Different types of strokes
TACS, PACS, POCS, LACS
TACS
Total anterior circulation syndrome
All 3 need to be present for diagnosis:
* Hemiparesis AND
* Higher cortical dysfunction (dysphasia or visuospatial neglect) AND
* Homonymous hemianopia
PACS
Partial anterior circulation syndrome
- Isolated higher cortical dysfunction
OR - Any 2 of hemiparesis, higher cortical dysfunction, hemianopia
POCS
Posterior circulation syndrome
One of these to be present for POCS
- Cerebellar dysfunction (vertigo, nystagmus, ataxia)
- Isolated homonymous hemianopia
- Bilateral motor/sensory deficit
- Cranial nerve palsy and a contralateral motor/sensory deficit
- Conjugate eye movement disorder (horizontal gaze palsy)
LACS
Lacunar stroke is subcortical
One of following:
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
MCA Stroke Impairments and hemisphere-specific
Impairments
Increased tone
Decreased activation
* Reduced muscle contraction
* Weakness
* Fatigue
* Poor activation in certain positions, ranges, and alignments
Decreased tone
Reduced fractionation
R MCA (non-dominant)
Hemispatial neglect
Anosognosia - refusal to recognize defect/injury
L MCA (dominant) impairments
Aphasia:
* Brocha’s aphasia - expressive (gibberish)
* Wernickes aphasia - receptive (can’t make sense)
Dysarthria
Ataxia (motor planning deficits)
Homonymous hemianopia
R MCA (non-dominant)
Hemispatial neglect
Anosognosia - refusal to recognize defect/injury
Neuroplasticity
Repititions, intensity, time
Salience (relevance)
Specificity (nature of the training experience)
Transference (some ability to transfer to other abilities)
Interference (practice of bad habits can interfere with usefulness of practice)
Sensory impairments of MCA stroke
Loss of kinaesthesia, tactile sensation, pain/temperature sensation
Visual deficit of MCA stroke
Homonymous hemianopia
Higher cortical dysfunction of MCA
Right hemisphere, left hemiparesis
* Anosognosia, left neglect, visuospacial deficits
Left hemisphere, right hemiparesis
* Dyspraxia (motor skill, planning and movement)
* Dysphasia
** expressive or receptive
Physiotherapy assessment & treatment in patients with acute stroke
Observation, then assess, then treatment
Observe conscious state, ability to interact, features of higher cortical dysfunction: neglect or communication impairment.
Assess respiratory status, PROM and movement control UL & LL (tone) in supine
Assess vision
Assess sensation - LT, sharp/blunt, kinaesthesia
Treat - bed mobility and postural control
