Stroke: Risk factor

STROKE (CEREBRO VASCULAR ACCIDENT Bleeding stroke: ICH and PSA Non-bleeding stroke (Ischemic). Non-bleeding (Ischemic) stroke. • Transient ischemic attack (TIA)→neurological symptoms <24 hours • Reversible ischemic neurological deficit (RIND)→ 24 hours-21 days • Stroke progression (stroke in evolution)—mild→severe neurological disorders • Complete stroke—persistent neurological abnormalities Risk factor • cannot be controlled – Age, old age, higher incidence – RAS. Africa/Negro, Japan, China are at high risk – Gender,L>W – Family history Controllable TIA - Atrial fibrillation Hypertension - DM Post stroke - Lipoprotein abnormalities Smoker - Infections : viruses and bacteria Alcohol drinker - Contraceptive drugs Hypercholesteromy - Lack of physical activity Physical stress - obesity BLEEDING STROKE (Aneurysm rupture, Angioma, arteoscerotic lesions) Clinical Symptoms (ICH) • Headache, vomiting, dizziness, impaired consciousness. • Neurologic deficit, depending on the location of the bleeding Internal capsule – Contra lateral hemiparesis – Comma – Bl sp cerebellum: ataxia, occipital headache, vertigo, nystagmus, dysatria Brain stem – Plaxite quadriplegia – Small pupils and minimal light reaction – Respiratory depression – Hypertension (reactive) – Febris - Loss of consciousness Thalamus – Hemisensory deficit – Contra lateral hemiparesis – Aphasia Lobe – Frontalis: contra lateral hemiparesis, headache. conjugate deviation towards the lesion – Parietal: contra lateral sensory perception deficit, mild hemiparesis – Occipitalis: hemi aanopsia, minimal ipsilateral hemi paresis - Temporalis: sensory aphasia Putamen – Contralateral hemi paresis – Hemisensory deficit – Aphasia Clinical symptoms of PSA • Sudden and severe headache starting from the neck • Nausea and vomiting • Photo phobia (easily dazzled • Oculomotor nerve paresis, retinal hemorrhage • Autonomic disorders (temperature, blood pressure rises) • Stiff neck • Impaired consciousness (somnolence sp coma) When with intracerebral hematoma • Hemiparesis • Aphasia • Oculomotor paresis • Visual field narrows • Epileptic seizures Ischemic Stroke Pathology of an infarction: • Thrombosis • Embolism • Arteritis Pathophysiology Cerebral ischemic infarction is closely related to atherosclerosis: • Narrows the lumen • Sudden occlusion of blood vessels, thrombus occurs • Is the formation of a thrombus • Causes vessel walls to become weak Factors that influence blood flow to the brain: • Condition of blood vessels • Blood condition • Systemic blood pressure • Heart defects Symptoms of blockage of the carotid system: • Symptoms of blockage of the internal carotid artery – Sudden blindness (amaurosis fugax) – Dysphasia if the disorder is located on the dominant side - Contra lateral hemiparesis Symptoms of anterior cerebral artery blockage – Contra lateral hemiparesis with more prominent levels of paralysis - Mental disorders – Sensibility disorders in paralyzed limbs – Incontinence – Can have convulsions Symptoms of blockage of the middle cerebral artery – If the blockage is at the base of the artery, the same hemiparesis occurs, if it is not at the base then the arm is more prominent – Hemihypesthesia – Disruption of high function in the dominant hemisphere cortex which is affected by motor/sesoric aphasia Disruption on both sides • Due to sclerosis in many places, blockage can occur on both sides. • Pseudobulbar disorders arise, usually vascular with symptoms: – Duplex hemiplegia – Difficulty swallowing – Emotional disturbances, crying easily STROKE INTERVENTION TREATMENT OF STROKE IN THE ACUTE PERIOD (Help when a stroke occurs) • Clear the airway • Clear the airway of foreign objects • Position your head slightly ext & tilted left/right • Remove clothing that interferes with breathing • Body half asleep • Relaxed legs, semi-plexi hip and knee • Give enough oxygen • Head position: Head CVD is higher 15-20 degrees Horizontal thrombosis • Cold compress on the head • infusion SIGNS OF PARTIAL OBSTRUCTION OF THE AIRBORNE • The sound of snoring (snoring) is caused by the base of the tongue falling backwards • Gargling sound (garling) due to the presence of foreign objects (fluid, blood, secretions) • A screeching sound (crowing) due to laryngeal spasm • A wheezing sound (weezing) bronchial obstruction PARTIAL OBSTRUCTION RESPIRATORY MEASURES When there is snoring - Head extension - Open your mouth If there is a gargling sound Tilt head, open mouth, oral cavity If there is a screeching sound • perform manual ventilation with 100% O2 • Relax the laryngeal muscles (warm compress) POST STROKE ARM AND HAND TRAINING Hand functional classification • Prehention (holding) - Fingertip stoption (pinch/jump) - Lateral stoption (pinching) - Palmar prestoption (holding • Grasp (grasp) - cylidrical grasp (full grasp) - spherical grasp (holding half full - Hook grasp (touch) An important component for arm and hand activities. In the arms • Shoulder abduction • Shoulder flexion forward • Shoulder extension • Elbow flexion and extension On hand • Radial deviation with wrist extension • Flexion and extension of the wrist when holding an object • Abduction & rotation (opposition) of thumb CMC • Flexion & rotation (opposition) of finger to thumb • MCP flexion & extension w/ IP • Supination and pronation Problems that often occur in the arms & hands • Loss or reduction of active motor control • Spaticity On the arm • Poor scapular movement (especially lateral rotation and protraction), depressed shoulder girdle • Difficult humeral gleno sedi abd and shoulder flexion, compensatory shoulder girdle elevation • Elbow flexion, shoulder internal rotation and forearm pronation WALKING EXERCISE FOR STROKE SUFFERS An important component of walking. The tread phase Hip extension Lateral horizontal shift of the pelvis and trunk Knee flexion is about 150at the beginning of the heel strike, followed by extension and flexion again before toe off. Swing phase • Knee flexion with initial hip extension • Pelvic tilt laterally • Hip flexion • Forward rotation of the pelvis as the leg swings • Rapid knee extension and ankle dorsiflexion just before heel strike Walking problems in stroke patients Swing phase of affected side • Limited knee flexion during swing • Limited hip flexion • Limited knee extension and ankle dorsiflexion on heel strike Secondary road adaptation • Reduced amplitude of movement • Reduced and/or unbalanced step length and strike length • Increased stride width • Reduced speed or increased travel time • Increased use as support and balance Forms of exercise Stepping phase • Practice hip extension during the stride phase • Train knee control for the landing phase • Training pelvic horizontal-lateral shear Swing phase • Practice knee flexion at the start of the swing phase • Train knee extension and dorsiflexion of the foot at heel strike Walking practice • Make sure before walking that your standing position is stable. • It must be remembered that people who walk are standing on one leg alternately, so they also need to be trained to stand on one leg • Walk sideways to the right or left first to ensure balance • Increase the complexity of walking exercises with a good pattern