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Stroke (Examination (Postural Control and Balance (The Berg Balance Scale…
Stroke
Etiology
Atherosclerosis
Ischemic Stroke
Cerebral Thrombosis
Cerebral Infarction (Atherothrombotic Brain Infarction (ABI)
Cerebral Embolus (CE)
Hemorrhagic Stroke
Intracerebral hemorrhage (IH)
Cerebral Hemorrhage
Subarachnoid hemorrhage (SH)
Arteriovenous Malformation (AVM)
Pathophysiology
Ischemic cascade
Cerebral Edema
Clinical Signs of Elevated Intracranial Pressure (ICP)
Decreasing level of consciousness (stupor or coma)
Widened pulse pressure
Increased HR
Irregular respiration (Cheyne-Stokes respirations)
Vomitting
Unresponsive pupils
Papilledema
Management Categories
Transient Ischemic Attack (TIA)
Vascular Conditions
Anterior Cerebral Artery Syndrome (Table 15.1)
Lacunar Strokes
Middle Cerebral Artery Syndrome (Table 15.2)
Internal Carotid Artery Syndrome
Posterior Cerebral Artery Syndrome (Table 15.3)
Vertebrobasilar Artery Syndrome (Table 15.4)
Prevention
Stroke Warning Signs (Box 15.1)
Sudden numbness or weakness on the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking, or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
Examination
Cranial Nerve Integrity
Sensation
Box 15.3 Elements of the Examination of the Patient with Stroke
Flexibility and Joint Integrity
Motor Function
Stages of Motor Recovery (Box 15.4)
Tone
Reflexes
Voluntary Movement
Coordination
Motor Programming
Muscle Strength
Postural Control and Balance
The Berg Balance Scale (BBS)
The Performance-Oriented Mobility Assessment (Tinetti)
The Functional Reach Test (RT) and Multidirectional Reach Test (MDRT)
The Timed Up and Go Test (TUG)
The Clinical Test for Sensory Interaction in Balance (CTSIB)
The Postural Assessment Scale for Stroke Patients (PASS)
The Trunk Impairment Scale
The Function in Sitting Test (FIST)
Ipsilateral Pushing
Gait and Locomotion
Gait Deviations Seen Following Stroke (Box 15.5)
Integumentary Integrity
Aerobic Capacity and Endurance
Functional Status
Stroke Specific Instruments
Fugl-Meyer Assessment of Physical Performance (FMA)
Stroke Rehabilitation Assessment of Movement (STREAM)
Chedoke-McMaster Stroke Assessment
Stroke Impact Scale (SIS)
Self-report measure assess function and QOL
Pharmacological
Medications Commonly Used to Treat Patients with Stroke (Box 15.2)
Thrombolytics
Anticoagulants
Antiplatelet therapy
Antihypertensive agents
Angiotensin II receptor antagonists
Anticholesterol agents/statins
Antispastics
Anticonvulsants
Antidepressants
Goals and Outcomes
Physical Therapy Interventions
Strategies to Improve Motor Learning
Strategy Development
Feedback
Practice
Interventions to Improve Sensory Function
Interventions to Improve Flexibility and Joint Integrity (p682)
Positioning Strategies to Reduce Common Malalignment (Box 15.8)
Safe Self-ROM activities
Arm cradling
Table-top polishing
Sitting, patient leans forward and reaches both hands to floor
Supine, hands clasped together and placed behind he head, elbows fall flat to the mat
Interventions to Improve Strength
Exercise Precautions
Managing Spasticity
Interventions to Improve Movement Control
Task-Oriented Reaching and Manipulation
UE Weight-bearing as a Postural Support
Constraint-Induced Movement Therapy (CIMT)
Simultaneous Bilateral Training
Electromyographic Biofeedback
Electrical Stimulation
Neuromuscular Electrical Stimulation (NMES)
Robot-Assisted Therapy
Management of Shoulder Pain
Interventions to Improve Functional Status
Bed Mobility
Sitting
Sit-to-Stand and Sit-Down Transfers
Standing
Transfers
Interventions to Improve Postural Control and Balance
Force Platform Biofeedback
Pusher Syndrome
Interventions to Improve Gait and Locomotion
Task-Specific Overground Locomotor Training
Locomotor Training (LT) using BW Support and Motorized Treadmill Training
Robotic-Assisted LT
Functional-Electrical Stimulation (FES)
Orthotics and Assistive Devices
Wheelchairs
Interventions to Improve Aerobic Capacity and Endurance
Exercise Precautions
BP, HR, and RPE should be taken initially, during, and after each exercise
Medical Diagnosis of Stroke
History and Examination
Test and Measures
The National Institutes of Health Stroke Scale (NIHSS)
Biomarker assays
IL-6
Matrix metalloproteinase (MMP-9)
Markers of glial activation
Cerebrovascular Imaging
Computed Tomography (CT) Scan
Magnetic Resonance Imaging
Magnetic Resonance Angiography (MRA)
Doppler Ultrasound
Arteriography and Digital Subtraction Angiography
Neurological Complications and Associated Conditions
Altered Consciousness
The Glasgow Coma Scale
Normal
Lethargy
Obtundation
Stupor
Coma
Disorders of Speech and Language
Aphasia
Fluent aphasia (Wernicke's)
Nonfluent aphasia (Broca's)
Global aphasia
Dysarthria
Dysphagia
Cognitive Dysfunction
Attention disorders
Immediate and short-term memory impairments
Confabulation
Confusion
Perservation
Impairment in executive function
Multi-infarct dementia (vascular dementia)
Delirium
Mini-Mental Status Examination (MMSE)
Altered Emotional Status
Pseudobulbar Affect (PBA)
Apathy
Euphoria
Depression
Anxiety
Hemispheric Behavioral Differences
Left Hemisphere lesions (right hemiplegia)
difficulty in communication and processing information
Cautious, anxious, disorganized
Right hemisphere lesions (left hemiplegia)
difficulty in spatial-perceptual tasks and grasping whole idea of a task
Quick and impulsive
Hemispheric Differences Seen Following Stroke (Table 15.5)
Perceptual Dysfunction
Unilateral neglect
Anosognosia
Somatoagnosia
Right-left discrimination
Finger agnosia
Anosoagnosia
Figure-ground discrimination
Form discrimination
Spatial relations
Positions in space
Topographical disorientation
Agnosia
Seizures
Bladder and Bowel Dysfunction
Cardiovascular and Pulmonary Dysfunction
Osteoporosis and Fracture Risk
Fall risk
Risk Factors
Hypertension
140/90 mm Hg or higher
Heart Disease
Disorders of Heart Rhythm
Diabetes Mellitus (DM)
Women
Early Menopause (before 42 years of age)
Use of estrogen
Pregnancy, birth, and first 6 weeks postpartum
Preeclampsia
Modifiable Risk Factors
Cigarette smoking
Physical inactivity
Obesity
Diet
Sleep apnea
End stage renal disease and chronic kidney disease
Framework for Rehabilitation
Acute Phase
Subacute Phase
Chronic Phase
Outpatient
Home care
Patient/Client-Related Instruction
Discharge Planning
Recovery and Outcomes