Transcript الشريحة 1

How to prevent Hemiplegia
 Reduce
body weight to avoid obesity.
 Reduce the physical and mental stress.
 Increasing overall physical conditioning
 Avoid smoking.
 Regular use of hypertension drugs.
 Exercise regularly.
 Paralysis
of one side of the body due to
pyramidal tract lesion at any point from its origin
in the cerebral cortex down to the fifth cervical
segment.
Risk Factor of Hemiplegia
 Diabetes
Mellitus
 High Blood Pressure
 High Cholesterol level
 Obesity
 Smoking
 Sedentary lifestyle
Causes of Hemiplegia

Vascular Causes:
 Thrombosis
 Atherosclerosis.
 Blood Disease.
 Embolic
 Heart
 Deep venous thrombosis
 Hemorrhage
 Hypertension
 Rupture of intracranial aneurysm
Hemiplegia Back Pain
 Infective
Encephalitis
Neoplastic
Meningioma
Demyelination
Disseminated Sclerosis
Traumatic
Congenital
CP
Hystrical
Site of Lesion
 Spinal
Cord
 At the level of C1-C5
 Brown - Sequard syndrome
 Brain Stem
 Mid brain-Pones-Medulla
 Cerebral
 Cortical- Subcortical- Capsular
According to the Onset
 Acute Lesion
 Stage of Flaccidity
 Stage of Spasticity
Stage
 Last
 Gradual Lesion
 Stage of Spasticity
of Flaccidity:
from 2-6 weeks
 On the
paralysed side there is
complete lose of muscle tone and
absence of deep reflex
 May be accompanied with Coma
Stage
of Spasticity:
 Paralysis
of one side of the body
(Affect the progravity more than the
antigravity muscles)
 Spasticity of the paralysed muscles
(Affect the antigravity more than the
progravity muscles)
 Exaggerated deep reflex and lose
superficial reflex.
Rehabilitation Team
 Physician
 physiotherapist
 Social
workers
 Psychologist
 Nurse
 Occupational therapist
 Vocational counselor
Consideration Before Assessment

The clinic should be cleaned, suitable temperature
of room, and ready instrumentation to use.
 Plinths should be wide, suitable height, clean
blankets.
 Behavior and social aspect should be noticed.
 Notice patient from head to ankles.
 Explain to patient what will happen.
 Covering patient till the beginning the assessment.
 Discover disabilities that responsible for restriction
of ADL.

Discover abilities that are suitable for ADL
performance.
Considerations During Assessment

Good fixation of target joint during assessment.

Patient completely relaxed (physically & mentally)
during assessment.

All movements and test procedure should be within
the limit of pain.

Removing tight clothes during assessment.

Explain the tests procedure to the patient.

Close communications during assessment.
DIAGNOSTIC INTERVIEW
Personal History:
 Name: To be familiar with the patient
 Age:
occurs in people aged 40-50 years
(cerbrovascular stroke)
 Sex: affects men and women equally
 Marital status: Married or single
 Style of life: his habits, activities and if he living a
sedentary life. It assist in providing the therapist with
hint about causes and the expected prognosis.
 Occupation: as people in certain job are more
susceptible to some disease. Most plan of treatment
require occupational modification.
Personal History

Environmental
assessment: is the patient
living in crowded and noisy
area or not, which floor, and
availability of Facilities .

Weight: obesity increase
the difficulty in performing
activities.
Past history
 Hereditary
and Genetic diseases.
 Previous and multiple trauma.
 Diabetes Mellitus.
 Cardiac problems and Hypertension.
 Previous surgery.
 Associated Trauma or injury.
 Drug use.
 Cancer or tumor.
Present history
Mechanism of injury.
Onset and course of disease:
o
Acute onset and regressive course (Vascular,
Infective. Traumatic lesion)
o
Gradual onset and progressive course
(Neoplastic lesion)
o
Remittent and relapsing course (DS)
Duration of symptoms:
 Flaccid
Stage: 2-6 weeks
 Spastic
Stage: After Flaccid Stage
Functional activities of daily living
What problems interfere
with ADL:
There are 4 grades
for evaluation:
*Can’t do it.

Hygiene: affected

Dressing and
undressing: affected.
*Do it with maximum
assistance.

Feeding: affected
*Do it with minimal
assistance.

