FYI.
Effects of Physical Rehabilitation With X-Sens Inertial Technology Feedback on Posterior Cerebral Artery Infarcts: A Case Study
Published: March 18, 2024
DOI: 10.7759/cureus.56379
Cite this article as: Sawra A K, Sharath H, Chavan N (March 18, 2024) Effects of Physical Rehabilitation With X-Sens Inertial Technology Feedback on Posterior Cerebral Artery Infarcts: A Case Study. Cureus 16(3): e56379. doi:10.7759/cureus.56379
Abstract
Acute ischemic stroke (AIS) affecting the posterior cerebral artery (PCA) represents a unique clinical challenge, necessitating a multifaceted approach to rehabilitation. This review aims to provide a comprehensive overview of physiotherapeutic interventions tailored specifically for individuals with AIS involving the PCA territory. The PCA supplies critical areas of the brain responsible for visual processing, memory, and sensory integration. Consequently, patients with PCA infarcts often exhibit a distinct set of neurological deficits, including visual field disturbances, cognitive impairments, and sensory abnormalities. This case report highlights evidence-based physiotherapy strategies that encompass a spectrum of interventions, ranging from early mobilization and motor training to sensory reintegration and cognitive rehabilitation. Early mobilization, including bed mobility exercises and upright activities, is crucial to prevent complications associated with immobility. Motor training interventions target the restoration of functional movement patterns, addressing hemiparesis and balance impairments.
Introduction
Cerebrovascular diseases, with stroke in their first place, are the most common neurological diseases of adults. They belong to chronic, mass non-infectious diseases. Stroke is an illness in which one or more blood vessels supplying the brain with oxygen and nutrients are damaged by a pathological process, and consequently, there is damage to the brain parenchyma [1]. Despite the obvious improvements in the prevention, diagnosis, treatment, and rehabilitation of persons with stroke, it still holds third place as the cause of death, after cardiovascular and malignant diseases. New studies based on an examination of the global burden of illness, the incidence, and death brought on by this disease worldwide also support these statistics [2].
Each interruption of blood flow (ischemia) to the brain means the discontinuation of oxygen and nutrient flow, and since nerve cells do not have a stock of nutrients, the disruption of blood flow leads to the cell's energy crisis. Ischemia can be global or regional, but an important point is the degree of ischemia compared to the normal flow and duration of ischemia. The higher the degree of ischemia and longer lasting, is more likely to occur irreversible changes which end in death (necrosis) of nerve cells [3]. There are two primary artery systems that provide blood to the brain: the anterior and posterior circulations.
The deep branches of the anterior and middle cerebral arteries (ACA and MCA) and the internal carotid artery (ICA) make up the anterior carotid circulation system. This confluence blood supplies nourishment to the orbit and most of the cerebral hemispheres, excluding the occipital lobe and a small area of the thalamus [4]. The vertebral artery, basilar artery, rear cerebral artery, and its branches make up the posterior circulation. They nourish the occipital lobe, a portion of the thalamus, the medio-inferior temporal lobe, and the majority of the brain stem [5].
The major objective of stroke patients' rehabilitation is to help them regain their social and personal identities as well as their maximal functional ability in everyday activities. For those over 60, stroke is the primary cause of rehabilitation as well as the primary source of functional disability [6]. Studies have shown that 10-20% of those who experience an ischemic stroke die somewhat soon after the stroke. The purpose of this study is to assess anterior circulation syndrome patients' functional recovery following their original ischemic stroke, the acute and post-acute phases of posterior circulation syndrome, and the chronic phase of physical therapy and rehabilitation [7].
Case Presentation
Patient information
The patient, a 44-year-old woman with a dominant right extremity, said she was unable to move her lower limb limbs or trunk and was taken to the hospital. She was too weak to walk, sit, or stand, had visual disturbances, and also had trouble doing activities of daily living (ADLs). A year prior, the patient suffered an ischemic stroke that left her with a quick onset of headache, difficulty speaking, and collapse from loss of consciousness. Seven days back, the patient started complaining of bilateral lower limb weakness, unable to sit, stand, or walk and decreased vision, slurred speech. The patient was immediately rushed to the hospital where investigations like CT brain and MRI brain were done which revealed chronic lacunar infracts involving bilateral corona radiata and ganglio-capsular region involved. The patient was admitted to the neuro ICU for 10 days and the patient was on 2 liters of O2 via nasal prongs, she was referred to neuro physiotherapy for further management, where the assessment was done, and according to the problem list, tailored physiotherapy rehabilitation was given.
Clinical finding
After admitting to the neuro ICU, the patient appeared unconscious, so a thorough examination was done. At first, mental state examination was not possible since the patient was unable to communicate. She was unable to speak or communicate. The inability to speak additionally impeded the sensory evaluation. Comprehensive evaluations were conducted on motor assessment, spasticity, and soft tissue compliance. Bilateral lower limb spasticity was graded 1+ (hypotonia), In the case of the shoulder, elbow, wrist, and hip flexors, and grade 3+ (hypertonia), in the case of the knee and ankle plantar flexors (Table 1).
No comments:
Post a Comment