Question

A 50-year-old woman suddenly felt numbness and weakness of the left upper and lower limb. She was immediately admitted at a near-by hospital and diagnosed with Right MCA syndrome. The patient is referred for physiotherapy. Assessment revealed Brunnstrom grade 2 and hemisensory loss mainly involving the upper and lower extremity. She presented with, DTR: Left upper and lower extremity brisk, Passive Full ROM of all extremities in all planes of motion a) List ANY FIVE Facilitatory and ANY FIVE Inhibitory technique to improve the impairment that patient experienced. (5 mark)

b) Brief the typical hemiplegic posture that a CVA patient can experience in general.

c) Describe ANY TEN clinical manifestation that a MCA stroke patient can experience and rationale.

Answer 1

Stroke can be defined as sudden neurological loss of function due to interruption in the blood supply to the brain which maybe due to ischemic or hemorrhagic causes.MCA is middle cerebral artery supplies the entire lateral aspect of the cerebral hemisphere and subcortal structures.it is the second branch of the intral carotid artery. Damage of the MCA leads to neurological damage that leads to cerebral edema, incareased cranial pressure, whcih futher leads to loss of consciousness,brain hernia,and finally death.

(A).Facilitatory methods helps in enhancing the postural tone that uses somatosensory cues. Some of the techniques will be vibration,quick stretch, fast and slow vestibular stimulation,cryotherapy, slow stroking, manual contacts and light touch, traction and approximation whcih all can be comprised in roods approach, brunstrom approach, NDT, sensory integration

inhibitory methods are neural warmth, fast and slow vestibular stimulation, joint compression, PNF, inhibitory pressure,

(B) A typical posture the patien with CVA adapts is called abnormal synergy pattern. These patterns emrge with spasiticty of the muscle where the patient is unable to perfroma a single isolated movement like if they attempt to do elbow flexion it will be accompained by shoulder flexion and elevation, external rotation and abduction. These synergy patterns are clasified as two types namley flexion type and externsion type. Not all the muscles are involved in this for example muslce like serratus naterioe, finger externsors, ankle evertors, teres majoe, latissimus dorsi are not involved in this.

	FLEXION SYNERGY	EXTENSION SYNERGY
UPPER LIMB	scapular retraction elevation shoulder abduction shoulder abduction elbow flexion forearm supination wrist and finger flexion	Scapular protaction shoulder adduction Shoulder internal rotation Elbow extension Forearm pronation Wrist and finger flexion
LOWER LIMB	Hip flexion Knee flexion Ankle dorsiflexion Ankle inversion Toe dorsiflexion	Hip extension HIP adduction Hip internal rotation Knee extension Ankle plantar flexion Ankel inversion Toe plantarflexion

(C) Following are some of the clincial manifestation patien woth MCA experiences

• contralateral or opposite side hemiparesis(weakness) of the upper and lower limb due to the involovement of the internal capsule and primary motor cortex
• Contralateral hemisensory loss of the upper and lower limb due to the involovement of the internal capsule and primary motor cortex.
• lime-kinetic apraxia (difficulty to perform movment ) due to the involvement of the premotor or paritel cortex.
• global aphasia: speech is nonfluent with poor comprehensio due to the involvement of the superior temporal gyrus.
• receptive speech impairement due to the involvement of the Wernickes area.
• motor speech impairement due to the involvement of the Broca area.
• unilateral neglect.
• agnosis
• loss of conjugate gaze to the opposite side due to the involevement of the descending tracts.
• ataxia of contralateral limbs due to the involvement of the parietal lobe.