This My Case Study, So I Hope Those Information Will Be Helpful

1. STROKE
(CEREBROVASCULAR
ACCIDENT)
NAME: GOPI SUBRAMANIAM
COLLEGE: VICTORIA INTERNATIONAL
COLLEGE
PROGRAM: DIPLOMA IN PHYSIOTHERAPY
TOPIC: STROKE

2. INTRODUCTION
 A stroke occurs when the blood supply
to part of your brain is interrupted or
severely reduced, depriving brain
tissue of oxygen and food. Within
minutes, brain cells begin to die.
 Stroke is caused by the blockage of
blood flow or rupture of an artery to or
in the brain.

3. AETIOLOGY
Ischaemic stroke
 Due to blockage of a brain artery by an
embolus or by thrombosis. If it lasts for
less than 24 hours it is a transient
ischaemic attack (TIA).
 About 85 percent of strokes are
ischemic strokes.

4. Haemorrhagic stroke
 Hemorrhagic stroke occurs when a blood
vessel in your brain leaks or ruptures. Brain
hemorrhages can result from many
conditions that affect your blood vessels,
including uncontrolled high blood pressure
(hypertension) and weak spots in your
blood vessel walls (aneurysms).

6. Intracerebral hemorrhage
 In an intracerebral hemorrhage, a
blood vessel in the brain bursts and
spills into the surrounding brain tissue,
damaging brain cells. High blood
pressure, trauma, vascular
malformations, use of blood-thinning
medications and other conditions may
cause intracerebral hemorrhage.

7. Subarachnoid hemorrhage
 In a subarachnoid hemorrhage, an artery
on or near the surface of your brain bursts
and spills into the space between the
surface of your brain and your skull.
 This bleeding is often signaled by a sudden,
severe headache. A subarachnoid
hemorrhage is commonly caused by the
rupture of an aneurysm,.

9. SIGN AND SYMPTOMS
Anterior cerebral artery
 Paralysis or weakness of the contralateral foot
and leg due to involvement of Motor leg area
 Cortical Sensory loss in the contralateral foot
and leg
 Gait apraxia, Impairtment of gait and stance
 Abulia akinetic mutism, slowness and lack of
spontaneity
 Urinary incontinence which usually occurs with
bilateral damage in the acute phase

10. Anterior communicating artery
 visual field defects
Internal carotid artery
 paralysis of the entire opposite half to the face
and body
 temporary blindness in one eye
 Sensation may be lost on the other side of the
body
 Memory may be impaired. Urinary Incontinence
is another possible symptom

11. Posterior cerebral artery
 Contralateral loss of pain and
temperature sensations.
 Visual field defects
 Ipsilateral deficit of oculomotor nerve
 Contralateral deficits of facial nerve
Posterior communicating artery
 Nystagmas

12. Basilar artery
 Pupillary and oculomotor abnormalities,
dysarthria, and dysphagia
Middle cerebral artery
 Paralysis or weakness of the
contralateral face and arm
 Sensory loss of the contralateral face
and arm.
 Aphasia
 contralateral neglect syndrome

13. DIAGNOSIS
Computerized tomography (CT) scan
 A CT scan can show a brain
hemorrhage, tumors, strokes and other
conditions.
Magnetic resonance imaging (MRI)
 An MRI can detect brain tissue
damaged by an ischemic stroke and
brain hemorrhages.

14. CT SCAN

16. MEDICAL MANAGEMENT
Aspirin
 Aspirin prevents blood clots from
forming
 Heparin
Surgical endarterectomy
 A surgeon removes fatty deposits
(plaques) from your carotid arteries
that run along each side of your neck
to your brain.

17.  Surgical blood vessel repair. Surgery
may be used to repair certain blood
vessel abnormalities associated with
hemorrhagic strokes.

18. PHYSIOTHERAPY
MANAGEMENT
 Bed mobility : increase ability to roll /
move in bed / sit / stand
 Active exercise, active assisted exercise,
active resisted exercise, resisted
exercise
 improve balance and coordination
 retrain normal patterns of movement
 increase affected arm and leg function
 Gait training and posture correction
 increase independence and quality of life
 reduce the risk of falls

19. CASE
STUDY

20. SUBJECTIVE ASSESSMENT
Demographic date
Name: Miss. K
Age: 54 years old
Sex: Female
Race: Indian
R/N: 00****
Date of assessment: 19/04/2013
Doctor’s diagnosis: Right CVA with left hemiparesis
Doctor’s management : conservative management

21. Chief complains
 Unable to lift left arm and leg
 c/o muscle weakness on left side
Current hx : On 05/04/2013 Pt fainted during
marriage function at her brother house, then
was brought to ED of HSDG at 4 PM, she
wasn’t conscious until she was admitted to
ward 6 B for 3 days and was discharged on
08/04/2013, until 19/04/2013 Pt was cared by
her sister in law.
Type of stroke: infarction
Site of lesion: cortical
Motor deficit: Left

