MIDDLE CEREBRAL ARTERY

SHARMINIY A/P MUNIANDY

1000356
AIMST UNIVERSITY

M ID D LE CEREBRAL ARTERY
(DEFINITIONS
M CA)

Middle cerebral artery syndrome

is a condition whereby the blood supply
from the middle cerebral artery (MCA) is
restricted, leading to a reduction of the
function of the portions of the brain
supplied by that vessel: the lateral
aspects of frontal, temporal and parietal
lobes, the corona radiata, globus pallidus
, caudate and putamen. The MCA is the
most common site for the occurrence of
ischemic stroke.

PATHOPHYSIOLOGY
Atherosclerosis
atherosclerotic plaque along the inner wall of the carotid artery
development of blood clots
turbulent blood flow
dislodgment of plaques
Embolus
obstructing blood flow
Injury & death of tissue lead to STROKE

bifurcation.

C LIN IC A L FEATU R ES
Contralateral hemiparesis involving mainly the

upper limb and face ( lower limb is more spared)

Contralateral hemisensory loss involving mainly
the upper limb and face (lower limb is more
spared)
Motor speech impairment : brocas or nonfluent
aphasia with limited vocabulary and
slow,hesitant speech
Receptive speech impairment:wernickes or
fluent aphasia with impaired auditory
comprehension and fluent speech with normal
rate and melody.

 Global apahasia : nonfluent speech with poor

comprehension
Perceptual deficits: unilateral neglect,depth
perception,spatial relations,agnosia
Limb kinetic apraxia
Contralateral homonymous hemianopsia
Loss of conjugate gaze to the opposite side
Ataxia of contralateral limbs (sensory ataxia)
Pure motor hemiplegia (lacunar stroke)
Difficulity in reading,writing and calculating

MEDICAL MANAGEMENT
antiplatelet (aspirin ,Thienopyridines

or anticoagulant (warfarin) at first

diagnosis.

SU RG ICAL M AN AG EM EN T
Carotid endarterectomy or carotid

angioplasty can be used to remove

atherosclerotic narrowing (stenosis)
of the carotid artery.

Endarterectomy for a significant

stenosis has been shown to be useful
in the secondary prevention after a
previous stroke
Hemicraniectomy

D IA G N O SIS
Ultrasonography
Magnetic Resonance Imaging
CT ANGIOGRAPHY

EVID EN CE BASED JO U RN ALS

Emilia Mikoajewska

NDT-Bobath Method in Normalization of Muscle

Tone in Post-Stroke Patients 2012
In all cases with recovery, this level of recovery was

grade 1. The greatest number of recoveries was

observed from grade 1 to grade 0 on the Ashworth
Scale.
It implicates the conclusion that, in the area of
muscle tension normalization, the NDT-Bobath
method is most efficient in cases of mid-range
increased muscle tension.

 Constraint-Induced Movement Therapy

During Early Stroke Rehabilitation Corwin

Boake, Elizabeth A. Noser, Tony Ro, Sarah
Baraniuk, Mary Gaber, Ruth Johnson, Eva T.
Salmeron, Thao M. Tran 2007
On all measures of motor function of the affected

arm and hand, patients who received

CIMT showed an apparent advantageous trend
over patients who received intensive traditional
therapy.
Relative to the control group, the CIMT group
reported significantly greater improvement in
quality of performing daily activities using the
affected hand.

PH YSIO TH ERAPY
M AN AG EM EN T
Flaccidity stage

weightbearing, passive range of motion,

proper positioning of limbs, and facilitation

techniques such as tapping, quick stretch,
and electrical stimulation.
Scapular mobilization is important during
the spastic stage to help reduce stiffness of
scapula and increase shoulder range of
motion.

 A hand or wrist splint may also be

useful, particularly at night.

Heat or cold therapy can temporarily

decrease spasticity and allow the

muscle to be stretched.

Electromyographic biofeedback

EMGBF:

 Weight bearing can be done by the

caregiver placing the patient's open

hand on a flat surface (i.e. mat, bed,
book), supporting the patient's elbow
so the arm won't buckle, and having
the patient lean and put weight down
through the flaccid arm and hand.
One can also tap the muscles to try
an initiate movement.

Sensation Interventions
Encourage pt to use the more involved

side to increase awareness and function.

Stroking involved extremity using textured
fabrics, pressing objects into hand, or
drawing shapes and letters on the skin.
Approximation through weight bearing in
sitting/modified plantigrade/standing
Stretching
Superficial and Deep pressure stimulation

M otor Function
Interventions
AROM and PROM daily in all jts and

motions. (scapula is very important to

prevent impingement in subacromial
space during overhead movements)
arm cradling, table top polishing,
sitting leaning forward and reaching
both hands down to the floor.
Positioning strategies w/ proper jt
alignment splints may be necessary

M anage Spasticity
Prolonged pressure on long flexor

tendons in arm
Kneeling or quadruped to reduce
spasticity in the quadriceps
Hooklying w/ lower trunk rotation or PNF
chops to reduce tone in the trunk
Ice wraps or ice packs can be used
temporarily to reduce spasticity.
splints to provide for early wb and break
up synergy patterns

Strength Interventions
Free Weights
Step-ups while wearing ankle

weights
Functional Activities
PNF

P ostural and Functional

M obility Interventions
Rolling to both side
Supine <>Sit from both sides- shift

LEs over edge of bed and use UEs

to push up.
Sitting with symmetrical posture
and proper spine and pelvic
alignment. Progress from
stability>dynamic stabilty>
reaching. Practice trunk flex/ext,
lateral flex, and rotation.

 Standing, Modified Plantigrade

Standing with unilateral support on

the affected side.

transfer towards the less affected
side, but it is important to practice
transferring using both sides.

B alance Interventions
Achieve postural alignment and static

stability, progress to weight shifting

within limits of stability, maintain
symmetrical weight bearing.
Increase the difficulty by applying
perturbations, standing on a less
stable surface, narrow BOS, extend UE
or LE out to side, add head
movements, add dual tasks, move
from a closed environment to an open
environment.

G ait Training Interventions

Overhead harness on treadmill
Parallel bars and ambulation aids
Maintain Natural rhythm of walking and

speed.
Encourage Pt to take even steps.
Recognize gait abnormalities and correct.
Position UE in extension and abduction with
the hand open to break up synergy pattern.
Practice walking
forward/backward/sideward/cross-stepping,
step-ups, stair climbing, step-overs/travel
training in environment.