hemiplegic strokes

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Stroke Hemiplegia

STROKE (HEMIPLEGIA)Nurul Nadhiroh Mohamad NaserKED120014Nurul Nadia Ashikin ZakariaKED120015Nurul Naemah Md SallehKED120016Siti Nur Nabilah LutfiKED120020Siti Zubaidah HassanKED120022Signs and symptomsHemiparesis, monoparesis, or (rarely) quadriparesisHemisensory deficitsMonocular or binocular visual lossVisual field deficitsDiplopiaDysarthriaFacial droopAtaxiaVertigo (rarely in isolation)AphasiaSudden decrease in the level of consciousnessDiagnosisCT angiography and CT perfusion scanningMagnetic resonance imaging (MRI)Carotid duplex scanningDigital subtraction angiographyDiagnosisLaboratory testComplete blood count (CBC): A baseline study that may reveal a cause for the stroke or provide evidence of concurrent illness (eg, anemia)Coagulation studies: May reveal a coagulopathy and are useful when fibrinolytics or anticoagulants are to be usedToxicology screening: May assist in identifying intoxicated patients with symptoms/behavior mimicking stroke syndromes

Differential DiagnosisStroke mimics commonly confound the clinical diagnosis of stroke. One study reported that 19% of patients diagnosed with acute ischemic stroke by neurologists before cranial CT scanning actually had non-cerebrovascular causes for their symptoms.

The most frequent stroke mimics include the following:Seizure (17%)Systemic infection (17%)Brain tumor (15%)Toxic-metabolic disorders, such as hyponatremia and hypoglycemia (13%)Positional vertigo (6%)Conversion disorderRISK FACTORNonmodifiable:

AgeRaceSexEthnicityHistory of migraine headachesFibromuscular dysplasiaHeredity: Family history of stroke or transient ischemic attacks (TIAs)

Modifiable:

Hypertension Diabetes mellitusCardiac diseaseHypercholesterolemiaTIAsLifestyle issuesObesityOral contraceptive use/postmenopausal hormone useSickle cell disease

COMPLICATIONSParalysis or loss of muscle movementusually on one side of body(HEMIPLGIA)loss of sensation on one side of bodylose control of certain musclesDifficulty talking or swallowingdifficulty with language (aphasia), including speaking or understanding speech, reading, or writingless control over the way the muscles in mouth and throat moveMemory and concentration difficultiesexperience some memory lossOthers may have difficulty thinking, making judgments, reasoning and understanding concepts.

Emotional problemsmore difficulty controlling their emotionspsychological problems such as anxiety or depressionExtreme tiredness and sleep problemsProblems with vision, such as double vision or partial blindnessDifficulty controlling bladder and bowel movements (incontinence or constipation)Changes in personality, behaviour and self care abilitymore withdrawnless social or more impulsiveneed help with grooming and daily chores.

Painpain, numbness or other strange sensations in parts of the bodies affected by strokeFor example: if a stroke causes lose feeling in left arm, itcan develop an uncomfortable tingling sensation in that arm.sensitive to temperature changes, especially extreme cold (central stroke pain or central pain syndrome)Dynamic balance and gait symmetryThe former has been linked to fall risk, whereas the later has been associated with both fall risk and poor balance. drop foot which is a lack of dorsiflexion during the swing phase of gait and equinovarus deformity.lack of knee and hip stability (an incorrect ankle position during their gait cycle).toe contact at the initial stance phase of gait.unaffected side is always turned forwardequinovarus deformity of the foot and ankle often accompanied by a hyperextension or recurvatum at the knee joint

If patient cant move because of stroke, they could be at risk of:

Bed sores (pressure ulcers)Deep vein thrombosis (DVT)Pneumonia Contractures (altered position of your hands, feet, arms or legs because of muscle tightness)

Goals of Occupational Therapy InterventionPrevent secondary impairments Restore performance skills Modify activity demands and the contexts in which activities are performedPromote a healthy and satisfying lifestyle Maintain performance and healthGoals of Occupational Therapy InterventionPrevent secondary impairments Restore performance skills Modify activity demands and the contexts in which activities are performedPromote a healthy and satisfying lifestyle Maintain performance and healthIntervention to Prevent Secondary ImpairmentsAbnormal changes in postural alignment (postural deformities) using available motor control in the affected and nonaffected limbs to begin a self-exercise program designed to stretch muscles gently throughout the bodyPain associated with immobility or abnormal joint alignment

