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Acute Rehab > case study 5 - CVA > Flashcards

case study 5 - CVA Flashcards

1
Q

What is the circle of willis

A

A ring of blood vessels connecting the anterior and posterior circulations of the brain and providing important communication between them.

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2
Q

what are the arteries of the brain

A
  • right and left carotid arteries
  • Anterior + posterior cerebral artery
  • Middle cerebral artery
  • Anterior communicating artery
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3
Q

what is diabetes melititus

A
  • known as diabetes where the insulin in your body is affected (can be type 1 or 2)
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4
Q

what is type 1 diabetes

A

– a lifelong condition where the body’s immune system attacks and destroys the cells that produce insulin.

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5
Q

what is type 2 diabetes

A

– where the body does not produce enough insulin, or the body’s cells do not react to insulin properly.

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6
Q

symptoms of diabetes mellititus

A
  • Increased urination often at night
  • Blurry vision
  • Lack of energy/fatigue
  • Tingling/numbness in hands/feet
  • Delayed wound healing.
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7
Q

where is insulin produced

A
  • in the pancreas
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8
Q

what is the glasgow coma scale

A
  • used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients
  • score of 13-15 = mild
  • score of 3-8 = severe
  • looks at visual, verbal and motor reponse
  • could also use AVPU method
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9
Q

what are the phases of gait

A
  • initial contact
  • loading response
  • mid stance
  • terminal stance
  • pre swing
  • initial swing
  • terminal swing
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10
Q

what is the middle cerebral artery

A
  • allows for oxygenated blood to glia cells (important for movement)
  • branches directly from the internal carotid artery and consists of four main branches, M1, M2, M3, and M4.
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11
Q

risk factors of stroke

A
  • smoking
  • obesity
  • high blood pressure
  • decreased physical acitivity
  • diabetes
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12
Q

name for high blood pressure

A

hypertension

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13
Q

what is normal blood pressure

A

120/80

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14
Q

risk factors of high blood pressure

A
  • poor diet
  • family history
  • obesity
  • lack of exercise
  • increase salt in diet
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15
Q

what is postural hypertension

A

an increase in the blood pressure upon assuming an upright posture.
- may cause fatigue
- fainting

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16
Q

what is tone

A
  • steady state of tension in muscles even at rest
  • high tone = stiffness in movement
  • low tone = muscles are floppy /flaccid
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17
Q

what is hypertonia

A
  • high muscle tone
  • stiffness to movement
  • can lead to contractures
18
Q

what is hypotonia

A
  • low muscle tone
  • flaccid/ heavy to move
  • may affect their balance
19
Q

what controls muscle tone

A
  • cerebellum
  • extraperimidal asecnding tracts (rubrospinal tract)
20
Q

what is the reason for decrease in muscle strength following stroke

A

due to disruption in communication between brain and muscles, corticospinal tract is disrupted, decreasing strength and tone as stroke is an upper motor neurone disease.

21
Q

what medication is given for hypertension

A

most common is pistril

22
Q

what muscles may be affected on his upper and lower left side

A

upper:
- bicep, tricep, deltoids, pectoralis major, wrist flexors +extensors
lower:
- quadriceps, hamstrings, hip flexors (psoas major, iliacus), glutes, gastrocnemius, tibialis anterior

23
Q

what causes foot drop

A
  • perineal nerve affected by stroke
  • low tone in tibialis anterior and gastrocnemius
24
Q

what is shoulder sublaxation

A
  • occurs when the humerus partially slides in and out of place quickly
  • when assessing ROM shoulder joints, check for sublaxation by performing flexion and holding inferior angle scaupla so it moves with joint.
25
Q

How would you assess left upper limb weakness?

A
  • using Oxford Grading Scale will assess the muscle strength
  • likely to be 5/5 for right upper limb
  • likely to be 3/5 (against gravity) for left upper limb
  • also assess tone whilst doing this, palpating muscle
  • likely to feel softer muscle in left side
  • ensure to take into account shoulder sublaxation, checking for pain
26
Q

How would you treat left upper limb weakness?