Gait ambulation:
affected.
 Transfer activities:
affected.
Assistive Devises
*Do it without
assistance.
Social and psychological status
 Attitude
and
behavior:
Nervous,
depressed, accepted.
 Relationship with family.
 Review of a patient’s home, work,
recreational activities.
 Information
should be obtained on
patient’s prior functional and present
functional levels on these tasks.
Vocational assessment
If the patient can return
to his job or need new
suitable one?
Chief complain
 Difficulties
in performing ADL
 Difficulty walking
 Problems with balance
 Difficulty using arms to dress, feed self, or
perform other tasks
 Urinary incontinence
 Decreased sensation, numbness, or tingling
on affected side of the body
 Difficulty speaking and/or or understanding
words
 Depression
Medical Record
 Drugs:
(according to the cause of the
disease).
 Reports: (all reports from other physicianprevious investigations).
 Laboratory tests. (blood test)
 Vital signs.
 Bowel or bladder incontinence
 Vision, hearing, speech records.
 Cardiopulmonary reports.
 Electrocephalogram
activity of the brain)
EEG (to measure electrical
Computed Tomography (CT)
Magnetic Resonance Imaging
(MRI)
Screening and scanning
examination
General inspection:
 General health.
 Wearing glasses,
hearing aids
 Relation between
family.
 Proportion of body
parts.
 Weight& height.
Posture assessment;
 Posterior, anterior and
lateral views.
 From static and dynamic
positions.
• Position of head & neck.
• Levels of shoulders.
• Scoliosis
• Chest shape .
• Level of waist (ASIS).
• Anterior or posterior pelvic
tilting.
• Any deformities of upper
and lower limbs.
Screening and scanning
examination

Involuntary Movement
 Function:
Observe
any
functional
disabilities during taking his
cloth off.

Gait:
 Phases
of gait or any
abnormalities in gait
 wearing assisted devices.
Specific Inspection
Inspect
the
trunk
and
extremities
for
signs
of
asymmetry, lesions, scars,
trauma,
deformities
or
previous surgery.

Involuntary movement: Chorea, Athetosis, Tremors
 Convulsion

Face Texture: Deviation of mouth angle
 Skin: color, hair patches, scars, wounds , of the skin
 Bones: alignment, deformity.
 Muscle: Spasticity, spasm, atrophy
Palpation
 Soft
tissues of upper and lower limbs .
 Changes in temperature or texture.
 Mobility of the skin.
 Tenderness.
 Spastic and atrophied muscles.
Comprehensive Motor Control Assessment
Examination of the Mental Function






State of consciousness:
Alert
Drowsiness
Coma
Orientation for Time and Place.
Memory:
Immediate
Recent
Remote
Communication Abilities:
Vision
Hearing
Speech
Behavior and Psychological Status:
Depression
Angry
Intelligence:
IQ
Examination of Speech
 Sensory Aphasia:
1)Visual:
 Visual Agnosia
 Alexia
2)Auditory:
 Auditory Agnosia
 Motor Aphasia:
 Verbal aphasia
 Agraphia
Sensory Examination
 Superficial
sensation
Touch, Pain, Temperature ( compare on each
side of limbs)
Semmes Weinstein monofilament test
Pin prick test
Sensory Examination
Deep Sensation

Vibration sense
The use of a 256-Hz tuning
fork over different bony
prominance.
 Joint Sense
 Sense of position
 sense of movement
Deep Sensation
 Romberg’s Test
 Muscle sense
Sensory Examination
Cortical Sensation
 Tactile Localization
 2-point discrimination
Cortical Sensation

Stereognosis
 Graphosthesia
 Perceptual Sense
Examination of Cranial Nerves










Oculomotor Nerve (3rd cranial nerve):
Ask patient to look upward
abducent Nerve (6th cranial nerve):
Ask patient to look laterally
Facial Nerve (7th cranial nerve):
Ask patient to smile and showing teeth
Absence of nasolabial fold and dropping angle of
mouth
Hypoglossal nerve (12th cranial nerve):
Deviation of tongue toward the affected side
Ask patient to push his check with the tip of tongue
Muscle Tone Assessment
 Spasticity
or hypertonia of the paralysed
muscles of the clasp-knife type:
It affect the antigravity more than the progravity
muscles.
 In UL: the flexors more spastic than the
extensors
 In LL: the extensors more spastic than the
flexors
Factors affecting Muscle tone
 Anxiety
 Temperature
 Tension
 Drugs
 Fear
 Fullness
of bladder
 Position of the head
 Environmental condition
 Vision and hearing
 Pain
Assessment of Muscle Tone
 Passive Movement
Ashworth Scale :
To perform this test, the part is moved through
the joint range-of-motion (ROM).
Ashworth Score Criteria:
0 No increase in tone
1 Slight increase in tone, giving a “catch” when
the limb is moved in flexion or extension
2 More marked increase in tone, but limb easily
flexed
3 Considerable increase in tone; passive
movement difficult
4 Limb rigid in flexion or extension
Assessment of Muscle Tone

