Question

Write on any 2 out of these 3 diseases/disorders below with a focus on these sections: Anatomy, Pathophysiology, the role of the Physiotherapist/Occupational Therapist in managing it.(800 words)

a. Cerebrovascular accident

b. Facial nerve palsy

c. Alzheimer’s disease

1.​Compare and contrast the mechanisms underlying two theories which seek to explain our perception of referred pain. Describe a scenario where knowledge of common sites for pain referral can be useful in clinical practise. (10 marks; maximum 300 words)

2.​Explain your understanding of non-associative learning and its various forms. Describe a scenario where non-associative learning becomes relevant in relation to motor control and function. (10 marks; maximum 300 words)

Answer 1

Ans :

Cerebrovascular accident :

Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood vessel

Types of cerebrovascular accident

There are two main types of cerebrovascular accident, or stroke: an ischemic stroke is caused by a blockage; a hemorrhagic stroke is caused by the rupture of a blood vessel.

Ischemic stroke :

An ischemic stroke is the most common and occurs when a blood clot blocks a blood vessel and prevents blood and oxygen from getting to a part of the brain. There are two ways that this can happen. One way is an embolic stroke, which occurs when a clot forms somewhere else in your body and gets lodged in a blood vessel in the brain. The other way is a thrombotic stroke, which occurs when the clot forms in a blood vessel within the brain.

Hemorrhagic stroke :

A hemorrhagic stroke occurs when a blood vessel ruptures, or hemorrhages, and then prevents blood from getting to part of the brain. The hemorrhage may occur in any blood vessel in the brain, or it may occur in the membrane surrounding the brain.

Symptoms :

loss of balance and coordination

difficulty speaking or understanding others who are speaking

numbness or paralysis in the face, leg, or arm, most likely on just one side of the body

blurred or darkened vision

a sudden headache, especially when accompanied by nausea, vomiting, or dizziness

Treatment :

Treatment for stroke depends on the type of stroke you’ve had. The goal of treatment for ischemic stroke, for instance, is to restore the blood flow. Treatments for hemorrhagic stroke are aimed at controlling the bleeding.

Ischemic stroke treatment

To treat an ischemic stroke, you may be given a clot-dissolving drug or a blood thinner. You may also be given aspirin to prevent a second stroke. Emergency treatment for this type of stroke may include injecting medicine into the brain or removing a blockage with a procedure.

Hemorrhagic stroke treatment

For a hemorrhagic stroke, you may be given a drug that lowers the pressure in your brain caused by the bleeding. If the bleeding is severe, you may need surgery to remove excess blood. It’s also possible that you will need surgery to repair the ruptured blood vessel.

Facial nerve palsy :

Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. The pathway of the facial nerve is long and relatively convoluted, so there are a number of causes that may result in facial nerve paralysis.The most common is Bell's palsy, a disease of unknown cause that may only be diagnosed by exclusion of identifiable serious causes

Signs and symptoms :

Facial nerve paralysis is characterised by facial weakness, usually only in one side of the face, with other symptoms possibly including loss of taste, hyperacusis and decreased salivation and tear secretion. Other signs may be linked to the cause of the paralysis, such as vesicles in the ear, which may occur if the facial palsy is due to shingles. Symptoms may develop over several hours.Acute facial pain radiating from the ear may precede the onset of other symptoms

Treatment:  

If an underlying cause has been found for the facial palsy, it should be treated. If it is estimated that the likelihood that the facial palsy is caused by Lyme disease exceeds 10%, empiric therapy with antibiotics should be initiated, without corticosteroids, and reevaluated upon completion of laboratory tests for Lyme disease.All other patients should be treated with corticosteroids and, if the palsy is severe, antivirals. Facial palsy is considered severe if the person is unable to close the affected eye completely or the face is asymmetric even at rest. Corticosteroids initiated within three days of Bell's palsy onset have been found to increase chances of recovery, reduce time to recovery, and reduce residual symptoms in case of incomplete recovery.However, for facial palsy caused by Lyme disease, corticosteroids have been found in some studies to harm outcomes.Other studies have found antivirals to possibly improve outcomes relative to corticosteroids alone for severe Bell's palsy.In those whose blinking is disrupted by the facial palsy, frequent use of artificial tears while awake is recommended, along with ointment and a patch or taping the eye closed when sleeping.

Causes :

Bell's palsy is the most common cause of acute facial nerve paralysis. There is no known cause of Bell's palsy, although it has been associated with herpes simplex infection. Bell's palsy may develop over several days, and may last several months, in the majority of cases recovering spontaneously. It is typically diagnosed clinically, in patients with no risk factors for other causes, without vesicles in the ear, and with no other neurological signs. Recovery may be delayed in the elderly, or those with a complete paralysis. Bell's palsy is often treated with corticosteroids

Infections :

Lyme disease, an infection caused by Borrelia burgdorferi bacteria and spread by ticks, can account for about 25% of cases of facial palsy in areas where Lyme disease is common .In the U.S., Lyme is most common in the New England and Mid-Atlantic states and parts of Wisconsin and Minnesota, but it is expanding into other areas.The first sign of about 80% of Lyme infections, typically one or two weeks after a tick byte, is usually an expanding rash that may be accompanied by headaches, body aches, fatigue, or fever.In up to 10-15% of Lyme infections, facial palsy appears several weeks later, and may be the first sign of infection that is noticed, as the Lyme rash typically does not itch and is not painful. Lyme disease is treated with antibiotics.