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Neuro Flashcards

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1
Q

What is a stroke ?

A

Defined as: A condition with “rapidly developing clinical signs of focal loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of a vascular origin.” (World Health Organisation)

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2
Q

Sign of a stoke ?

A

F- ace
A -rm
S- peech
T -ime (call 999)

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3
Q

How common are stokes?

A

the third most common cause of death in developed world after heart disease and cancer
29 – 50% of stroke survivors have some degree of dependency in ADL

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4
Q

Types of stroke ?

A

Ischaemic: blockage to the brain (plaques) in the cereberal blood vessels disrupts blood flow to the brain 80% common

Haemorrhagic: 20% leaking or burst vessel within the brain (primary or subarchnoid)

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5
Q

what is a Transient Ischaemic Attack?

A

Neurological deficit lasting up to 24 hours but then symptoms fully resolve Seen as a warning sign for impending stroke, Particularly if crescendo TIA’s seen (2 or more in 1 week) mini stroke with no lasting damage.

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6
Q

whta is a thrombolysis?

A

‘Clot busting’ medication given to reduce the effects of an ischaemic stroke. Protocol to be followed.Usually needs to be administered within 3 hours of incident

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7
Q

What are the three main parts of the brain ?

A
  1. cerebrum
  2. cerebellum
  3. brain stem
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8
Q

What is the circle of Willis

A

Brain circulation - the circle of Willis allows stroke victims to redict blood flow around the cerebral arteries (anterior, posterior and middle)

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9
Q

The 4 parts of the Cerebrum ?

A

largest part of the brain (left and right). There are 4 lobes:

>FRONTAL > PARIETAL

>TEMPORAL > OCCIPITAL

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10
Q

Left hemishere control ….

A

•numeric or scientific skills•use and understanding of language•spoken or written language

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11
Q

Right hemishphere control

A

•Controls muscles on left side and left visual field • musical and artistic awareness •space and pattern perception • recognition of faces and emotion •emotionalcontent of language •mental images to compare spatial relationships

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12
Q

Frontal lobes controls…

A
  • Motor centres •Motor aspects of speech
  • Behaviour and emotion (limbic system)•Cognition•Smell
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13
Q

Parietal lobe controls

A

•Receives and interprets sensory information•Body position•Touch and pressure, writing issues

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14
Q

Temporal lobe controls

A

•Memory• Sound processing •Language

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15
Q

occipital lobe controls

A

•Receives and interprets visual information

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16
Q

4 classes of strokes

A

TACS = Total Anterior Circulation Stroke

PACS = Partial Anterior Circulation Stroke

POCS= Posterior Circulation Stroke

LACS= Lacunar Stroke

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17
Q

Ataxia definition

A

co-ordination issues

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18
Q

TACS = Total Anterior Circulation Stroke

A

Ischemia: anterior/middle cerebral artery

Affecting Lobes: temporal, parietal and spacial

Clinical signs: Unilateral weakness &/or higher cerebral dysfunction, &/or Homonymous hemianopia

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19
Q

PACS = Partial Anterior Circulation Stroke

A

Ischemia: anterior/middle cerebral artery

Affecting Lobes: temporal, spacial and frontal

Clinical signs: Unilateral weakness (and/or sensory deficit) AND Homonymous hemianopia and higher cerebral dysfunction or higher cerebral dysfunction alone

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20
Q

POCS= Posterior Circulation Stroke

A

Ischemia: Posterior cerebral artery, posterior communicating artery

Affecting Lobes: Occipital lobe, brainstem

Clinical signs: Weakness/sensory deficit (can be bilateral), Cranial nerve palsy with ipsilateral weakness, Cerebellar dysfunction, Isolated homonymous hemianopia

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21
Q

LACS= Lacunar Stroke

A

Ischemia: Single occlusion of small deep vessel (lenticulostriate artery) branching from cerebral arteries

