Card Set Information
What is a watershed infarct?
- where no defined area if the cause of a bleed. shared eg MCAand ACA
What is hemiplegia?
- complete loss of movement
What is hemiparesis?
What is aphasia?
- difficulty with language
What are possible primary impairements from stroke?
- motor- ataxic
- sensory- tactile, kinaesthetic, visual, vestibular,
- language- aphasia
- perceptual- congitive- slow processing, attention, memory
- behaviour- positive, negative
What causes mm weakness?
- decrease in descenging inputs to lower motor neuron
- decreased number of motor units activated
- decreased motor unit discharge rate
- dsrupted motor unit synchronisation
How will a pt present with hemiparesis?
- slowness in force generated
- altered length tension relationship
- deficient force output
: generation and sustained
- stroke pts can sustain a forced contraction
What are the usual patterns for hemiparesis weakness?
- usually UL flexors weaker than extension
What is dexderity?
- is the ability to carry out a motor task precisely, quickly, rationally and deftly with flexibility with respect to the changing environment
- hard to assess as it relies on strength
What are the presentationsof problems with dexterity?
- loss of smoothness
- indirect trajectories
- disrupted inter-jt coordination
What are ptterns of synergistic movements?
- both loss ofstrength and dexterity probably contribute to abnormal synergies
- actions are perormed in the most biomechanically effective manner given the impairements- response give coordination and strength comb
- flexor or extensorsynergies in both UL and LL
When people go to do a mvoemetn they auto go into flexor syngery, what is this movement?
- scapular elevation and retraction
- shoulder flexion and abduction
- elnow flexion
- frearm supination
When people go to do a mvoemetn they auto go into extensor syngery, what is this movement?
- scap protraction
- shoulder adduction and internal rot
- elnow extension
- forearm pronation
What are positive motor impairements?
- extensive motor activity- effor tone, iradation, assocatied reactions
What is spacticity?
- velocity dependent while moving jt
- develops over time (flaccid 4-6 weeks) but will develop over time
LMN- spasticity occurs sooner
Effort tone- trying so hard pt recruit everything
Irradation- no specific activation trying to activate on emm it spills over to the other mm
Associated reactions- eg when doing something else eg walking arm moves upinto contracted position
WHat are the positive motor impairments: Involventary movements disorders?
Sensory impairements what are you test?
- tactile and kinaethetic
- sensory loss is complex and mulitfactorial
- you cannot predict sensory recovery
- it common in > 60% of stroke pts
What are the tests used to assess tactile problems?
- texture discrimination
- 2 point discrimination
- sensory inattention (perceptual rivarly)
- light touch
What are the tests used to assess kinaesthetics?
- sense of movement
- sense of heaviness
- stereognosis (recognise objects being placed in hand)
- graphaesthis (sensation of writing on hand)
What are implications of sensory impairments?
- decreased ability to pick up and manipulate objects
- decreased ability to use an appropriate level of force during grasp and manipulation (esp without vision)
- dereased spontaneous use of hand because of lack of input
- implications for functional lower limb, or feel amount of wiehgt through it or detect mm contraction
- safety implications (wounds, burns)
- inability to integrate sensory feedback results in imapired ability to learn new motor skills
- learn non- use- may be nothing wrong withmotor control, pt doesnt have sensation and dont use it. Pt limb gets weak and brain- use it or lose it
- if you tie up a god arm they have to use a bad one
How can you tell if a pt has sensory impairements- vestibular?
- vertigo and nausea
- disorientation to gravity (pusher syndrome) = oreintation of vertical and favour bad side
Visual sensory imapirements
- incidence of homonomous hemianopia 8.3% in stroke survivors
- visuo- spatial neglect
Sesnory impairements: Vision picture
What are the primary impairements?
- sensory impairements
What are secondary MS impairments?
-length associated- contracture, stiffness
- use- asociated- disue atrophy, oedema, subluxation (missuse handling)
- pain- trauma induced (handling), injury induced (pt conflict self)
What is a contracture?
- loss of passive jt range, it involves shortening and stiffness
- mm immobilised in a shortene position demonstrated- a loss of scromeres in series, an increase proportion of connective tissue in mm
What mm are at risk of mm contractures?
- hip flexors
- neck mm
- wrist flexors
- finger flexors
Secondary MS Impairments: stiffness
- altered ratio of connective tissue to mm tissue
- increased number of actin-myosin cros links
- behaviour and type of extra-sacromeric proteins
- decreased connective tissue extensibility due to tissue dehydration
- decreased lubrication causing adhesions between collagen fibres
How can you prevent contracture?
- having adequate length
- even tho mm is stiff
What accors with mm atrophy?
- keep moving mm
How does mm atrophy occur?
- overtime with disuse
- motor unit changes
- decrease number of motor units
- decrease of type 2- fast twitch, phasic mm fibres- used for speed movts fatigue quickly
- increase number of type 1, slow twitch fibres
- change in recruitment order
- decrease mm cross- sectional area
- history on file
- subjective history and observation
- motor screen
- sensory screen
- functional tests (MAS)
- cranial nerves