STROKE

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 INTRODUCTION

Definition
Types of stroke
• Ischemic stroke
• Hemorrhagic stoke
• TIA
Causes
Risk factors
Etiology
Pathophysiology

1. Ischemic
• Thrombosis
• Embolism
• 2. Hemorrhage
• Intracerebral hemorrhage
• Subarachnoid hemorrhage
Vascular Syndrome
MIDDLE CEREBRAL ARTERY SYNDROME.
• Structure involved.
• Signs and symptoms.
ANTERIOR CEREBRAL ARTERY SYNDROME.
• Structure involved.
• Signs and symptoms.
 POSTERIOR CEREBRAL ARTERY SYNDROME.
• Structure involved.
• Signs and symptoms..
BASILAR ARTERY SYNDROME.
Structure involved.
Signs and symptoms.
VERTEBRAL ARTERY SYNDROME
Structure involved.
Signs and symptoms.
Neurological complications and associated conditions-

• Altered consciousness Disorders of speech and language Dysphagia

• Altered emotional status
• Hemispheric behavioral difference Seizures
• Bladder and bowel dysfunction
• Cardiovascular and pulmonary dysfunction
• DVT and pulmonary embolism
• Osteoporosis and fracture risk
.

• INVESTIGATIONS
• NEUROLOGICAL ASSESSMENT
Scales
1. Modified Ashworth Scale – Use
Grades
2. Barthel ADL Index Scale – Use
Components
Scoring
3. National Institute of Health Stroke Scale – Use
Component
Scoring
SCALES USED FOR STROKE PATIENTSPRE HOSPITAL
STROKE ASSESSMENT SCALE -:

Rapid Arterial Occlusion Evaluation (RACE) Scale-

- focuses on- score
- instructions
FUNCTIONAL ASSESSMENT SCALE-:
BERG BALANCE SCALE(BBS) –
- 14 balance item
- scoring Range
- interpretation
VMC(VOLUNTARY MOTOR CONTROL) GRADING –
- uses
- grades
Motor Examination
• Myotome
• Reflexes
-Grades of Reflexes.

Types of Reflexes :
1. Superficial Reflexes
2. Deep reflexes ( Deep Tendon Reflexes )
Sensory Examination
DERMATOMES-
• Upper limb-
• Lower limb-
• Trunk
TYPES-
• Superficial (Pain, touch, temperature)
• Deep(vibration, proprioception)
• Cortical( stereognosis,graphesthesia,2 point discrimination)
POSTURE , BALANCE AND GAIT
ASSESSMENT

-POSTURE
• PASS: Posture Assessment Scale for Stroke
-GAIT
• Gait impairments in stroke survivors
• Types
-BALANCE
• Equilibrium tests
• Nonequilibrium tests
REHABILITATION
Brunnstrom Approach
.

• Introduction
• Principles of Brunnstrom’s approach
• Evaluation - sensation, tonic reflex, associated limb synergy, and other
associated reactions.
• Effectiveness
Roods Approach

• Introduction
• Principle of Roods approach
• Rules of sensory input
• Technique of Roods approach
-There are 2 techniques
1. Facilitatory techniques
• Cutaneous facilitation
• Thermal facilitation
• Proprioceptive facilitation
2. Inhibitory technique
•Gentle shaking or rocking
•Slow stroking
•Slow rolling
•Light joint compression
•Tendinous pressure
•Maintained stretch
•Rocking in developmental stages
NEURODEVELOPMENT TECHNIQUE

• Introduction
• Principle
• Assessment and examination of the process
• NDT intervention
• Bobath technique
MOTOR RELEARNING PROGRAMME

• Introduction
• Problem solving process :
- Recognition
- Analysis
- Decision making
- Action taking
- Re- evaluation
• Sections of MRP :
- Upper limb function
- Orofacial function
- Sitting up from supine
- Sitting
- Standing up and sitting down
- Standing
- Walking
MUSCLE RE EDUCATION:
• Introduction
• Objectives :
1. Activation
2. Strengthening
3. Co ordinated movement
4. Endurance
• Exercises according to MMT
• 5 Techniques for training :
- Balance
- Coordination
- Kinesthetics sense
- Proprioception
- Posture
DNS, VIRTUAL REALITY, CIMT

DNS VIRTUAL REALITY CIMT

• Introduction •Definition Definition
• Principles •uses Benefits
•Techniques How it work
• Assessment
•Drawback Dosage and Timing
• Treatment Indication and Contraindication
Management of Shoulder Pain
.

• Introduction -Flaccid and Spastic presentation

• Treatment -Flaccid stage and Spastic stage
• Shoulder Impingement Syndrome
• Adhesive Capsulitis
• Complex regional pain Syndrome type 1
Shoulder Hand Syndrome
Reflex Sympathetic Dystrophy
Task-Oriented Approach
• Introduction
• How it can be done.
Robotic rehabilitation
• Introduction
• Types
• Work
• Effects on human body
.

SPINAL CORD STIMULATION

• Introduction of SCS
• Components of SCS
• Working of SCS
• Advantages and disadvantages
• Conclusion
..

VOJTA

• Introduction
• what is reflex locomotion
• Indication and contraindications
• Stimulating zones - supine - prone - side lying
• Reflex locomotion - reflex rolling - reflex creeping
• Perception
.

HYDROTHERAPY

• Introduction
• Physical properties of water- specific heat and thermal conductivity-
buoyancy- resistance- hydrostatic pressure
• physiological effect- cleaning effect- musculoskeletal effect-
cardiovascular effect- respiratory effect- bend effect- psychological
effect
• Uses - contraindications- precautions- adverse effects
• Application techniques- whirlpool- Hubbard tank- contrast bath
(advantages and disadvantages)
.

Temple Fay approach

• Introduction
• Techniques
• Benefits
.

Daman approach

• Introduction
• Techniques
• Benefits
.

PNF - PROPRIOCEPTIVE NEUROSMUSCULAR FCAILITATION.

• The Neurophysiological basis of PNF.

• Uses of PNF.
• Basic principles of PNF.
• Technique of PNF.
Manual exercises.

• Exercises for strength and control.

• Strengthening exercises for arms, shoulders, hip, knee, ankle.
• Exercises to help with standing and walking.
• Stretching exercises.
• Mat exercises.
• Balance and coordination exercises.
.

Sensory Re-education

•Introduction
•How does It work?
•Sensory reeducation exercise
.

Intervention to Improve Hemianopia and Unilateral Neglect:

1. Hemianopia
• Introduction
• Symptoms
• How it affect person’s day-to-day life following a stroke
• Treatment along with advancement
2. Unilateral Neglect
Introduction
Evaluation
Treatment
.

Posture correction exercises for stroke patients:-

•Neck Stretches
•Shoulder black squeezes
•Mirror therapy
•Core strengthening
•Assistive devices
Balance and Gait training exercises:-
‘

•Weight shifting exercises

•Standing leg raises
•Sit to stand exercises
•Marching in place
•Single-leg balance
•Tandem walking
•Step-ups
•Functional tasks
•Treadmill training
•Resistance band exercises
.

Dance Movement Therapy

• Introduction.
• Benefits.
• Uses.
• Ballroom dance.
• Argentine tango dance
Electrotherapy

• Introduction
• Uses
• Types
• Advancements
Orthosis and prosthesis.

• Definition
• Upper and lower limb orthosis
• Uses of orthosis
• Advantages and disadvantages of orthosis
• Introduction to prosthesis.