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STROKE - features and clinical management - Coggle Diagram
STROKE - features and clinical management
Motor Symptoms
Motor Pathways
motor information originates in
motor cortex in frontal lobe
main descending pathway is the
Cortico-spinal tract
in the medulla 80% of fibres cross
Synapses with the alpha motor neurone in the spinal cord
Peripheral motor nerve/lower motor nerve
sends the message to the muscle
Alterations in Tone
low tone - flaccidity
high tone - spacticity
Ataxia - lack of coordination
Weakness
Asymmetry
Loss of normal movement patterns
loss of postural adjustments - balence
Spasticity
Flexor pattern in upper limb
Shoulder elevation + retraction
Internal rotation of humorous
wrist + finger flexion
Elbow flexion and pronation
Extensor pattern in lower limb
Hip retraction + extension
Knee extension
Ankle plantarflexion + inversion
Sensory Symptoms
Sensory pathway
sensory messages are initiated in sensory receptors e.g. touch receptors, pressure receptors
transferred to the spinal cord via the sensory peripheral nerves - first order neurons
transmitted up the cortex via specific tracts - main tracts are dorsal tracts transmitting touch
synapse in the thalamus (sensory relay station) before going to the cortex
messages are perceived in the sensory cortex part of the frontal lobe
Sensory Impairment
Impaired cutaneous sensation
stereognosis
Proprioceptive impairment
Visual problems
Visual felid loss
Homonymous Hemianopia
Speech Symptoms
Dysarthria
Expressive Dysphasia
Damage to Brocas area
Usually associated with Rt Hemiplegia
lose ability to produce speech
Receptive Dysphasia
Damage to Wernikes area in temporal lobe
Lose ability to understand speech
Global aphasia
Cognitive Symptoms
Perceptual Problems
Agnosia (Inability to recognise objects when using a specific sense)
Astereognosis (feel)
Visual Agnosia (sight)
Auditory Agnosia (hear)
Depth perception (not allowed to drive immediately following stroke)
Apraxia (difficulty with motor planning to perform a task or movement)
Anosagnosia (lack of self-awareness)
Inattention/neglect
more common with left hemiplegia
patients fails to attend to stimuli from the left side
poor prognosis if persists
results in functional problems - self care, eating, dressing, walking
Other related disorders
Emotion
Dysphagia - delay/ absent swallow reflex
Incontinence
Secondary MSK problems
Balance/ gait problems
Functional difficulties
Social problems
Physiotherapy Treatment
Primary goals are to prevent complications, minimise impairments and to maximise function
Assessment
Identification of problems
Clinical reasoning
goal setting
objective outcomes
Choice of Rx method
Interdisciplinary input
Factors Affecting Recovery
Extent and nature of lesion
Integrity of collateral circulation
Pre-morbid status
Age - often older motivated people have better recovery than younger patients
Capacity of nervous system to reorganise
Environment
Motivation and Attitude of patient
Patient Experience
Co-existing conditions
Nutrition/ hydration
medication