22. Past Hx: No previous stoke and TIA, previous
mobility was normal
PMHx/Surgery: HPT for past 4 years ( under
medication ), DM type II for past 6 months,
hyperlipidemia for past 1 month.
Social Hx: Pt married with 2 kids and staying in
terrace house, pt doesn’t involve in any outdoor
activites
Medication Hx: amlodipine 5 mg (HPT)

23. SPECIAL QUESTION
 General health : Well
 Investigation:
 Home /Social Situation (pre current episode)
- Home Care independent
 Home /Social Situation (Current Status) -
Home Care Dependent
 Bladder and bowel incontinence: No
 Occupation: house wife

24. OBJECTIVE ASSESSMENT
General Observation
 Body built: A medium size indian lady came to
physio department by wheelchair with her son
 Dominant hand: Right
 Mental/cognitive impairment: none
 Visual field deficit: no
 Hearing deficit: no
 Perceptual status: NAD
 Posture: normal
 Gait pattern : unable to analyse gait d/t pt on
wheelchair

25. Palpation
 Sensation
-Light touch: impaired
-Pain: impaired
-Temperature: impaired
Comment: light touch and pain is impaired
d/t interruption of sensory receptors in the
skin
 Muscle tone: Left : UL: 1+
LL: 1+

26.  Proprioception
UL: Impaired
LL: Impaired
 Range of motion:
UL:
LL:
 Muscle power:
UL: 0
LL: 0
P F(ROM)

27.  Complication/ Others
Painful shoulder:
Subluxed shoulder:
Chest complication:
Oro-facial function:
 Movement And Function
Shoulder:
Elbow:
Forearm:
Wrist:
Hand:
No
Poor

28.  Reflexes
Biceps: brisk
Triceps: normal
Quadriceps: normal
TA: normal
 Balance
Static balance: Fair
Dynamic balance: Fair

29. Motor Assessment Scale
 Supine to side lying: 1
 Supine to sitting over side of bed: 2
 Balanced sitting: 3
 Sitting to standing: 1
 Walking: 0
 Upper arm function: 0
 Hand movements: 0
 Advanced hand activities: 0

30. Functional Activities
 A: dependent
 B: dependent
 C: Independent
 D: dependent
 E: Independent
 T: dependent

31. PHYSIOTHERAPY
IMPRESSION
 Unable to lift arm and legs d/t muscle
weakness
 Muscle weakness is d/t hypotrophy

32. SHORT TERM GOALS
 To improve bed mobility
 To improve functional activities
 To improve balance
 To normalize muscle tone
 To teach transfer techniques
 To educate patient

33. LONG TERM GOALS
 To improve ADL activities
 To regain balance in sitting and
standing

34. PLAN OF TREATMENT
 Bed mobility
 Joint approximation
 Active assisted exercise
 Balance exercise
 HEP/ Patient education

35. INTERVENTION
Bed mobility
 Supine to side lying with unaffected
knee bend 90 degree with moderate
assistance
 Side lying to sitting with moderate
assistance
 Sitting to standing with maximal
assistance
 Standing to transfer wheelchair with
maximal assistance

36. Joint approximation
 Knee joint approximation, shoulder joint
approximation
 To improve joint sense by applying
compression to the joint
Active Assisted exercise
 Use right hand to carry left hand for
X10
 Use right leg to carry left leg X 10
 In supine lying

37. Balance exercise
 Wobble board in sitting position
 Weight shifting more on affected side
in sitting position
 Shifting forward and backward

38. HEP/ PATIENT EDUCATION
 Educate pt to perform all the exercise
that have been taught
 Educate pt to avoid sleeping on
affected side
 In sitting position educate pt to shift
more weight on affected side
 Educate pt to support shoulder with
triangular sling
 Teach pt proper way of waking up
from bed

39. EVALUATION
 Pt is very cooperative and able to
perform all the exercise

40. REVIEW
 Review for next visit to improve
functional activities and bed mobility,
balance,

41. REFERENCES
 Lennon S, Ashburn, A. The Bobath
concept in stroke rehabilitation: a
focus group study of the experienced
physiotherapists' perspective.
Disability and Rehabilitation. 2000;
22(15): 665-674.
 Dickinson, John (1976).
Proprioceptive control of human
movement. Princeton Book Co. p. 4.
Retrieved 8 April 2011.

42.  O'Sullivan, Susan (2007). "Physical
Rehabilitation", p.60, 512, 720. F.A.
Davis, Philadelphia.
 O'Sullivan, Susan B; Schmitz, Thomas
J (2007). Physical Rehabilitation, Fifth
Edition. Philadelphia, PA: F.A. Davis
Company. p. 512.