This document provides information about stroke, including its definition, types, risk factors, and the role of physiotherapy in treatment. It discusses the two main types of stroke - ischemic and hemorrhagic - and describes some common syndromes associated with different areas of brain injury, such as the middle cerebral artery syndrome. It then outlines physiotherapy techniques used in both the acute and rehabilitation stages, including positioning, improving range of motion, strengthening, balance training, and gait re-education.

1. STROKE
-PURVI SHAH
(B.P.T)

2. Brain Parts & Function

3. Circle of willis

4. ACA/MCA/PCA Supply

5. Definition
• It is a focal neurological deficit from CVA lasting more than 24
h.
• Brain injury caused by when the blood vessels to the brain cut,
burst, laceration as a result of blood supply & o2 to brain is
decresed.

6. Types
Ischemic Haemorrhagic

7. Types
ISCHEMIC
• 80 %
• Block the blood flow as a
result of loss of blood supply
& o2
HAEMORRHAGIC
• 20 %
• When the blood vessels
rupture, causing leakage of
blood in & around brain

8. Ischemic Stroke
• ETIOLOGY :
1.Atherosclerosis
2.cerebral thrombus
3.cerebral embolism
4.embolism of heart

9. Atherosclerosis

10. HAEMORRHAGIC STOKE
• ETIOLOGY :
1.ICH
2.SAH
3.Intracrainal small blood vessels disease
4.Aneurysm
5.Aeteriovenous malformation

11. Risk Factor
• MODIFIABLE :
Smoking / Alcohol consumption
Obesity
Lack of physical activities
Infection
Psychological factor

12. Risk Factor
• NON MODIFIABLE :
AGE
Gender
Positive family history
Blood pathology
TIA
HTN & Diabetes
Heart disease

13. ACA SYNDEOME
• Contralateral hemiparesis in LE> UE, face
• Contralateral hemisensory loss
• Urinary incontinence
• Problem with limitation & bimanual tasks, apraxia
• Abulia, slowness, delay, lack of spontaneity motor action
• Contalateral grasp reflex & sucking reflex can be
asymptomatic

14. MCA SYNDROME
• Contralateral hemiparesis UE>face, LE
• Contralateral hemisensory
• Broca’s aphasia
• Receptive aphasia
• Global aphasia
• Perceptual deficits
• Limb kinetic apraxia
• Contralateral homonymous hemianopia
• Pure motor hemiplegia

15. PCA SYNDROME
PERIPHERAL TERRITOEY
• Contralateral & bilateral
homonymous hemianopia
• Visual agnosia
• Prospagnosia
• Dyslexia,agraphia,anomia
• Memory defect
• Topographic disorientation
CENTRAL TERRITORY
• Central post stroke
• Involuntary movement
• Contralateral hemiplegia
• Webber’s syndrome
• Paresis of vertical eye
movement, miosis,ptosis

16. HEMIPLEGIC GAIT
• CIRCUMDUCTORY GAIT
• Circumduction seen in swing phase to clear ground
• Poor proprioception
• Spasticity
• Weakness
• Flexion contracture
• Abnormal synergy pattern
• Equinus gait, varus deformity (ankle), hammer toe
• Unequal stride & step length
• Insufficient pelvic rotation

18. Pathophysiology
Plaque formation in the arterial wall
Cerebral blood flow & o2 reduced
Ischemic core tissue die, in longer time surrounding
penumbra survive but without reperfusion it’s die
Neuronal activity reduce & infarct expanded
Damage brain cells

19. PHYSIOTHERAPY
• In ACTUE stage, low intensity rehabilitation begun.
• Patient is medically stabilized within 72 h.

20. POSITIONING STRATEGIES

21. FOR RESPIRATORY FUNCTION
• BREATHING EXERCISE, PD, FET, Chest Expansion
Exercise

22. IMPROVE FLEXIBILITY & JOINT
INTEGRITY
• AAROM & PROM
• Scapula mobilization
• Safe self ROM activity such as arm cradling, table top
polishing, stretching & splinting

23. REEDUCATE SENSORY FUNCTION
• Presentation of repeated sensory stimuli like pressure,
vibration, touch, temp
• Weight bearing & joint approximation tech
• PNF
• Use bilateral extremity

24. SPASTICITY MANAGEMENT
• Ice
• Splinting
• Weight bearing ex
• Neural warmth
• Massage
• Inhibitory tech such as stoking, pressure on tendentious
insertion of muscle

25. IMPROVE STRENGTH
• Both agonist & antagonist muscles
• For weak muscle <3/5 gravity eliminated plan & for >3/5
against gravity
• Use therabands, weight cuff, dumbells

26. IMPROVE MOVEMENT CONTROL
• Task oriented exercise
• CIMT
• MCIMT
• NMES
• EMG Biofeedback
• EFS

27. • Postural control & bed mobility
Rolling, transfer activity, sit to stand
• For improve UL function
Lifting activity, push up, manipulation activity, weight
bearing ex, pick up the objects
• For improve LL function
PNF pattern, improve pelvic/knee & ankle control

28. FOR PUSHER SYNDROME
• Use visual stimuli, verbal cues
• Use an environmental boundary corner or doorway
• Therapist sit towards the stronger side & ask the patient lean
over me

29. FOR SHOULDER PAIN
• Two types of pain
1.SPASTIC
2.FLACCID
• Treatment
Proper handling, splinting, perper
positioning, taping & sling, EMG, NMES

30. IMPROVE BALANCE
• Symmetrical weight bearing on both side
• Wide BOS to Narrow BOS
• Stable surface to dynamic surface
• Postural perturbation
• Later on reaching activity, dual tasks training, divert
attention
LATER ON MORE CHELLENGEBLE ACTIVITY

32. IMPROVE GAIT
• Initially in parallel bar with help of crutches
• Later on out of parallel bar with or without crutches
• Use hemiplegic wheelchair
Assistive devices: crutches, cane
Orthosis : HKAFO/KAFO/AFO ( depending upon
weakness)
Correct gait pattern with help to verbal cues, visual feedback
& manually by therapist

33. AEROBIC ACTIVITY
• Functional activity
• Treadmill training
• Cycle ergometer
• Graded exercise training
• Proper & adequate rest

34. IMPROVE FEEDING & SWALLOWING
• Exercise of jaw, lips, tongue
• Facial exercise
• Rubbing of ice chips around lips

35. Thank You