Physical therapy intervention with a stroke patient Essay

The clinical manifestations of neurologic disease are as varied as the disease processes themselves. Symptoms can be subtle or intense, fluctuating or permanent, an inconvenience or devastating. First clinical manifestation is Pain, it is considered an unpleasant sensory perception and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is therefore considered multidimensional and entirely subjective. Seizures are the result of abnormal paroxysmal discharges in the cerebral cortex, which then manifest as an alteration in sensation, behavior, movement, perception, or consciousness. The alteration may be short, as in a blank stare lasting only a second, or of longer duration, such as tonic- clonic grand mal seizure that can last several minutes. Dizziness, an abnormal sensation of imbalance or movement. It is fairly common in the elderly and one of the most common complaints encountered by health professionals. Visual Disturbances, visual defects that cause people to seek health care can range from the decreased visual acuity associated with aging to sudden blindness. Weakness, specifically muscle weakness is a common manifestation of CVA. Weakness frequently co exists with other symptoms of disease and can affect a variety of muscles, causing a wide range of disability. Weakness can be sudden and permanent, a sin stroke, or progressive, as in many neuromuscular diseases. Abnormal sensation, numbness, abnormal sensation, or loss of sensation is a manifestation of cerebrovascular accident. Altered sensation can affect small or large areas of the body. It is frequently associated with weakness or pain and is potentially disabling. Both numbness and weakness can significantly affect balance and coordination.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Assessment of cortical motor integration is carried out by asking the patient to perform a skilled act like asking a patient to throw a ball, move a chair. Successful performance requires the ability to understand the activity desired and normal motor strength. Failure signals cerebral dysfunction. Examining the Motor System, a thorough examination of the motor system includes an assessment of the muscle size, tone and strength, coordination, and balance. The patient is instructed to walk across the room while the examiner observes posture and gait. The muscles are inspected, and palpated if necessary, for their size and symmetry. Resistance and Abnormalities are documented after. Assessing the patient’s ability to flex or extend the extremities against resistance test muscle strength. Once the leg is straightened, it is exceedingly difficult for the examiner to flex the knee. Conversely, if the knee of the patient is flexed and is asked to straighten the leg against resistance, a more subtle disability can be elicited. For example, the right upper extremity is compared to the left upper extremity. In this way, subtle differences in muscle strength can be more easily detected and accurately described. Coordination in the hands and upper extremities is tested by having the patient perform rapid, alternating movements and point-to-point testing. First the patient is instructed to pat his or her thigh as fast as possible with each hand separately. Then the patient is instructed to alternately pronate and supinate the hand as rapidly as possible. The n lastly, the patient is asked to touch each of the fingers with the thumb in a consecutive motion. Speed, symmetry, and degree of difficulty are noted. Coordination in the lower extremities is tested by having the patient run the heel down the anterior surface of the tibia of the other leg. Each leg is tested in turn. The motor reflexes are involuntary contractions of muscles or muscle groups in response to abrupt stretching near the site of the muscle’s insertion. The tendon is struck directly with a reflex hammer or indirectly by striking the examiner’s thumb, which is placed firmly against the tendon. Testing these reflexes enables the examiner to assess involuntary reflex arcs that depend on the presence of afferent stretch receptors, spinal synapses, efferent motor fibers, and a variety of modifying influences from higher levels. Common reflexes that maybe tested include the deep tendon reflexes like biceps, brachioradialis, triceps, patellar, and ankle reflexes and superficial or cutaneous reflexes like abdominal reflexes and plantar or Babinski response.    References: Brunner, K., Suddarith, L. (2003) Medical- Surgical Nursing.   J. G. Ferguson Publishing Company.