Title Managment of stroke ..pdf ✅

Rehabilitation OF Stroke Patients Outlines 1-Anatomy 2-Definition of hemiplegia, Identify risk factors of hemiplegia ,Classification of hemiplegia 3- Clinical picture of hemiplegia 4- Common problems of hemiplegia 5- Clinical examination of hemiplegia 6- Role of physical therapy according to the stage of recovery 7- Identify principles of rehabilitation program 8- Identify Neurophysiological approaches Corticospinal tract • arises from the pyramidal cells of cerebral cortex – fibres travel through • corona radiata • posterior limb of the internal capsule • cerebral peduncle ( middle 3/ 5th ) • pons • medulla oblongata ( passed through the pyramids ) – eventually fibres cross the mid line and terminate on LMN of anterior gray column of respective spinal cord segments Upper Motor Neuron Syndrome {UMNS} Positive  Spasticity  Spastic gait pattern  Clonus/ hyper-reflexia  Reflex flexor and extensor spasms  Associated reactions Negative  Weakness  Fatigue  Loss of selective motor control  Sensory deficits  Incoordination  Poor balance 1 \ 35 overseas - 01091980847
Hemiplgia Definition: Paralysis of one side of the body due to unilateral pyramidal tract (∆) lesion at any point from its origin in the cerebral cortex down to the 5th cervical segment. WHY? (beginning of origin of brachial plexus) 6 Hemiplegia vs. Hemiparesis  Hemiplegia is total paralysis of one part of the arm, leg, and /or trunk on the same side of the body, whereas hemiparesis is weakness on the whole one side of the body. 7  Factors affect the recovery of hemiplegic patient : - Site of lesion - Cause of lesion - Extent of lesion - Health of body at the time of injury ( The risk factor ) 8 2 \ 35 overseas - 01091980847
Risk factors for Stroke Non Modifiable  Age.  gender.  Race.  family history. Classification: 1- According to Site of Lesion 2- According to Etiology:  Vascular.  Infective.  Neoplastic.  Demyelinations.  Traumatic.  Congenital.  Hysterical.  Cortical (specific areas). - Subcortical (more wide range lesion).  Capsular (most wide & complete lesion).  Brain Stem level.  Spinal cord. According to the site of the lesion Spinal -Cerebral Brain stem 3 \ 35 overseas - 01091980847
Cortical: Characterized by one or more of the following: 1. Coma if the lesion is extensive. 2. Convulsions if the lesion is irritative. 3. Contralateral cortical sensory loss if the parietal lobe is involved. 4. Aphasia and agraphia if the lesion is in the dominant hemisphere. 5. The paralysis usually involves one limb (monoplegia) especially in vascular lesions. 13 Subcortical: It is indistinguishable from cortical hemiplegia except that the paralysis is more extensive. Capsular: Characterized by the following: 1. Complete hemiplegia associated with U.M.N. facial and hypoglossal paralysis on the opposite side of the lesion. 2. Hemihyposthesia on the opposite side of the lesion. 3. Hemianopia may occur, if the fibers of the optic radiation in the capsule are involved. 4. No convulsions, aphasia or coma. 14 - Brain Stem: The lesion is on one side of the brain stem resulting in the picture of crossed hemiplegia characterized by: 1. Hemiplegia on the opposite side of the lesion. 2. Cranial nerve paralysis of L.M.N. nature on the same side of the lesion. 15 According to the site of the lesion. Spinal cord: Brown-Sequard syndrome.  Lesion is on one side of the cord  Situated between C1 & C5 segments caused by:  Stab wound  Disc prolapse  D.S.  Tumor. which is characterized by: a) At the Level of the Lesion: 1. Ipsilateral localized L.M.N.L. of the muscles supplied by the affected segments. 2. Ipsilateral loss of all sensations in the area supplied by the dorsal roots of the affected segments. 16 4 \ 35 overseas - 01091980847
b) Below the Level of the Lesion; 1. Ipsilateral hemiplegia. 2. Ipsilateral deep sensory loss. 3. Contralateral superficial sensory loss for pain & temperature. 4. Touch diminishes on both sides. Brown-Sequard syndrome 2- According to Etiology:  I. Vascular Causes: These are the most common: A)-Thrombotic:- 1-Vessels wall diseases. 2-Blood diseases. 3-Circulation diseases. B) - Embolic : 1- Heart 2-Distal vessels 3-Rare sources: *Lung *Bones C)- Haemorrhagic: 1-Intracerebral 2-Subarachnoid 3-Subdural or extradural As the vascular causes are the commonest in hemiplegia, it is important to differentiate the clinical picture in thrombotic, embolic and hemorrhagic lesions. Feature Thrombosis Embolism Haemorrhage Age Old age Any age Commonly old age Onset Rapid (hours) Sudden (seconds) Dramatic Prodromata T.I.As Absent Absent Vomiting Absent Absent Common Consciousness Usually preserved Usually preserved Lost with deepening coma Convulsions May occur May occur Frequent Pupils and equal and equal Dilated and irreactive Fever Absent Absent Present Blood pressure May be high High Usually high Heart May be cardiac insufficiency Usually valvular lesion Left ventricular hypertrophy CSF Clear Clear Bloody, ↑ tension CT scan, MRI Hypodense area Hypodense area Hyperdense area 19 CLINICAL PICTURE: 1-Acute lesions: The clinical picture passes through 2 stages: A) Stage of flaccidity: due to neuronal shock. B) Stage of spasticity: this is the stage of established hemiplegia. C) Stage of Recovery 2-Gradual lesions: The hemiplegia passes directly to the stage of spasticity. 5 \ 35 overseas - 01091980847