Affecting Lobes: Temporal, parietal , frontal, occipital or brainstem

Clinical signs: Unilateral weakness (and/or sensory deficit), Ataxic (co-ordination and speech) hemiparesis, No higher cerebral dysfunction

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22
Q

stoke risk factors

A

•Hypertension (systolic>160mmhg, diastolic>95)•Diabetes•Atrial fibrillation•High cholesterol•Family history•Ethnicity- more common in Black or South Asian ethnicity•Sickle cell disease•Women- during pregnancy and use of the combined contraceptive pill•Lifestyle:•Smoking, drinking excess alcohol, being overweight, poor diet, physical inactivity

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23
Q

Upper Motor Neurone Lesions negative features

Study These Flashcards
A

A stroke is an example of an upper motor neurone lesion.

•Develop in acute stages of stroke due loss of corticospinal tract activation•Muscle weakness, paralysis, decreased motor control, fatigueability

24
Q

Upper Motor Neurone Lesions (UMNL) positives

Study These Flashcards
A

•Positive Features•Spasticity,

clonus, hyperreflexia of deep tendon reflexes

25
**Upper Motor Neurone Lesions (UMNL) adaptive features**
•*Adaptive Features*•**Altered mechanical and functional properties of muscle**
26
The issues that patients with MS have?
Reduced balance, Ataxic gate Low tone in the trunk/pelvis Hypertonus of upper limbs Sensory impairment Reduced dorsiflexion (foot cleareance)
27
MS problems living with MS
Impaired cognition Incontinence/ sphincer dysfunction Increases symptoms with higher temperatures Depression Dysarthia (effected speech) Visual - diplopia, nystagmus
28
Aims of physiotherapy for MS
Provide aids Maintain/improve posture Manage fatigue/ improve aerobic function Education & promote self-management and physical activity Maintain/improve weight bearing
29
Explain the underlying pathology of an ishemic stroke?
loss of vascular supply causing cerebral dysfunction (24 hours +) from a thrombus or embolism causing hypoxia. Decrease in descending corticospinal ouput (motor cortex to spinal cord).
30
What are the effect of isheamic stroke on tone, movement and posture?
leads to a reduction in postural tone, muscle activity, on the opposite side of the body to the brain. Immobiliy will alos cause reduction in muscle tone and function.
31
Discuss the therapy activitities in sitting and standing that could be performing in the early stage of the stroke, discuss the biomechanical, physiological perspective ?
**weight bearing** increases muscle tone, **reduce BOS** so that muscle activity increases and tone, **proprioceptive** feedback with feet, **neuroplasciicity**, reaching for a ball in sitting, **balance** activities and **functional upper limb tasks**
32
Health and Safety considerations to minimise risk to patients
check **equipement** is safe, check **HR & BP** before, manual handing required, **prepare the environment** in advance, (support with plinth etc), clear instructions (ready, steady, STAND), **footwear,** **monitor fatigue**,
33
what outcome measures can you use for tone, posture and in a stoke,
***impairment meaures***:, **Oxford** strength Scale, **Ashworth** **tone scale**, active/passive **ROM,** berg balance scale or **Tinetti for activity based meaure**
34
Underlying pathology for **parkinsons disease** and how it affetcs tone, movement and function?
**Dopamine** (neurostranmitter) production in the **substanstia nigra** degenertates (progessive). Dopamine **activivates the exhibatory** pathway but **inhibits the inhibatory** pathway, **causing movement.** The circuit is disrupted that between the muslces that extend and relax causing **rigidity.**
35
Underlying pathology for **parkinsons disease** and how it affetcs tone, movement and function?
Parkinsons' disease patients have difficulty initiating movement, so if the task is cognitive it bypasses the automatic step, they will have freezing, shuffled gait and reduced arm swing, flexed posture, freezing, bradykinesia and tremor
36
Exercises for Parkinson's Disease bed mobility and difficulties managing movements (biologoical and physiologial perspective)
