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52 Cards in this Set

  • Front
  • Back

Stroke

Sudden loss of neurological function caused by interruption of the blood flow to the brain


4th leading cause of death


Leading cause of long term disability


7,000,000 americans have experienced stroke


5-14% who survive stroke will experience another within 1yr


Within 5yrs recur stroke = 24% women & 42% men

What are the two types of strokes?

1. Ischemic


2. Hemorrhagic

Ischemic Stroke

Results when a clot blocks or impairs blood flow

What type of stroke is most common?

Ischemic, 80%

Hemorrhagic stroke

Occurs when blood vessels rupture, causing leakage of blood around the brain

To be classified as a stroke, neurological deficits must persists for how long?

24 hours

For cells to survive, how much blood flow is required?

20-25%

What are major risk factors for CVA?

Hypertension


Heart Disease


Diabetes Mellitus


Disorders of heart rhythm


(end stage renal disease)


(sleep apnea)

What are the five stroke warning signs?

1. Sudden numbness or weakness of the face, arm or leg, one side of the body


2. Sudden confusion, trouble speaking or understanding


3. Sudden vision changes


4. Sudden trouble walking, dizziness, LOB, coordination


5. Sudden severe headache

Circle of Willis

Circular anastomosis that supplies blood the brain

Name the Circle of Willis

Circle of Willis Picture

Posterior Communicating Artery

Connects the posterior cerebral arteries with the internal carotid arteries to complete the circle of Willis

External Carotid artery

Supplies circulation to the face

Internal Carotid Artery

Supplies cerebral hemispheres

What does the Anterior Cerebral Artery Supply?

the superior border for the parietal and frontal lobes and subcortical structures

Blood Supply to brain

What does the middle cerebral artery supply?

The lateral surface of the brain and deep portions of frontal and parietal lobes

What is the most common type of CVA?

Middle Cerebral Artery Occlusion

What do the vertebral arteries supply?

The cerebellum, and medulla

What does the basilar artery supply?

Pons, internal ear, and cerebellum

What does the posterior cerebral artery supply?

Occipital lobe and temporal lobe

Rood Approach

involves superficial cutaneous stimulation using stroking, brushing, icing, or muscle stimulation with vibration tendon tapping and joint compression to evoke voluntary contraction or inhibition of proximal muscle

Rood's Four Basic Principals

1. Sensory input is required for normalization of tone and evocation of desired muscular response


2. Sensory motor control is based on development


3. Movement is purposeful; engagement in activities is required to produce a normal response


4. Repetition of movement is necessary

Stages of Motor Recovery Post CVA

1. flaccidity


2. Spasticity


3. Reflexes


4. Voluntary movements


5. coordination


6. motor programming

Hypotonicity

Presents immediately after a stroke and is due to cerebral shock. Short lived

Hypertonicity

Emerges in 90% of cases on affected side


Generally in antigravity muscles

facilitation

Intervention to increase the likelihood of a desired response


Inhibition

intervention to decrease the likelihood of an undesired response

Facilitation for hypotonic muscles

Quick stretch


Tapping


Vibration


Brushing


Icing


Joint approximation

Inhibition for hypertonic muscles

Inhibitory pressure


Slow stroking


Neutral warmth


Gentle rocking


Prolonged stretch


Prolonged Ice

Initially in a stroke, what reflex response happens?

Hyporeflexia with flaccidity

When spasticity emerges, what reflex response happens?

Hyperreflexia


Ex: deep tendon reflex, clonus, clasp-knife reflex, positive babinski

Tonic reflexes

movement of head or position of body may elicit an obligatory change in resting tone or movement of the extremities: ATNR most common

Associated reaction

Unintentional movement of the hemiparetic limb caused by voluntary action of another limb or by other stimuli.



See in strong spasticity cases!

Non-equilibrium coordination tests
address components of limb movements (finger to nose, tapping hand/foot, finger to finger)

Sharp/Dull Discriminations

indicates function of protective sensation.


Alternate between pin and dull end and patient tells you if it is a sharp or dull pain

Light Touch test

Lightly apply a cotton swab against patients skin. They say "yes/no" if they feel it.

Proprioception

awareness of one's position of body in space

2 point discrimination

The ability to differentiate one stimulus from two

Stereognosis

The ability to recognize objects by touch

orientation

the ability to comprehend and to adjust oneself with regard to time, location, and identity of persons

Modified Ashworth 0

No increase in mm tone

Modified Ashworth 1

Slight ^ in mm tone, manifested by a catch/by minimal resistance @ end of ROM when affected part(s) is moved in flex/ext

Modified Ashworth 1+

Slight ^ in mm tone, manifested by a catch, followed by minimal resistance through remainder of (less than half) of ROM

Modified Ashworth 2

More marked ^ in mm tone through most ROM, but affected part(s) easily moved

Modified Ashworth 3

Considerable ^ in mm tone, passive movmt difficult

Modified Ashworth 4

Affected part(s) rigid in flex/ext

Modified Ashworth 9

Unable to test

FIM
7-indep w/o AD
6-indep w AD (mod I)
5-supervision
4-minA/CGA
3-modA
2-maxA
1-fully dependent/totA
ATNR
ASYMMETRICAL TONIC NECK REFLEX
Bow and arrow
STNR
SYMMETRIC TONIC NECK REFLEX
Flex of neck = flex of UE, ext of LE
Ext of neck = ext of UE, flex of LE