensory stimuli in the contralesional side. Can be visual - eg. may not see door or person, auditory eg. may not acknowledge info in one side, somatosensory.

Answer 10

Sensory (inattentive, attentional neglect)

Question 11

Type of unilateral neglect wherein there is a failure to generate movement responses to a stimulus even though person is aware of the stimulus and can not be explained by weakness.

Answer 11

Motor (output, intentional neglect)

Question 12

Three types of neglect in relation to where in space

Answer 12

• Personal space: one’s own bubble, eg. dressing, shaving, etc…
• Peri-personal space: within reaching distance
• Extra-personal space: beyond arm’s reach

Question 13

Another type of unilateral neglect where the person ignores contralesionally half of internally generated images - visualization of task, environment, and action

Answer 13

Representational Neglect

Question 14

Type of unilateral neglect wherein there is a failure to respond to stimulus on affected side, when simultaneous stimuli are presented on both sides of the body in the same area.
- patient can only report one stimuli at a time but when there are two stimulus at once - they can only report ipsilesional item

Answer 14

Extinction (Inattention) - sensory or visual

Question 15

what is egocentric neglect? (Space versus object)

Answer 15

• ignores items on the left side of a display

Question 16

what is allocentric neglect? (space versus object)

Answer 16

• ignores the left side of items no matter the position in the display

Question 17

What is Agnosia?

Answer 17

Perceptual deficit that deals with a person’s lack of recognition of familiar objects as perceived through senses/
can be
- Visual agnosia - pt. may fail to recognise family or physician
- Tactile agnosia - steorognosis
- Auditory agnosia - unable to recognise familiar sounds (eg. piano playing in the BG, but the patient is unable to recognise whether the audio is a piano or a drum)

Question 18

Unawareness of one’s own body part, patient may deny owning a limb and can neglect one side of the body

Answer 18

Autotopagnosia

Question 19

Unawareness of a condition or denial of an illness. Patient may be unconcern for paralysis

Answer 19

Anosognosia

Question 20

This is the failure to sustain a motor activity/contraction due to inability to sustain direct attention

Answer 20

Motor impersistence

Question 21

How do we assess for Autotopagnosia?

Answer 21

• we look at how they walk, what they do with their limb, is foot position poorly on a plate or floor
• unaware of position inspace/verticality

Question 22

how do we assess for Anosognosia?

Answer 22

• no standardised assessment
• observe and list to patient for explanations of their condition or denials of their condition, confabulation & etc…

Question 23

What is Apraxia?

Answer 23

• inability or difficulty to perform certain skills or purposeful movement in the absence of a loss of power or motor control

Question 24

R (non dom) hemisphere - CONSTRUCTIONAL APRAXIA

Answer 24

• impairment when producing designs/drawaings 2D or 3D dimensions by copying, drawing, and or constructing, whether on command or spontaneously.

Question 25

R (non dom) hemisphere - DRESSING APRAXIA

Answer 25

• inability to dress oneself due to disorders in one’s own body scheme and or spatial relations.

Question 26

An inability to find one’s way in familiar surroundings or learn in a new situation.
- patient has difficulty understanding and remembering relationships of places to one another

Answer 26

R (non dom) hemisphere - TOPOGRAPHICAL DISORIENTATION

Question 27

This is an inability to judge distance, depth, size or shape
Verticality - position of self and objects in external environment

Answer 27

R (non dom) hemisphere - POOR SPATIAL JUDGEMENT

Question 28

How do we assess for Constructional Apraxia?

Answer 28

2D - ask patient to draw and copy a matchstick pattern
3D - copy block designs, puzzles, build tower (Benton’s 3D constructional Praxis test)

Question 29

How do we assess for Topographical?orientation?

Answer 29

• ask patient to draw a floor plan of their home
• ask patient to show ways back to the ward or how to move from dining to bedroom

Question 30

How do we assess for Dressing apraxia?

Answer 30

• observe patient when attempting to dress

Question 31

How do we assess for Poor spatial Judgement?

Answer 31

• ask patient to determine whether an object is nearer, bigger, or round
  Verticality - hold up stick against plain background and ask whether patient indicates if upright?

Question 31

What is L (dom) Hemisphere - Ideomotor Apraxia?

Answer 31

• inability to imitate gestures/perform purposeful movements on command even if concept is fully understood

Question 31

An inability to carry out activities automatically or on command because patient no longer understands concepts or idea behind the act.

Answer 31

L (dom) Hemisphere - Ideational Apraxia