Week 1 Flashcards
(21 cards)
Stroke definition and pathophysiology
- Acute onset of neurological deficit, lasting >24 hours with a vascular cause
- Can be ischemic or haemorrhagic
Risk factors of strokes
Risk factors:
- older age
- Hypertension
- Diabetes mellitus
- Increased blood lipid levels
- Obesity
- Smoking
- Family history
- Male gender
Impairments of strokes
Primary: Sensori-motor Negative - Decreased strength - Decreased coordination - Decreased sensation Positive - Spasticity - Dystonia
Primary: non-motor
- Decreased vision
- Decreased speech/language
- Decreased perceptual function
- Decreased cognitive function
- Apraxia
- Behaviour
- Emotion
Secondary: motor
- Decreased mm length/joint stiffness
- Decreased fitness
- Decreased strength
- Learned non-use compensatory movements
- Swelling
- Pain
- Shoulder subluxation
- Soft tissue damage
Secondary non-motor
- Depression
- Fatigue
Dysarthria
Difficulty with articulation (motor problem)
Vision impairment terms
Hemianopia: loss of visual field on the side of the hemiplegia
Quadrantanopia: loss of a quadrant of the visual field
Aphasia/dysphasia
Difficulty with the spoken word (receptive, expressive, global)
Impairment of language
Dyspraxia/apraxia
Inability to plan/execute movements
Lability
excessive emotion
perception
ability to perceive and interpret sensory information
Agnosia
inability to recognise objects
Anterior circulation
The carotid system supplies most of the hemispheres and cortical deep white matter
Impairments:
- Decreased strength
- Decreased co-ordination
- Decreased sensation
- Spasticity
- Decreased vision
- Decreased speech/language
- Decreased perceptual function
- Decreased cognitive function
- Apraxia
- Behaviour
- Emotion
Posterior circulation
The vertebro-basilar system supplies the brain stem, cerebellum and occipital lobes
Impairments
- Decreased strength
- Decreased coordination
- Decreased sensation
- Spasticity
- Decreased vision
Higher cognitive functions tend to remain more intact (as it’s a more frontal and parietal lobe issue)
Dominant and non-dominant stroke
Most people have a dominant left hemisphere
Left hemisphere: language, analytical functions
Right hemisphere: awareness of body and visuo-spatial skills, attention
Anterior circulation stroke on dominant hemisphere impairments (L)
Primary:
- Decreased strength (R)
- Decreased co-ordination (R)
- Decreased sensation (R)
- Spasticity (R)
- Decreased vision (R - common to be right hemianopia)
- Decreased speech/language
- Cognitive function
- Apraxia
- Behaviour
- Emotion
Anterior circulation stroke on non-dominant hemisphere impairments (R)
- Decreased strength (L)
- Decreased coordination (L)
- Decreased sensation (L)
- Spasticity (L)
- Decreased vision (L)
- Perceptual function
- Cognitive function
- Behaviour
- Emotion
Behaviour characteristics from strokes that may impact learning
Left sided stroke (right hemiplegia)
- Good concentration
- Slow movement time
- Good performance
- Good carryover effect
- Realistic attitude
- Mood can be depressed, anxious, frustrated, can be labile
Right sided stroke (left hemiplegia)
- Poor/distractible
- Impulsive
- Erratic
- Poor carryover effect
- Unrealistic attitude
- May appear unmotivated, can be labile
Bamford classification
- TACS = total anterior
- PACS = partial anterior
- LACS = lacunar
- POCS = posterior
Code:
- S = syndrome
- I = infarct
- H = haemorrhage
TACS
Total anterior circulation stroke
All of the following three:
- Hemiplegia +/- sensory loss
- Hemianopia
- Cortical signs (e.g. cognitive, perceptual, aphasia)
Most serve stroke
PACS
Two of the following three…
- Hemiplegia +/- sensory loss
- Hemianopia
- Cortical signs (e.g. cognitive, perceptual, aphasia)
OR
- Isolated cortical dysfunction
OR
- Pure motor or sensory signs less severe than lacunar
LACS = lacunar
- Hemiplegia +/- sensory loss - affecting at least 2/3 of face/arm/leg
- No cortical signs
- occlusion of deep perforating arteries
POCS = posterior circulation stroke
- Multitude of signs
- Can include the following
o Cranial nerve palsies
o Ipsilateral or bilateral motor and/or sensory impairments
o Eye movement disorders
o Isolated hemianopia
o Cerebellar deficits (ataxia)