Shaking:
Wrist and Ankle


Drop arm Test
Postural tone:
Righting and
Equilibrium Reactions
Examination of Muscle Power
 Paralysis
or Weakness of one side of the
body.
 It affect the progravity more than the
antigravity muscles.
 Upper
limbs: The Extensors are weaker
than the Flexors.
 Lower limbs: The Flexors are weaker than
the Extensors
Examination of Muscle Power
Shoulder Joint: C4-C5
Flexion
Extension
Medial and Lateral Rotation
Adduction
Abduction
Elbow Joint: C5,6,7
Flexion
Extension
Examination of Muscle Power
Wrist joint: C7,8
Extension
Flexion
Hand:C8-T1
Fingers and Thumb
Flexion, Extension
Abduction, Adduction
Examination of Muscle Power
Abdominal Muscles:T6-T12
Examination of Muscle Power
Flexion: L1-2-3
Extension: L4-5-S1-2
Hip Joint
Adduction: L2-3-4
Flexion: L5-S1-2
Dorsiflexion: L4-5
Abduction: L5-S1
Knee Joint
Extension: L2-3-4
Ankle Joint and Foot
Plantarflexion: S1-2
Inversion: L4-L5
Eversion: L5-S1
Examination of Reflexes
A) Deep Reflexes
Exaggerated deep reflex in Hemiplegia
Biceps Reflex(C5,6)
Triceps Reflex(C6,7)
Deep Reflexes
 Brachioradialis
reflex (C5,6)
Deep Reflexes
Knee reflex(L2,3,4)
Achilles tendon (Ankle) reflex(S1,2)
B) Superficial Reflexes
Lost on the paralysed side
Abdominal Reflex (T6-T12)
Planter Reflex (S1-S2)
Positive Babinski Sign
Test For Clonus
Clonus : Is a rhythmical series of
contraction in response to the sudden
sustained stretch of the tendon of the
muscle.it appear in the UMNL.
 Ankle
Clonus
Range of Motion Assessment
 Active
and Passive ROM
Range of Motion Assessment
Electrogoniometer
Universal goniometer
Long and Round measurement
Circumferential measurements: By tape
measurement to determine atrophy of lower
limb muscles (quadriceps, calf muscles).
Long Measurement: Measure leg lengths
from anterior superior iliac spine to medial
malleolus by Tape measurement.
Functional Assessment
•Dressing and undressing
•Transferee activities
•Gait and ambulation
•Ability to get up from chair or on/off the
examination table
•Using assistive device
There are 4 grade for evaluation:
*Can’t do it.
*Do it with maximum assistance.
*Do it with minimal assistance.
*Do it without assistance.
Balance Assessment
Coordination assessment
Finger-to-nose test
Finger-to-finger test
Finger-to-doctor's finger test
Coordination assessment
Heel-to-knee test
Gait Assessment
 The
gait of hemiplegic patients is circumduction
Gait

1)patient walk across the room under observation and
gross gait abnormalities should be noted.
2)Heel to toes
3)Walk on toes 4)Walk on heels
Special Tests

Upright Motor Control Test:
Upright Motor Control Test
A) Knee extension:
patient bends both knees to approximately 30
degrees and then lifts the unaffected leg off the
ground.
Grades:
 Strong: straightens the flexed knee to full
extension.
 Moderate: supports body weight on the flexed
knee.
 Poor: unable to support body weight on the
flexed knee
Upright Motor Control Test
B) Knee flexion:
The patient stands as straight as possible and
brings the knee and foot on the affected side up
toward the chest as high and as fast as possible,
repeated three times.
Grades:
Strong: joint flexes more than 60
degrees
Moderate: joint flexes less than 60
degrees or cannot complete three efforts in
10 seconds.
Poor: cannot make flexion.

Postural Assessment

Computerized Posture Analysis
Postural Assessment
 Moire
Topography
Postural Assessment
3D/4D Formetric
Postural Assessment
 posturalprint
Postural Assessment
Posture Evaluation Kit
Range of Motion Assessment
3D Motion Analysis System
Evaluation of Muscles Strength
Isokinetic Dynamometer
Isokinetic Dynamometer
Evaluation of Muscles Strength
Dynamometer :
 For trunk and lower limb movements
Lumbar Extension
Lumbar Rotation
Dynamometer
Ankle dorsi Flexion
Hip Flexion
Ankle Plantar Flexion
Knee Flexion
Evaluation of Muscles Strength
 Digital
Muscle Tester
Gait Evaluation
3D motion analysis and force platform
Detect
different kinetics and kinematics of gait.
Gait Evaluation

Detect any abnormalities in gait
Balance Assessment
Tetrax
Balance Master
Balance Manager
Muscle Tone Assessment
Electromyography
Detect abnormalities of muscle tone.