Learned nonuse Therapists use every opportunity to teach the stroke survivor to be aware of and to use the paretic limbs to the limits of current available motor function.Injury due to falls develop strategies for adjusting to shifts in their body's center of mass to enhance their balance skill and efficacyAspiration during feeding, eating, and swallowinguse techniques to improve sensation, strength, and muscle tone of oral structures to maximize the potential for safe of independent eating. Depression following stroke by promoting independence, autonomy, participation

Goals of Occupational Therapy InterventionPrevent secondary impairments Restore performance skills Modify activity demands and the contexts in which activities are performedPromote a healthy and satisfying lifestyle Maintain performance and healthIntervention to Restore Performance SkillsTo generalize their new skills to enhanced performance of activities in their daily livesCognitive skills include the abilities to attend to environmental stimuli; remember relevant information; plan, organize, and sequence activity performance; and assess actions. Perceptual skills include the abilities to interpret sensory information and navigate the spatial environment.Emotional coping skills include a core of effective strategies that stroke survivors must develop to negotiate their interactions with others and return to full participation in their communitiesGoals of Occupational Therapy InterventionPrevent secondary impairments Restore performance skills Modify activity demands and the contexts in which activities are performedPromote a healthy and satisfying lifestyle Maintain performance and healthIntervention to Modify Activity Demands and the Contexts in Which Activities Are PerformedEnvironmental ModificationsDepend on each client's ambulation status and capacity to use the paretic armAdaptive EquipmentEquipment selection is highly individualized and is based on the constellation of factors assessed in the occupational therapy evaluationGoals of Occupational Therapy InterventionPrevent secondary impairments Restore performance skills Modify activity demands and the contexts in which activities are performedPromote a healthy and satisfying lifestyle Maintain performance and healthIntervention to Promote a Healthy and Satisfying LifestyleHelp stroke survivors establish performance patterns in:Medication routineAppropriate dietAppropriate levels of physical activity Satisfying levels of engagement in social relationships and activitiesGoals of Occupational Therapy InterventionPrevent secondary impairments Restore performance skills Modify activity demands and the contexts in which activities are performedPromote a healthy and satisfying lifestyle Maintain performance and healthIntervention to Maintain Performance and HealthEducation of clients, family, and caregivers to maintain performance and health after services have endedEstablish active, healthy daily routines:Maintaining the performance capacities Preventing an avoidable decline toward inactivity, loss of social roles, and emotional depression.PROSTHETIST & ORTHOTISTThe role are To assess patient condition.To produce (prescribe and design) suitable devices for patient. To fit and help patient learn to wear the devices.To educate regarding the use and care of an appropriate orthosis/prosthesis that serves an individuals requirements.

LOWER EXTREMITYIn general ankle foot orthosis(AFO) is given to improves stroke patients stability, safety, and efficiency of walking. Types of orthosis given based onpatient condition.muscle strength in ankle, calf, and lower leg. In order to improve biomechanical correction of deformity, the footplate will be put on the base of polypropylene AFO.

Knee ankle foot orthosis (KAFO) not a suitable choice for stroke patient. Reason:HeavyNo strength to lift it to walk properly.Can control the problem at the knee by correctly addressing the problem at the foot and ankle.UPPER EXTREMITYThe majority of orthotic prescriptions for upper extremity stroke patients are for the wrist, hand or both. Sling- Support the arm when sublaxation occur.- Used to hold joint and assist in long term stability Upper ExtremityHistorically, OT has primarily been involved in the provision of upper extremity orthotic.In upper extremity orthotic practice for stroke patient, OT typically design, fabricate, fit and supervise functional training.OT manage every stage of the upper extremity orthotic delivery process therefore able to adapt each step to individual need in stroke patientLower ExtremityIn contrast, OT are not direct providers of lower extremity orthotic care. Orthotist design, fabricate and fit lower extremity and PT provide functional gait training with the orthotics.OT collaborates in the delivery of the lower extremity orthotic services to ensure that the orthosis is designed to facilitate occupational performance at each stage of development.

The orthosis may address a biomechanical goal such as providing a stable base of support and a functional gait training goal such as increasing the ankle dorsiflexion during toe-off.However, if the orthosis does not address the occupational perfo