Exercises to improve **flexibity of the trunk,** neck and shoulders, **improve roll over in bed,** to move from lying to sitting, **hip bridging with lateral** movement to help with repositioning, upper limb stregthenning, **auditory, visual cues** to initiate movement **(bypass basal ganglia)**
37
steps to maximise safety with patients
bed height, therapist posture, appropriate footwear, risk assess, safe equipement, planned out, good communicate with staff and patient, clear instructions, ready, Steady, Stand.
38
Underlying pathophysiology of MS
Degeneration of the myelin shealth autoimmune disease, could be a vitamin D deficiency. Hardening (sclerosis) of the nerve axon. disrupts the ability iof the action potential to ‘jump’ the gaps of the nodes of ranvier. sensoy input issues & processing (cerebellum, brainstem) & output (motor, co-ordination, tone and weakness).
39
What activities can you do to improve balance, gait & strength in the lower limb for MS (biomechanical & physiological)
Use high kneeling proprioceptice work for **pelvic stability & control**, improve balance with ankle, hip or stepping stragagies, **Alter BOS**/surface or use sensory input to increase/decrease challenege. work on reducing ataxia. **Functional tasks** to decrease fatigue i.e, STS
40
patient/therapist health & safety considerations to ensure therapist safety MS session
is the patient safe in that position? do they have support ? parellel bars? or a wall?, walking aid, appropriate footwear (**NO SOCKS**), warm environment for MS you must have cool it down and have drinks.
41
Outcome measures for MS
Romberg, Tinetti gait and balance test, oxford sregth test (Impairment), MS impact scale, Rivermead (Activity) & MS QoL (participation)
42
Primary progressive MS
Progressive and relentless progression of the disease
43
Relapse-remitting MS
Acute worsening then remission, with residual neurological deficits
44
Secondary progressive MS
Relapse remitting followed by a progression of the disease
45
Progressive relapsing
Baseline progressive course with episodes of acute relapse followed by a return to baseline progressive course
46
MS definition
Autoimmune disease where the body attacks the healthy tissue of the Myelin sheath. This disrupts nerve signals down the myelin sheath and across the nodes or Ranvier disrupting the electrical signals
47
Causes of MS
Affects 1-500 people in the Uk. More common in whites (women) than black/Asians, age 15-45 but generally in 30-‘s. Can be lack of vitamin D, smoking and Epstein Bar virus, 2-3% can be genetic
48
Diagnosis of MS
Two attacks disseminating in space and time. Can be evidenced my MRI, spinal tap or visually evoked
49
Symptoms of MS
Fatigue, pain, incontinence, ataxia, spasms, muscle weakness, cognitive impairment, Diplopia, nystagmus
50
Medication for MS
Corticosteroids of MS inflammation of Myelin, plasmapheresis. Beta interferon slows down lesions -!: reduces relapses.
51
Physiotherapy for MS
Postural deficits, ataxia, improve balance, mobility, improve quality of life
52
Therapeutic activities in sitting and standing for a stroke to increase tone and function from a biomechanics and physiological perspective
Decrease BOS (wobble cushion), standing (weight bearing), improve proprioceptive feedback at the feet, more function position to encourage ADL (feeding), able to work on upper limb and balance ( reaching for cups)
53
h&S considerations when getting a stroke patient to do sitting and standing balance activities
Stable CV system HR & BP, aids required, patients cognitive ability, prepare the environment in advance, monitor fatigue, footwear be aware it catheter
54
Therapeutic exercises to improve bed mobility in Parkinson’s patients
Hip bridges, with lateral rotations, trunk rotations, upper limb strengthening to push off from lying to sitting and repositioning, auditory/visual cues
55
Parkinson outside measure
Timed you and go, Tinetti gait and balance, Berg balance test, 6m walk test, SF-36 QoL questionnaire and freezing and gait questionnaire

Neuro OSCE (1 decks)

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