Rehab - Stroke PDF

# Brain: - **PARTS**: Cerebrum, Cerebellum, Brainstem - **LOBES**: - **Parietal Lobe**: Sensory perception - **Temporal Lobe**: Emotions - **Occipital Lobe**: - **Frontal Lobe**: # Stroke: - **Clinical syndrome**: - **Persistent**: due to abnormal cerebral circulation...

# Brain: - **PARTS**: Cerebrum, Cerebellum, Brainstem - **LOBES**: - **Parietal Lobe**: Sensory perception - **Temporal Lobe**: Emotions - **Occipital Lobe**: - **Frontal Lobe**: # Stroke: - **Clinical syndrome**: - **Persistent**: due to abnormal cerebral circulation - **Neurological deficit**: # Arteries: - Feed blood into the brain. - **Brain needs oxygenated blood**: - **Internal carotid arteries (anterior)** - **Vertebral arteries (posterior)** - 2 pathways, so if one is compromised the other takes over. # Mechanisms: - **Ischemic stroke**: - **Hemorrhagic stroke**: # Risk Factor: - **Atherosclerosis**: - **Result in**: Ischemia (blockage) # Ischemic Cascade: - **Clot stops blood supply**: - **Ischemia**: Lack blood flow - **Release excess neurotransmitters**: - **Uncontrolled, large quantities**: - **Distrupt energy metabolism**: - **Too much**: Can't control - **Increased calcium ions and failure of neuronal membrane pump**: - **Formation of substances further damage**: - **Formation of blood clot/plaque in cerebral arteries/branches**: - **Dislodged blood clot (plaque formed elsewhere and into blood stream)** # Cerebral Thrombosis: - **Cerebral embolism**: # Haemorrhagic cascade: - **Primary nontraumatic CH**: → Ø face - **Atherosclerosis and hypertension**: - **Weakened small vessels**: Handle BP - **↑ BP**: - **Microaneurysms/arterial necrosis**: - **Bleeding**: - **↑ Micro tears in vessels**: ↑ fluid in space = intracranial pressure. - **Adjacent brain tissue displaced**: - **Compressed = ischemia**: # Blood leaks into brain tissue: # Categories: - **Major stroke**: - **Deteriorating**: - **Yang stroke**: - **Transient ischemic attack**: # Transient Ischemic Attacks: - **Involve retinal/cerebral ischemia**: - **Last longer than 24 hrs**: - **Residual brain damage**: - **A stroke**: Precursor for cerebral infarction/myocardial infarction. # Anterior Cerebral Artery Syndrome: - **Cerebrovascular accident in ACA**: - **Contralateral hemiparesis**: - **Impaired motor**: Lower extremity - **Contralateral hemisensory**: - **Impaired sensation**: # ACA Artery: - Supplies **medial frontal**: - **Primary Motor Cortex**: Reason for hemiparesis - **Parietal Lobe**: - **Primary Sensory Cortex**: Reason for hemisensory loss # Primary sensory cortex: - Receives sensory input from the opposite side of the body. # 2 Pathways Sensory (ascending): - **Posterior column pathway**: - **2nd order neurons will cross over to the other side of medulla**: - **Sensation**: - **Anterior column pathway**: - **Crossover happens at spinal cord**: - **Touch/temp**: # 2 Pathways Motor (descending): - **Anterior corticospinal pathway**: - **Upper motor neurons (CNS) cross to opposite side of spinal cord**: - **At each SC level before synapsing with interneurons (lower motor neurons**: - **Lateral corticospinal pathway**: - **UMN cross at opposite side of medulla before descending**: - **Controls limb movements**: # Middle cerebral artery syndrome: - **Most common site for blockage**: - **Cerebral edema**: - **Contralateral hemiparesis**: - **Contralateral sensory loss** (face + UE more than LE): # Face and UE more than LE: - **MCA supplies blood to frontal/temporal/parietal lobes**: - **Controls face movements/VE**: # Frontal lobe: - Primary Motor cortex # Parietal lobe: - Primary sensory cortex # Aphasia: - **Wernicke's (left)**: - **Receptive speech impairment**: - **Affects comprehension/speech**: - **Affiliated with stroke**: - **Damage posterior to central fissure**: - **Broca's**: - **Motor/speech impairment**: - **Non-fluent aphasia**: - **Damage anterior to central fissure**: - **Limited vocab/issue with thoughts → speech**: # Homonymous Hemianopia: - **Visual field cut in ½**: - **An eye issue, but connection to the other eye**: # Functional Independence Measure: - **Scale to measure damage**: - **Measure functional skills**: 1-? - **1= total assist**: - **7= complete independence**: # Posterior association areas: - **Somatosensory association area**: - **Visual association area**: - **Auditory association area**: # Perceptual impairments: - **Posterior association areas**: - **Lesion**: Agnosia - **Inability to recognize incoming information**: - **Tactileasterognosis**: Recognize forms by handling - **Middle cerebral artery**: - **Prosopagnosia**: Difficulty naming people on sight. - **Posterior cerebral artery**: - **Compromised memory**: # Cognitive Impairments: - **Executive functioning**: - **Enables purposeful behaviors**: - **MCA**: Supplies lateral frontal cortex - **ACA**: Supplies frontal cortex: inc. executive - **Lesion & prefrontal cortex**: - **Impulsive thinking**: - **Impaired judgment**: - **Appraise environment**: - **Association cortex**: - **Put together streams of info via different senses**: - **Cognition**: - **Visual association**: - **When damaged, still see things**: - **Recognize as objects**: - **Auditory associative**: - **When damaged, perceptual and conceptual processing of sound impaired**: - **Somatosensory association**: - **Neurons here are responsive to somatosensory and visual stimuli**: - **Lesions**: Attentional deficit to tactile/visual stimuli delivered contralateral to lesion site. - **Neglect**: Ignore ½ of body and space. # Posterior Cerebral Arteries: - **Supplies oc/med/inf temporal lobe**: - **Temporal lobe ischemia**: Amnesia - **Also supplies hypothalamus**: - **Hypothalamus**: Memory # Dysphagia: - **Impaired swallowing**: - **Patients with medullary brainstem lesions**: - **Can see this in vertebrobasilar artery syndrome**: - **Swallowing 3 cranial nerves**: 9, 10, 12. # Pain: - **Thalamic nuclei**: Organize/amplify signals to cortex. - **PCA supplies most of thalamus**: - **Stroke & PCA can cause central post stroke thalamic pain syndrome**: - **Hyperalgesia**: Reg pain escalated - **Allodynia**: Normal touch = pain. # Lacunar Stroke Syndromes: - **Penetrate brains deep structures**: - **Associated with diabetes/↑ BP**: # Symptoms: - **Pure motor hemiplegia**: - **Weakness/paralysis on one side of body** (pons/internal capsule). - **Pure sensory stroke**: - **Loss of sensation on one side of body** (lesion of thalamus). - **Consciousness/language impairment**: As higher order cortical areas are preserved - **Faster recovery**: Neurological compromise is less. # Paresis: - **Results from: UMNL**: - **Weakness of voluntary movement**: - **A muscle tone**: - **Non antigravity muscles weakened**: - **Antigravity muscles**: Tone is ↑, spasticity, stabilization. # Arms: - **Flexed, pronated**: *UMNS CNS, ASC* # Legs: - **Extended**: # Hyperactive reflex: - **Passive stretch**: *LMNS PNS, VSC* # UMNL: - **Neural pathway above anterior horn cell of spinal cord**: - **Stroke causes lesion which impacts UMN**: # Direct motor control: - **Corticospinal tract**: - **UMN & collaterals to brainstem**: - **Motor nuclei**: - **Pathway starts at cerebral cortex**: - **Terminates on lower motor neurons in SC**: - **Influences distal**: Hand/foot - **Lateral**: Limb movements - **Anterior**: Proximal muscles (trunk) # Indirect Motor Control: - **Corticospinal tract**: - **Influences UMN that innervate distal extremity muscles**: - **Hand/foot**: - **Medullary control brainstem motor centres by collateral motor neurons**: - **Influences perf amount of tone**: # Spasticity: - **More tone than normal**: Impacts movement. # Rate dependent: - **UMNS or longer inhibit LMNS**: # Hypertonicity: - **The faster you try to move a joint, the greater resistance felt**: # Rigidity: - **Greater response to knee jerk**: - **Overactive reflex arc**: # Knee Jerk reflex: - **Tendon is tapped, causes stretch**: - **Stretch recognized by sensory receptors**: - **Sends message to spinal cord**: - **SC connects with motor neurons**: - **Sends message to muscle (contract)**: - **Lower leg gets kicked forward** # Characteristics of Spasticity: - **Resistance to passive movement**: - **Faster you move, ↑ resistance**: - **"Clasp-knife"**: - **Lots of resistance but then drops off at certain point**: # Stiffness: - **Increased muscle tone**: - **Hyperactive stretch reflex**: # Rigidity: - **Type of hypertonicity**: - **Rate/rare dependent**: - **Muscle tone remains consistent throughout the entire range of motion**: - **Speed matters**: - **Associated with basal ganglia**: # Motor impairment stroke sequence: - **Flaccidity (immediately after stroke)**: - **Hypotonicity (short lived)**: - **Immediately after stroke because of cerebral shock**: - **Spasticity**: - **Spasticity develops in majority**: - **Abnormal limb synergies**: - **Relative Recovery**: - **Some voluntary control of synergies**: - **Spasticity declines**: - **More control over challenging movements**: # Abnormal muscle synergies: - **Inability to move one part of limb without producing movement in other parts of limb**: # Review anatomical terms: - **Shoulder**: - Flex, Ext, ABd, ADd, Ext Rot, Int Rot, Protraction, Retraction - **Elbow**: - Flex, Ext, Pronate, Supinate - **Wrist**: - Flex, Ext, Ulnar/Radial Dev - **Hip**: - Flex, Ext, ABd, ADd, Ext Rot, Int Rot - **Knee**: - Flex, Ext - **Ankle**: - Plantar Flexion, Dorsi Flexion, Inversion, Eversion # Abnormal synergy patterns (LE): - **Flexion**: - **Everything flexed (UE)** - **Hip**: Flexion, Abduction, External Rotation - **Knee**: Flexion - **Ankle**: Dorsiflexion - **Toe**: Dorsiflexion - **Extension**: - **Hip**: Extension, Adduction, Internal rotation - **Knee**: Extension - **Ankle**: Plantarflexion (down) - **Toe**: Plantarflexion (down) # Abnormal synergy patterns (UE): - **Flexion**: - **Scapular retraction**: - **Shoulder blade pulled backward**: - **Shoulder**: - **Abduction**: - **External rotation**: - **Elbow**: Flexion - **Forearm**: Supination - **Wrist and fingers**: Flexion - **Extension**: - **Scapular protraction**: - **Shoulder**: Forward - **Arm rotates**: Inwards.