A
  • begin with active assisted exercises grasping hands performing extension, flexion
  • use weight bearing techniques
  • start with placing hands either side of body shifting weight onto each side
  • progress to all four kneeling shifting weight
27
Q

How would you assess left lower limb weakness?

A
  • using Oxford Grading Scale will assess the muscle strength
  • likely to be 5/5 for right lower limb
  • likely to be 3/5 (against gravity) for left lower limb
  • also assess tone whilst doing this, palpating muscle
  • likely to feel softer muscle in left side
28
Q

what evidence is there for treatment of upper limb weakness?

A
  • Zisi et all 2022
  • Explain aims, experiment, findings and conclusions
  • weight bearing exercises shown to help increase upper limb movement and grasping strength (particuaraly extension).
  • active assisted grasping
  • sit on edge of bed and perform sit and reach
29
Q

How would you treat lower limb weakness?

A
  • use a ball and ask patient to roll it with their foot up and down, if finding easy then ask them to bridge up and do the same
  • sit and reach also helping with balance, task specifity (mention Hasset 2023)
  • weight bearing techniques
  • progress to standing holding onto edge of plinth shifting weight from left to right
30
Q

what evidence is there for treatment of lower limb weakness?

A
  • Kim et al
  • Explain aims, experiment, findings and conclusions
  • weight bearing exercises shown to help increase upper limb movement and grasping strength (particurly extension).
  • if this helps with upper limb it should be benificial for lower limb.

HASSET ET AL
- task specific excerises once 3/5 strength

Chang et al -
5STS test good rather then 30STS AND 6MW when looking at breathlessness and imrpoved strength of lower limb

31
Q

how would you assess left foot drop?

A
  • sensation, proprioception and coordination in foot.
  • manual muscle testing: dorsiflexion (Hislop et al. 2013)
  • get patient to sit on edge of plinth with feet hanging down
  • sit on stool opposite and palpate tibialis anterior, other hand resistance onto dorsal foot
  • ask patient to dorsiflex (tests with gravity as resistance 3/5)
  • if able then move to 4/5
  • if 5/5 the full ROM should be done or end range held.
  • likely to be 3/5
  • assess patients gait using WZF progress to stick
32
Q

how would you treat left foot drop?

A
  • 3/5 perform dorsi flexion, foot pumps hourly
  • progress prescribe strengthening exercises for tibialis anterior to increase rom in dorsi-flexion
  • provide patient with a foot brace for extra support then splint and assess gait with this using stick.
33
Q

how would you assess sensation

A

use a peice of tissue and lightly brush the area of skin, patient closes eyes and tells you where
do unaffected side first

34
Q

how would you assess proprioception

A

holding onto the distal region of toes or finger laterally, bring it up and down and patient closes eyes telling whether it is up or down

35
Q

how would you assess coordination

A

touch your nose then my finger
rub your heel onto your contralateral shin

36
Q

what evidence is there supporting the importance of task specificity

A

Hasset 2023
- says mobilization with task specifity is important once patient can move against gravity

37
Q

what are the risk factors of strokes

A
  • high blood pressure
  • heart disease
  • smoking
  • diabetes
  • poor diet
  • gender (most common/higher risk in females)
  • brith control
38
Q

what is spactsity

A

muscles excitability, involuntary

39
Q

what do NICE guidelines say about stroke

A
  • NICE guidelines (2023) stroke patient should be offered rehab 3 hours a day, on at least 5 days of the week, and cover a range of multidisciplinary therapy including physiotherapy, occupational therapy and speech and language therapy.
40
Q

ischemic stroke

A

ischaemic – where the blood supply is stopped due to a blood clot

41
Q

haemorrhagic

A

haemorrhagic – where a weakened blood vessel supplying the brain bursts.

Acute Rehab (7 decks)

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