Stroke (cva) , CVA, Cerebrovascular Accident, Transient Ischemic Attack

Physiotherapy Managment of Stroke, Types of Stroke, Classification of Stroke, Risk Factor of Stroke, Assessment of Stroke, Warning Signs of Stroke.

1. Stroke (CVA)
By: Dr. Shahbaz Ahmad PT
DPT [UIPT][UOL], MS-MSK-PT[UIPT][UOL]

2. LEARNING OBJECTIVES
Attheendoflecture,thestudentswillbeableto;
Describethestrokeitsepidemiology,riskfactors,
classificationofstroke,earlywarningsignsofstroke&
imagingtechniques
DescribetheroleofPTinassessingtheimpairments
associatedwithstroke
Identify&describestrategiesofinterventionsduring
rehabilitation.

3. WHAT IS STROKE?
StrokealsoknownasCerebrovascular
accident(CVA)orbrainattackisthesuddenloss
ofneurologicalfunctioncausedbyaninterruption
ofthebloodflowtothebrainanddeprivingbrain
tissueofoxygenandfood.Withinminutes,brain
cellsbegintodie.
Neurologicaldeficitstobeclassifiedasstrokeif
theymustpersistforatleast24hours.Otherwise
it’sTransientIschemicStroke(TIA)

4. Stroke –Risk Factors
Modifiable
Diet
Obesity
Smoking
Hypertension
Heart Disease
Lack of exercise
Diabetes Mellitus
Alcohol consumption
Non-Modifiable
Age
Gender
Race
Family history

5. ATHEROSCLEROSIS
It’samajorcontributoryfactorinCVAandcharacterizedby
plaqueformationthatdepositsinthearterialwallandcausing
narrowingofbloodvessels.
Themostcommonsiteforlesionsiscommoncarotidartery
atBifurcationsandConstrictionofarteries.
Etiology

6. Classification of Stroke

7. It’sthemostcommontypeandresultswhena
clotblocksorimpairbloodflow,deprivingthe
brainofessentialoxygenandnutrients
Ischemic Stroke
Cerebral ThrombosisCerebral Embolus
Itreferstotheformationof
abloodclotwithincerebral
arteriesthatleadto
occlusionofanarteryand
ischemiaresultingcerebral
infarctionortissuedeath.
Abrokenpieceofarterial
plaqueformedelsewhere
andreleasedintotheblood
stream,lodgeintoavessel
andproducingocclusionor
infarction.

8. Itoccurswhenbloodvesselrupture,causingleakage
ofbloodinoraroundthebrain
Itiscausedbyruptureof
cerebralvesselwith
subsequentbleedingin
brain.
Primary cerebral
hemorrhagesoccursin
smallvesselsproducing
aneurysm
Itoccursfrombleeding
into subarachnoid
spacetypicallyfroma
saccularorberry
aneurysm affecting
largebloodvessels
Hemorrhagic Stroke
Intracerebral HemorrhageSubarachnoid Hemorrhage

9. Thebrainissuppliedwithbloodby
Twovertebralarteries
Twointernalcarotidarteries
4arteriesanastomoseontheinferioraspect
ofthebrainformingCIRCLEOFWILLIS.
StrokeisClassifiedas
AnteriorCerebralArtery(2.0%)
MiddleCerebralArtery(37.7%)
PosteriorCerebralArtery(8.8%)
InternalCarotidArtery(28.3%)
VertebralArtery(14.6%),
BasilarArtery(7.8%)
Cerebral Circulation

10. 1-ACASyndrome
Mostcommoncharacteristicof
ACA syndromeincludes
contralateralhemiparesisand
sensorylossinlowerextremity
(LE)thantheupperextremity
Vascular Syndrome

11. 2-MCASyndrome
Itsmostcommoncharacteristics
includescontralateralspastic
hemiparesisandsensorylossof
face,UEandLE.Upper
extremitymoreinvolvedthanLE
inthissyndrome
Vascular Syndrome

