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Clinical Manifestations and Assessment - Coggle Diagram
Clinical Manifestations and Assessment
Consciousness & Communication
Test
GCS
Speech and comprehension involving the functions of dominant hemisphere
Extensive brain damage may cause altered level of consciousness
Types of Language Deficits
Dysarthria
48% to 57%
Damage of central or peripheral (CN IX, X, XII).nerve system results in weakness, paralysis, or incoordination of the motor–speech system
Dysphonia
Disturbance in vocalization caused by vocal cord paralysis (CNIX & X)
Aphasia
30% to 36% of stroke cases, fluent, nonfluent, and global
Wernicke
Lesion site
The lesion of the posterior part of the left superior temporal gyrus
Characteristics
Inability to understand spoken or written language
Global
Lesion site
Damage over a large portion of the MCA
Characteristics
Lose almost all language function, both comprehension and expression. They cannot speak or understand speech, nor can they read or write
Broca
Lesion site
Anterior main division of the MCA that affecting h lower frontal cortex and anteroinferior parietal cortex (Brodmann’s area 44,45)
Characteristics
Difficulty in conveying thoughts through speech or writing.
The patient knows what he wants to say, but cannot find the words he needs.
Conduction aphasia( Afferent aphasia / repetition aphasia)
Lesion site
The lesion of arcuatefasciculus.
Characteristics
Nonsensical speech but poor repetition
Swallowing Dysfunction_Dysphagia
51% of patients with stroke
Lesion of CNIX & X due to brainstem or pseudobulbar and suprabulbarpalsy
Inability to chew/swallow or difficulty in chewing/swallowing
Common problem
Delayed triggering of the swallowing reflex
Reduced pharyngeal peristalsis
Reduced lingual control
Altered mental status
Altered sensation
Poor jaw and lip closure
Impaired head control
Poor sitting posture
Examination
Oral-motor function
Pharyngeal function
Functional status
Somatosensory Deficits
Relayed to the location and extent of the vascular lesion
Cortical lesion cause specific, localized area of sensory dysfunction
CPSP
10% of stroke patients
Lesion at any level of the somatosensory pathways cause diffuse involvement
Brain stem causes cross anesthesia
Sensory deficit on ipsilateral facile with contra-lateral trunk and limbs
Test
Superficial sensation
Deep sensation
Combined cortical sensation
Motor Function Deficits
Muscle tone and reflexes
Muscle performance
Hemiparesis
Voluntary movement patterns
Hemiplegia
Posture control
Movement coordination
Perceptual and cognitive function
Muscle Tone and Reflex
Flaccidity (hypotonicity)
The result of the lack of postural reflex activity against gravity, tonus is too low and no any movement.
Spasticity (hypertonicity)
Motor disorder
A velocity-dependentincrease in tonic stretch reflexeswith exaggerated tendon jerks
Hyperexcitabilityof the stretch reflex
Hyperreflexia
Reappearance of tonic reflex activity
ATNR
STNR
STLR
TLR
Test
MAS
DTR
Clinical indications of spasticity
An increase in deep tendon reflexes
Clonus
A repetitive rhythmic beating movement of a foot or wrist
Difficulty initiating movements
Impaired voluntary control of muscles
Difficulty relaxing muscles once a movement has ceased
Sensation of muscle tightness or pain
Changed movement patterns
Decreased range of motion
Hemiparesis & Hemiplegia
Weakness or loss of voluntary movement control
Recovery stages of Brunnstrom’s concept after stroke
Flaccidity without voluntary movement
Spasticity and hyper-reflexia
Synergies
Mass patterns of movement(obligatory synergy)
Isolated movement patterns
Test
Brunnstorm stage
Fugl-Meyer Assessment
MMT
Abnormal Reflexes
Associated reactions
Abnormal, involuntary, stereotyped movement patterns of the affected side
As phasic contractions lacking a background of postural control interfere with the efficient and effective movement
Unintentional movement of an involved limb is elicited when an intended action of uninvolved limb occurs
The same direction of movement in the contralateral UE, opposite movement in the LE
Associated Movements
Synkineticmovements
Normal movements of both limbs are seen when new and difficult tasks are learn
The activity of one limb reinforces the opposite side of body
Raimiste’sphenomenon
Same response is elicited in the opposite side when resistance is applied in the ipsilateral side