Case Study Ax

what is an ischaemic stroke

blood supply is blocked to a region of the brain

causes of an ischaemic stroke

thrombus or embolus

factors of a thrombus forming

carotid dissection, heart damage, heart conditions, large artery disease

process of an ischaemic stroke

blood clot forms, moves to L MCA, blocks glucose and oxygen supply, causes cell damage which releases DAMPS causing inflammation, increasing intracranial pressure and causing further damage to surrounding cells

how ischaemic stroke is diagnosed

clinical assessment and scans (CT and MRI)

how will an ischaemic stroke appear on scans

hypodense (black)

how does a haemorrhagic stroke appear on scans

hyperdense (white)

what is the middle of the ischaemic stroke, a cluster of necrotic cells

ischaemic core

what is the outer region of the stroke, cells that may survive

penumbra

what is a PACS

partial anterior circulation stroke, affecting 2/3 categories

what are the 3 categories of anterior stroke impairments

sensorimotor, visual and higher cortical dysfunction

what sensorimotor impairments are associated with L MCAS

right hemiparesis and paraesthesia, mostly in face, arm and hand

what visual impairments are associated with LMCAS

right homonymous hemianopia

what higher cortical dysfunction happens with LMCAS

aphasia and motor praxia

what is aphasia

inability to form language

receptive aphasia

Wernicke’s area is impaired causing a word salad

expressive aphasia

Broca’s area is impaired causing broken speech

what is motor apraxia

difficulty planning and initiating movements

what general impairment in higher cortical dysfunction is associated with LMCAS

issues with language, planning and processing

treatment of ischaemic stroke

thrombectomy, thrombolysis, thrombolystics and anti-coagulants

clinical course of ischaemic stroke

acute, sudden onset with lng healing time and likely becoming chronic

stages of stroke healing

acute (3 weeks), sub-acute (3 weeks to 6 months), chronic (>6 months)

types of stroke recovery

spontaneous biological recovery, behaviour restoration/true recovery, compensation/substitution

spontaneous biological recovery

period of heightened recovery of behaviours early after stroke

behaviour restoration/true recovery

return towards normal patterns of motor control with neural repair

compensation/substitution

learning new approaches compared to pre-stroke behaviour

trunk control

maintaining COM over BOS for functional movements and postural adjustments

movements required for reach, grasp and manipulation

trunk and scapula stability, shoulder flexion, elbow extension, hand dexterity

possible impairments of reach, grasp and manipulation

trunk and scapula fractionation, shoulder pain, shoulder and elbow fractionation, long finger flexor spasticity, loss of wrist and finger fractionation, loss of sensation, loss of ROM of IP joints/wrist extension

what is a synergy

muscles in a limb move all joints in the same direction

what synergy is common in the UL

flexor

what synergy is common in the lower limb

extensor

flexor synergy in the UL

shoulder elevation and retraction

GHJ abduction and external rotation

elbow flexion and supination

wrist flexion

finger and thumb flexion and adduction

general fractionation assessment

1. initiate movement

2. movement in synergy

3. small single joint out of synergy

4. 2 joint control

5. distal single joint control

6. 3 joint contro

fractionation assessment of upper limb

1. movement in arm

2. hand to face then opposite knee

3. isolated elbow flexion

4. pronation/supination in 90º elbow flexion/ 90º shoulder flexion and elbow extension

5. thumb extension/abduction, finger extension

6. shoulder flexion, elbow extension, wrist/finger/thumb movement

specific upper limb motor treatment

closed chain shoulder adduction, abduction and flexion

add on elbow movements, then wrist

kinaesthesia pathway

dorsal column system

what is kinaesthesia

joint position and movement sense

how to assess kinaesthesia

move the joint and ask whena nd which way

discriminative touch pathway

dorsal column system

what is discriminative touch

light touch

assessing discriminative touch

light touch with a tissue, ask wehen and where

nociceptive touch pathway

spinothalamic tract

assessing nociceptive touch

prick with a sharp object, ask where and when

types of sensation treatment

part of motor treatment, electrical stimulation, sensory input

how is sensory treatment part of motor treatment

increasing sensory awareness and stimulation

how to perform sensory input as sensory treatment

vary the stimulus type and area stimulated to engage the person’s awareness

physiotherapist’s role in stroke rehab

rehab motor and sensory function, relearn functional movements, return to ADLs and PADLs, continuing strengthening and balance training, education, assess functional

short term goals

independent ambulation and PADLs

medium term goals

stairs, return to work, gardening, swimming

long term goals

lifeguarding