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What is a watershed infarct?
- where no defined area if the cause of a bleed. shared eg MCAand ACA
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What is hemiplegia?
- complete loss of movement
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What is hemiparesis?
- weakness
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What is aphasia?
- difficulty with language
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What are possible primary impairements from stroke?
- - motor- ataxic
- - sensory- tactile, kinaesthetic, visual, vestibular,
- - language- aphasia
- - perceptual- congitive- slow processing, attention, memory
- - behaviour- positive, negative
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What causes mm weakness?
- - decrease in descenging inputs to lower motor neuron
- - decreased number of motor units activated
- - decreased motor unit discharge rate
- - dsrupted motor unit synchronisation
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How will a pt present with hemiparesis?
- - slowness in force generated
- - altered length tension relationship
- - deficient force output: generation and sustained
- - stroke pts can sustain a forced contraction
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What are the usual patterns for hemiparesis weakness?
- usually UL flexors weaker than extension
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What is dexderity?
- - is the ability to carry out a motor task precisely, quickly, rationally and deftly with flexibility with respect to the changing environment
- - hard to assess as it relies on strength
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What are the presentationsof problems with dexterity?
- - loss of smoothness
- - indirect trajectories
- - disrupted inter-jt coordination
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What are ptterns of synergistic movements?
- - both loss ofstrength and dexterity probably contribute to abnormal synergies
- - actions are perormed in the most biomechanically effective manner given the impairements- response give coordination and strength comb
- - flexor or extensorsynergies in both UL and LL
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When people go to do a mvoemetn they auto go into flexor syngery, what is this movement?
- - scapular elevation and retraction
- - shoulder flexion and abduction
- - elnow flexion
- - frearm supination
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When people go to do a mvoemetn they auto go into extensor syngery, what is this movement?
- - scap protraction
- - shoulder adduction and internal rot
- - elnow extension
- - forearm pronation
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What are positive motor impairements?
- - spasticity
- - extensive motor activity- effor tone, iradation, assocatied reactions
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What is spacticity?
- - velocity dependent while moving jt
- - develops over time (flaccid 4-6 weeks) but will develop over time
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LMN- spasticity occurs sooner
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Effort tone- trying so hard pt recruit everything
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Irradation- no specific activation trying to activate on emm it spills over to the other mm
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Associated reactions- eg when doing something else eg walking arm moves upinto contracted position
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WHat are the positive motor impairments: Involventary movements disorders?
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Sensory impairements what are you test?
- - tactile and kinaethetic
- - sensory loss is complex and mulitfactorial
- - you cannot predict sensory recovery
- - it common in > 60% of stroke pts
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What are the tests used to assess tactile problems?
- - texture discrimination
- - 2 point discrimination
- -point localisation
- - sensory inattention (perceptual rivarly)
- - light touch
- - pressure
- - vibration
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What are the tests used to assess kinaesthetics?
- - proprioception
- - sense of movement
- - sense of heaviness
- - pain
- - temp
- - stereognosis (recognise objects being placed in hand)
- - graphaesthis (sensation of writing on hand)
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What are implications of sensory impairments?
- - decreased ability to pick up and manipulate objects
- - decreased ability to use an appropriate level of force during grasp and manipulation (esp without vision)
- - dereased spontaneous use of hand because of lack of input
- - implications for functional lower limb, or feel amount of wiehgt through it or detect mm contraction
- - safety implications (wounds, burns)
- - inability to integrate sensory feedback results in imapired ability to learn new motor skills
- - learn non- use- may be nothing wrong withmotor control, pt doesnt have sensation and dont use it. Pt limb gets weak and brain- use it or lose it
- - if you tie up a god arm they have to use a bad one
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How can you tell if a pt has sensory impairements- vestibular?
- - vertigo and nausea
- - disorientation to gravity (pusher syndrome) = oreintation of vertical and favour bad side
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Visual sensory imapirements
- - incidence of homonomous hemianopia 8.3% in stroke survivors
- - visuo- spatial neglect
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Sesnory impairements: Vision picture
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What are the primary impairements?
- - motor
- - sensory impairements
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What are secondary MS impairments?
- -length associated- contracture, stiffness
- - use- asociated- disue atrophy, oedema, subluxation (missuse handling)
- - pain- trauma induced (handling), injury induced (pt conflict self)
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What is a contracture?
- - loss of passive jt range, it involves shortening and stiffness
- - mm immobilised in a shortene position demonstrated- a loss of scromeres in series, an increase proportion of connective tissue in mm
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What mm are at risk of mm contractures?
- - gastrocs
- - hip flexors
- - hamstrings
- - neck mm
- - wrist flexors
- - finger flexors
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Secondary MS Impairments: stiffness
- - altered ratio of connective tissue to mm tissue
- - increased number of actin-myosin cros links
- - behaviour and type of extra-sacromeric proteins
- - decreased connective tissue extensibility due to tissue dehydration
- - decreased lubrication causing adhesions between collagen fibres
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How can you prevent contracture?
- - having adequate length
- - even tho mm is stiff
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What accors with mm atrophy?
- keep moving mm
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How does mm atrophy occur?
- - overtime with disuse
- - motor unit changes
- - decrease number of motor units
- - decrease of type 2- fast twitch, phasic mm fibres- used for speed movts fatigue quickly
- - increase number of type 1, slow twitch fibres
- - change in recruitment order
- - decrease mm cross- sectional area
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Pt assessment
- - history on file
- - subjective history and observation
- - motor screen
- - sensory screen
- - functional tests (MAS)
- - dexterity
- - balance
- - reflexes
- - spasticity
- -vision
- - cranial nerves
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