Name:
NPTE - High Yield Review – Stroke, Part 1
Description:
NPTE - High Yield Review – Stroke, Part 1
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Upload Date:
2023-04-01T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[Dr. Dutton] This is the first in a number of high-yield presentations that we have put together to help you study for the NPTE examination. [Dr. Burke Doe] Welcome to AccessPhysiotherapy's High Yield Review for the National Physical Therapy Examination. I'm Dr. Annie Burke Doe, a practicing clinician and one of the authors of the NPTE exam and Board review text by McGraw Hill.
The neuromuscular and nervous system module series have been developed to assist candidates in the exam preparation by providing a targeted overview in the exam preparation by providing a targeted overview of key diagnoses in the neuromuscular rehabilitation area. of key diagnoses in the neuromuscular rehabilitation area. Stroke is the first topic in the series which will be presented in short modules. After this modular overview, the candidate should be able to apply the background pathophysiology and management of persons with stroke during the physical therapy examination, specifically addressing anatomy and physiology as related to tests and measures, movement analysis, and outcome measures.
Further, the candidate should be able to analyze and interpret the stroke evaluation results, understand differential diagnosis and prognosis to establish and carry out a plan of care including non-pharmacological medical management, the impact of pharmacological management, differential diagnosis, and the impact of regenerative medicine on physical therapy prognosis and interventions as it relates to stroke.
The candidate should also be able to formulate physical therapy interventions and differentiate appropriate responses from potential complications on all systems including the anatomy and physiology as related to the physical therapy interventions, daily activities and environmental factors, any adverse effects or complications of stroke from physical therapy interventions and interventions used on other body systems, and the motor control and motor learning principles of physical therapy interventions in the treatment of stroke.
According to the World Health Organization, stroke is defined as a rapidly developing clinical signs of focal, at times global, disturbance of cerebral function that lasts for more than 24 hours or leading to death with no apparent cause other than vascular origin. When compared to a transient ischemic attack, the Health Organization defines this as rapidly developing clinical signs of focal or global disturbance of cerebral function, but lasting less than 24 hours with no apparent vascular cause.
All rehabilitation professionals should be prepared to educate the general public on the warning signs and symptoms of stroke that can include the acronym FAST F for facial drooping, A for arm weakness, S for speech difficulty, and when these signs and symptoms are seen, it's time to call 911. Ischemic stroke is the result of a partial or complete loss of blood flow to an area of the brain.
They can be thrombotic, a narrowing of a cerebral artery; embolic, sudden blockage of an artery by an embolus; or lacunar, occlusion of small penetrating vessels deep in the brain. Hemorrhagic stroke is due to intracerebral or subarachnoid hemorrhage. Some of the causes include hypertension, trauma, drug abuse, vascular malformations.
Rehabilitation, intervention and therapies are key components of stroke care and are provided in a range of settings such as acute inpatient or subacute care, inpatient rehab units or general or mixed units, ambulatory and community settings. The length of service or stay for stroke rehab will depend on factors such as the types of services required, accessibility for the services, and the goals and needs of the person and families.
Stroke rehab requirements often continue for many months or even years after the stroke has occurred. Clinical manifestations of stroke are based on the vessel and the cerebral hemisphere involved. These sets of symptoms help identify which parts of the brain have been injured by the stroke. In right hemisphere lesions, we would see left-sided hemiparesis and sensory loss, left neglect, reduced sight, and inattention to the left side.
We could also see visual deficits such as left homonymous hemianopia, spatial problems, difficulty recognizing body parts, inability to understand maps and find objects, memory problems, and behavioral changes. In the left hemisphere, we would see right hemiparesis and sensory loss, aphasia, right homonymous hemianopsia, impaired ability to do math, behavioral changes such as depression, impaired ability to read, write, and learn new information.
Clinical characteristics of stroke can also be described by the vascular territory affected, large vessels such as the internal carotid or vertebrobasilar system, medium vessels such as anterior, middle, and posterior cerebral arteries, and those small lacunar deep penetrating infarcts. If the symptoms don't look familiar, take time to review this slide to make sure that you have an understanding of where the damage would be based on this anatomy.
Motor involvement is common in 73% to 88% of persons Motor involvement is common in 73% to 88% of persons after a stroke, and it can include loss of motor control in the arms, legs, core muscles, muscle weakness, reduction in power production, abnormal coordination of joint action, typically characterized as what we call muscle synergies. The person has an inability to isolate movements on the affected side.
Weakness tends to be greater distally in the lower extremity, but both proximal weakness and distal weakness may affect the upper extremity. We should not forget that muscle weakness may also affect the uninvolved extremity, although the impact is typically less marked. Persons with stroke have impaired proprioception and/or somatosensation that may affect functional use of the limb, and some descriptions are listed here.
Muscle tightness and loss of joint range of motion may develop as a result of weakness and the deforming effects of gravity, muscle spasticity, and non-neuronal connective tissue tightness. Here are some common sites of contracture at each joint, Here are some common sites of contracture at each joint, the direction you should stretch to improve that contracture, and the muscle specifically that would be stretched.
Cognitive dysfunction is common post-stroke and the deficits closely relate to the size and the location of the lesion at an estimated incidence between 10 and 82% of the population. Visual field loss or inattention to certain sensory stimuli may limit patient safety, functional mobility, and self-care. Pictured here are common visual field deficits and their anatomic bases.
Become familiar with this imaging. Strokes can be classified by acuity, acute onset to seven days, subacute a week to four months, and chronic greater than four months of onset. Severity can also be used to classify stroke by the grading of impairment of body structures and function. Specifically, the National Institute of Health Stroke Scale is used for that purpose and it grades items such as consciousness, gaze, visual fields, motor functions, as example, and you can see here the total score can classify the stroke into minor, moderate, moderate to severe, and severe.
Gait can also be used to classify stroke severity, Gait can also be used to classify stroke severity, specifically gait velocity. Ambulation ability has been correlated with gait velocity and gait velocity is commonly used as an activity level measure. A common test that should be noted is the 10 meter walk test and here are listed whether the person is a household ambulator or has limited community based on gait velocity.
Looking ahead, our next section will focus on stroke examination.
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