Physiotherapy Managment of Stroke, Types of Stroke, Classification of Stroke, Risk Factor of Stroke, Assessment of Stroke, Warning Signs of Stroke.

1. Stroke (CVA)
By: Dr. Shahbaz Ahmad PT
DPT [UIPT][UOL], MS-MSK-PT[UIPT][UOL]

2. LEARNING OBJECTIVES
 At the end of lecture, the students will be able to;
 Describe the stroke its epidemiology, risk factors,
classification of stroke, early warning signs of stroke &
imaging techniques
 Describe the role of PT in assessing the impairments
associated with stroke
 Identify & describe strategies of interventions during
rehabilitation.

3. WHAT IS STROKE?
Stroke also known as Cerebrovascular
accident (CVA) or brain attack is the sudden loss
of neurological function caused by an interruption
of the blood flow to the brain and depriving brain
tissue of oxygen and food. Within minutes, brain
cells begin to die.
Neurological deficits to be classified as stroke if
they must persist for at least 24 hours. Otherwise
it’s Transient Ischemic Stroke (TIA)

4. Stroke – Risk Factors
Modifiable
Diet
Obesity
Smoking
Hypertension
Heart Disease
Lack of exercise
Diabetes Mellitus
Alcohol consumption
Non-Modifiable
Age
Gender
Race
Family history

5. ATHEROSCLEROSIS
 It’s a major contributory factor in CVA and characterized by
plaque formation that deposits in the arterial wall and causing
narrowing of blood vessels.
 The most common site for lesions is common carotid artery
at Bifurcations and Constriction of arteries.
Etiology

6. Classification of Stroke

7. It’s the most common type and results when a
clot blocks or impair blood flow, depriving the
brain of essential oxygen and nutrients
Ischemic Stroke
Cerebral Thrombosis Cerebral Embolus
 It refers to the formation of
a blood clot within cerebral
arteries that lead to
occlusion of an artery and
ischemia resulting cerebral
infarction or tissue death.
 A broken piece of arterial
plaque formed elsewhere
and released into the blood
stream, lodge into a vessel
and producing occlusion or
infarction.

8. It occurs when blood vessel rupture, causing leakage
of blood in or around the brain
 It is caused by rupture of
cerebral vessel with
subsequent bleeding in
brain.
 Primary cerebral
hemorrhages occurs in
small vessels producing
aneurysm
 It occurs from bleeding
into subarachnoid
space typically from a
saccular or berry
aneurysm affecting
large blood vessels
Hemorrhagic Stroke
Intracerebral Hemorrhage Subarachnoid Hemorrhage

9.  The brain is supplied with blood by
 Two vertebral arteries
 Two internal carotid arteries
4 arteries anastomose on the inferior aspect
of the brain forming CIRCLE OF WILLIS.
Stroke is Classified as
 Anterior Cerebral Artery (2.0%)
 Middle Cerebral Artery (37.7%)
 Posterior Cerebral Artery (8.8%)
 Internal Carotid Artery (28.3%)
 Vertebral Artery (14.6%),
 Basilar Artery (7.8%)
Cerebral Circulation

10. 1- ACA Syndrome
Most common characteristic of
ACA syndrome includes
contralateral hemiparesis and
sensory loss in lower extremity
(LE) than the upper extremity
Vascular Syndrome

11. 2- MCA Syndrome
Its most common characteristics
includes contralateral spastic
hemiparesis and sensory loss of
face, UE and LE. Upper
extremity more involved than LE
in this syndrome
Vascular Syndrome

12. 3- PCA Syndrome
Its most common characteristics
include contralateral hemiplegia
with involvement of cerebral
syndrome. Homonymous
hemianopsia is a common
finding in this syndrome
Vascular Syndrome

13.  BLOOD TEST:
 High Cholesterol, Blood Clotting Time and Sugar level
 BRAIN IMAGING TEST
 CT Scan: shows cerebral edema (within 3 days) & cerebral
infarction (within 3-5 days).
 MRI: Detect damaged brain tissue 2-6 hours after stroke.
 MRA (Magnetic Resonance Angiography) Visualize Narrow
blood vessel.
 HEART & BLOOD VESSEL TEST
 Carotid Ultrasonography: Clotting in arteries leading to brain.
 Carotid Angiography: (Arteriography)
Diagnostic Test

14.  Sensory System (Pain, Touch, Temperature and Vibration)
 Visual changes
 Cranial Nerve Examination
 Motor function and Muscle Power
 Muscle tone (high/low)
 Reflexes
 Coordination/ Motor Programming
 Level of Consciousness (GCS)
 Postural Control & Balance
 Perception & Cognition
 Emotional Status
 Bladder & Bowl function
Assessment of Stroke

15.  1st Initial sign of Stroke is FAST
 Sudden Numbness or weakness of face, arm or leg
especially on one side of body.
 Sudden confusion, trouble speaking or understanding.
 Sudden trouble seeing in one or both eyes.
 Sudden trouble walking, dizziness, loss of balance or
coordination.
 Sudden severe headaches with no known cause
 Sudden nausea, fever, & vomiting distinguished from a viral
illness by the speed of onset.
 Brief loss of consciousness or a period of decreased
consciousness (fainting, confusion, or coma)
Warning Signs of Stroke

16.  Aspirin
 Heparin
 Surgical Endarterectomy
 Surgical Blood Vessel Repair
Medical Management
Surgical Management

17. Physiotherapy Intervention for Stroke

18. Improve sensory functions
Flexibility and joint integrity
Improve strength
Manage spasticity
Improve motor & postural control
Improve balance & locomotion
Improve aerobic functions
Improve feeding & swallowing
Improve motor learning
Patient & family educations
Discharge planning

19.  Limb physiotherapy that includes passive to active range-of-motion
exercise for the hemiplegic limbs To prevent limb contractures and
spasticity
 Chest physiotherapy, cough and forced expiratory technique (FET) for
bronchial hygiene clearance in stroke patient.
 Early mobilization the act of getting a patient to move in the bed, sit up,
stand, and eventually walk.
 Tone management stretching, prolonged stretching, passive
manipulation by therapists, weight bearing, ice, splinting, and casting.
 Electrical Stimulation could be used for tone management
 Edema management
 Balance retraining
 Gait re-education
 Functional Mobility Training These tasks include bridging, rolling to sit
to stand and vice versa, transfer skills, walking and earlier ambulation.

20.  Lennon S, Ashburn, A. The Both concept in stroke rehabilitation: a focus
group study of the experienced physiotherapists perspective. Disability and
Rehabilitation. 2000;22(15): 665-674.
 O’Sullivan SB, Schmitz TJ, Physical Rehabilitation, Fifth Edition, F.A.
Davis Company, 2007; Ch.18
 Dickinson, John (1976).Proprioceptive control of human movement.
Princeton Book Co. p. 4.Retrieved 8 April 2011.
 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
References

21. THANK YOU

22. Questions…?