Questions and Answers
What is the primary cause of an ischaemic stroke?
Which symptom is most commonly associated with stroke?
What distinctive behavior is associated with right-sided brain injury?
Which of the following is NOT a common effect of stroke?
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In what way do strokes affect cognitive functions?
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What characterizes a haemorrhagic stroke?
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What is a primary physiological change observed in patients post-stroke?
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Which side effects are observed more commonly with left-sided brain injury?
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What is a common cause of shoulder pain in stroke survivors?
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Which intervention is supported by weak recommendations for managing shoulder pain in stroke survivors?
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What is a potential mechanical consequence of poor motor control when walking after a stroke?
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Which of the following conditions is often associated with knee hyperextension in stroke survivors?
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Which intervention has strong recommendations for improving strength in stroke survivors?
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What is a key reason for the development of shoulder pain in individuals following a stroke?
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What should be considered when creating an exercise program for stroke survivors?
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Which of the following is NOT recommended for managing shoulder pain in stroke survivors?
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Which factor does NOT contribute to knee hyperextension in individuals recovering from a stroke?
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What can complicate rehabilitation efforts in stroke survivors with shoulder pain?
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Study Notes
Aetiology of Stroke
- Stroke is a sudden loss of brain function due to restricted blood flow, leading to cell death.
- Two main types of stroke:
- Ischaemic Stroke: Caused by a blockage (usually a clot) in a blood vessel supplying the brain.
- Haemorrhagic Stroke: Results from the rupture of blood vessels in the brain.
- Common cardiovascular risk factors often underlie strokes.
Common Effects of Stroke
- Muscle weakness and sensory deficits on one side of the body.
- Spasticity and changes in muscle tone or synergies.
- Impaired balance and coordination.
- Increased fatigue.
- Difficulties with speech and swallowing.
- Visual impairments or changes.
Hemispheric Responsibilities
- Right hemisphere injuries lead to perceptual deficits and impulsive behavior.
- Left hemisphere injuries cause speech difficulties and cautious behavior.
- Both sides can affect memory and cognitive functions.
Case Study: Ben
- 52-year-old male recovering from stroke, experiencing left shoulder pain.
- Aims to return to work involving extensive computer use.
- Interested in using an exercise bike for fitness.
Clinical Presentation of Shoulder Pain
- Approximately 50% of stroke survivors experience shoulder pain due to hemiplegia.
- Common cause: Glenohumeral joint subluxation due to rotator cuff weakness and changes in tone.
- Gravity, poor positioning, and improper handling during transfers can worsen shoulder pain.
- Immediate post-stroke flaccidity may lead to pain from subluxation, and later spasticity can exacerbate muscle imbalances.
Management Strategies for Shoulder Pain
- Electrical Stimulation: Weak recommendation for pain management.
- Steroid Injections: Weak recommendation for pain reduction.
- Botulinum Toxin A: Weak recommendation to alleviate pain and spasticity.
- Taping: Weak recommendation to manage shoulder pain.
- Acupuncture: Weak recommendation when combined with comprehensive rehabilitation.
Knee Mechanics Post-Stroke
- Poor motor control following stroke can result in knee hyperextension, affecting 20-68% of individuals walking post-stroke.
- Knee hyperextension leads to impaired walking speed, decreased efficiency, and potential knee pain.
Underlying Causes of Knee Hyperextension
- Weakness in knee extensor muscles.
- Spasticity in knee flexors.
- Altered hip joint mechanics.
- Muscle retraction in the paretic limb.
- Limited ankle mobility/strength.
- Proprioceptive disorders.
Evidence-Based Interventions for Knee Pain
- No specific clinical guidelines for knee pain management in stroke survivors.
- Exercise: Individualized programs recommended for improving strength.
- Proprioceptive Techniques: Moderate evidence supports their use for motor control, including kinesiotaping and gait training.
- Orthoses: Limited evidence for their effectiveness in addressing knee issues.
Biopsychosocial Approach
- Links motor impairments to function, emphasizing that improvements in strength do not automatically translate to functional gains.
- Understanding how damage in the nervous system produces various impairments aids in developing targeted rehabilitation strategies.
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Description
This quiz focuses on the application of clinical reasoning skills in the context of stroke as a model for nervous system impairment. You will explore the aetiology of stroke, understand common clinical presentation characteristics, and evaluate evidence for physiotherapy interventions through a case study. Engage with the material to deepen your understanding of stroke management in a neurological population.