12. 3-PCASyndrome
Itsmostcommoncharacteristics
includecontralateralhemiplegia
withinvolvementofcerebral
syndrome. Homonymous
hemianopsiaisacommon
findinginthissyndrome
Vascular Syndrome

13. BLOOD TEST:
High Cholesterol, Blood Clotting Time and Sugar level
BRAIN IMAGING TEST
CT Scan: shows cerebral edema (within 3 days) & cerebral
infarction (within 3-5 days).
MRI:Detect damaged brain tissue 2-6 hours after stroke.
MRA(Magnetic Resonance Angiography) Visualize Narrow
blood vessel.
HEART & BLOOD VESSEL TEST
Carotid Ultrasonography: Clotting in arteries leading to brain.
Carotid Angiography:(Arteriography)
Diagnostic Test

14. Sensory System (Pain, Touch, Temperature and Vibration)
Visual changes
Cranial Nerve Examination
Motor function and Muscle Power
Muscle tone (high/low)
Reflexes
Coordination/Motor Programming
Level of Consciousness (GCS)
Postural Control & Balance
Perception & Cognition
Emotional Status
Bladder & Bowl function
Assessment of Stroke

15. 1
st
InitialsignofStrokeisFAST
SuddenNumbnessorweaknessofface,armorleg
especiallyononesideofbody.
Suddenconfusion,troublespeakingorunderstanding.
Suddentroubleseeinginoneorbotheyes.
Suddentroublewalking,dizziness,lossofbalanceor
coordination.
Suddensevereheadacheswithnoknowncause
Suddennausea,fever,&vomitingdistinguishedfromaviral
illnessbythespeedofonset.
Brieflossofconsciousnessoraperiodofdecreased
consciousness(fainting,confusion,orcoma)
Warning Signs of Stroke

16. Aspirin
Heparin
Surgical Endarterectomy
Surgical Blood Vessel Repair
Medical Management
Surgical Management

17. Physiotherapy Intervention for Stroke

18. Improve sensory functions
Flexibility and joint integrity
Improve strength
Manage spasticity
Improve motor & postural control
Improve balance & locomotion
Improve aerobic functions
Improve feeding & swallowing
Improve motor learning
Patient & family educations
Discharge planning

19. Limbphysiotherapythatincludespassivetoactiverange-of-motion
exerciseforthehemiplegiclimbsTopreventlimbcontracturesand
spasticity
Chestphysiotherapy,coughandforcedexpiratorytechnique(FET)for
bronchialhygieneclearanceinstrokepatient.
Earlymobilizationtheactofgettingapatienttomoveinthebed,situp,
stand,andeventuallywalk.
Tonemanagementstretching,prolongedstretching,passive
manipulationbytherapists,weightbearing,ice,splinting,andcasting.
ElectricalStimulationcouldbeusedfortonemanagement
Edemamanagement
Balanceretraining
Gaitre-education
FunctionalMobilityTrainingThesetasksincludebridging,rollingtosit
tostandandviceversa,transferskills,walkingandearlierambulation.

20. Lennon S, Ashburn, A. The Both concept in stroke rehabilitation: a focus
group study of the experienced physiotherapists perspective. Disability and
Rehabilitation. 2000;22(15): 665-674.
O’Sullivan SB, Schmitz TJ, Physical Rehabilitation, Fifth Edition, F.A.
Davis Company, 2007; Ch.18
Dickinson, John (1976).Proprioceptive control of human movement.
Princeton Book Co. p. 4.Retrieved 8 April 2011.
O Sullivan, Susan (2007). "Physical Rehabilitation", p.60, 512, 720. F. A.
Davis, Philadelphia.
O Sullivan, Susan B; Schmitz, Thomas J (2007). Physical Rehabilitation,
Fifth Edition. Philadelphia, PA: F.A. Davis Company. p. 512
References

21. THANK YOU

22. Questions…?