Vertebral artery test

Approximately one‐quarter of ischaemic strokes involve the posterior or vertebrobasilar circulation. Stenosis of the vertebral artery can occur in either its extra‐ or intracranial portions, and may account for up to 20% of posterior circulation ischaemic strokes. Stenotic lesions, particularly at the origin of the vertebral artery, are not uncommon. In an angiographic study of 4748 patients with ischaemic stroke, some degree of proximal extracranial vertebral artery stenosis was seen in 18% of cases on the right and 22.3% on the left. This was the second most common site of stenosis after internal carotid artery stenosis at the carotid bifurcation. Such stenotic lesions are now potentially treatable by endovascular techniques.

In marked contrast with carotid artery stenosis, the optimal management of vertebral artery stenosis has received limited attention, and is poorly understood. This partly reflects difficulties in imaging the vertebral artery adequately, and limited surgical treatment options. Recent improvements in imaging and the arrival of vertebral artery angioplasty, however, have opened up new opportunities for intervention in this disease.

Read the rest "Diagnosis and management of vertebral artery stenosis" @ http://www.oxfordjournals.org/en/.

The treatment in such cases is purely medical. However, a Physical Therapist should be aware of this problem, the vertebral artery disease or  vertebrobasilar ischaemia, and should know the basic anatomy, symptoms and assessment test in his everyday practise.

A very nice article on Physiopedia explains these issues clearly.

What to keep in mind:

To test the blood flow in the vertebral artery, one should put the patient on his back and perform an passive extension, followed by a passive rotation of the neck. The rotation should be performed in both directions. The manoeuvre causes a reduction of the lumen at the third division of the vertebral artery, resulting in de decreased blood flow of the intracranial vertebral artery of the contralateral side. It causes an ischemia due to blood loss in the pons and the medulla oblongata of the brain. This results in dizziness, nausea, syncope, dysarthria, dysphagia, and disturbances of the hearing or vision, paresis or paralysis of patients with vertebrobasilar ischaemia.

Below is an alternate vertebral artery test, presented by http://www.thestudentphysicaltherapist.com/.

http://www.patient.co.uk/ offers an extended overview of the Vertebrobasilar Occlusion and Vertebral Artery Syndrome, including treatment and management options.

The Future of Prosthetics: Mind-Bending Robotic Arms

Researchers have shown that patients paralyzed from the neck down can move robotic arms with their minds, according to a new report in the journal Nature that documents two cases involving brain-stem stroke victims. Margaret Warner discusses the hopes for the technology with Dr. Leigh Hochberg of Massachusetts General Hospital.

Nutrition advices by the American Heart Association

"Heart disease is the No. 1 killer of Americans. We can reduce heart disease by promoting a healthy diet and lifestyle. Getting information from credible sources can help you make smart choices that will benefit your long-term heart health".

Stroke Engine

Welcome to Stroke Engine, a site for individuals who have experienced stroke, their families and health professionals who work in the field of stroke rehabilitation. Stroke Engine has been developed with the support of the Canadian Stroke Network to support the use of evidence-based stroke rehabilitation in clinical practice. Stroke Engine is recognized for its scientific rigor by the Canadian Cochrane Center. We receive over 300,000 visitors each year including clinicians, researchers, academics, teachers, students, patients with stroke and their family/friends.

Stroke Survivor Learns How to Use Hand

With the help of the electric impulses of a Ness H200 Hand Rehabilitation System (made by Bioness) applied to stroke survivor's arm, his hand is able to open and grasp pegs on a peg board. Read more about his stroke recovery and rehabilitation at http://www.strokesurvivorblog.com/.

Clinical guidelines for stroke management

The National Stroke Foundation: We are a not-for-profit organisation that works with stroke survivors, carers, health professionals, government and the public to reduce the impact of stroke on the Australian community.

We are the voice of stroke in Australia. Our mission is to stop stroke, save lives and end suffering.

Here is the clinical guidelines they have developed for stroke management.

I have already posted the KNGF's guidelines for stroke patients, too.

Physiotherapy exercises for people with spinal cord injuries

An amazing tool for physiotherapy exercises for people with spinal cord injuries. You can many different kind of exercises designed for these people and make your own exercise set by filtering them by exercise type, level of injury, difficulty level and other criteria.

Click here.

Treatment guidelines: stroke

The Royal Dutch Society for Physical Therapy has created some really state of the art guidelines documents for physio therapeutic treatment of some major pathologies. I have presented that before, but I thought it would be useful for students to have access to each treatment guideline separately in this blog.

So, here is the guideline for stroke.