Nbcot Review For Cva

Front 1

Aphagia

Back 1

Language disorder caused by brain damage that affects production and/or comprehension of written and spoken words.

Front 2

Apraxia

Back 2

Impairment of motor planning or organized, controlled movement not explained by motor or sensory impairment.

Front 3

Backward chaining

Back 3

Process of breaking a task into steps and guiding or assisting learner through all but the last step, which learner performs independently. Preceding steps of task are added until learner can perform entire sequence independently.

Front 4

Hemiparesis

Back 4

Weakness or partial paralysis on one side of the body caused by brain damage.

Front 5

Hemiplegia

Back 5

Paralysis on one side of the body caused by brain damage.

Front 6

Hemorrhage

Back 6

Bleeding resulting from the rupture of a blood vessel.

Front 7

Learned non-use

Back 7

Phenomenon observed in patients with hemiparesis in which patient avoids functional use of involved arm after failed attempts to use it and successful attempts to use uninvolved arm.

Front 8

Ischemia

Back 8

Loss of blood flow through a vessel resulting in an insufficient supply of blood and oxygen to the surrounding tissues, as when a blood clot blocks a cerebral artery.

Front 9

Homonymous Hemianopsia

Back 9

Visual field deficit caused by brain damage in which patient cannot perceive half of visual field of each eye.

Front 10

Postural adaptation

Back 10

Ability of body to maintain balance automatically and remain upright during alterations in position and challenges to stability.

Front 11

Shoulder subluxation

Back 11

Incomplete dislocation of humerus out of glenohumeral joint caused by weakness, stretch, or abnormal tone in the scapulohumeral and/or scapular muscles.

Front 12

Unilateral neglect

Back 12

Disturbance in the ability to notice, orient, or respond to stimuli on space on side of the body opposite site of brain damage.

Front 13

2 types of Cerebrovascular accident (CVA) (Stroke)

Back 13

Ischemic strokes result from a blockage of a cerebral vessel and can further be categorized as caused by thrombosis or embolism. Most common, representing roughly 80% of strokes.

Hemorrhagic strokes result from rupture of a cerebral blood vessel. Blood is released outside of the vascular space cutting off pathways and leading to pressure injuries on the brain. Less common than Ischemic strokes, but result in a higher mortality rate.

Front 14

Intrinsic recovery

Back 14

The remediation of neurological impairments, such as the return of movement to a paralyzed limb.

Front 15

Adaptive recovery

Back 15

regaining the ability to perform meaningful activities, tasks, and roles without full restorations of neurological function, such as using the unaffected hand for dressing, or walking with a cane or walker.

Front 16

Motor recovery in patients with hemiparesis

Back 16

Historically progresses from proximal to distal movement, and from mass, patterned, undifferentiated movements to selective, coordinated movement.

Front 17

Aspects of functional recovery

Back 17

Includes:
1- The amount of assistance required to carry out daily living tasks.
2. Whether a stroke survivor can resume function at home.

Front 18

Neurological Impairments/Risks following stroke: Hemiplegia/Hemiparesis

Back 18

- Impaired postural adaptation
- Impaired mobility
- Decreased independence in any or all ADL, IADL

Front 19

Neurological Impairments/Risks following stroke: Hemianopsia, other visual defecits

Back 19

- Decreased awareness of environment; decreased ability to adapt to environment
- Impaired ability to read, write, navigate during mobility, recognize people and places, drive, can affect all ADL, IADL

Front 20

Neurological Impairments/Risks following stroke: Aphasia

Back 20

- Impaired speech and comprehension of verbal or written language; inability to communicate, read, or comprehend signs or directions
- Decreased social, community involvement; isolation

Front 21

Neurological Impairments/Risks following stroke: Dysarthria

Back 21

Slurred speech, difficulty with oral motor functions such as eating, altered facial expressions.

Front 22

Neurological Impairments/Risks following stroke: Somatosensory deficits

Back 22

- Increased risk of injury to insensitive areas.
- Impairment of coordinated, dextrous movement

Front 23

Neurological Impairments/Risks following stroke: Incontinence

Back 23

- Loss of independence in toileting
- Increased risk of skin breakdown
- Decreased social, community involvement

Front 24

Neurological Impairments/Risks following stroke: Dysphagia

Back 24

- At risk for aspiration
- Impaired ability to eat or drink by mouth

Front 25

Neurological Impairments/Risks following stroke: Apraxia

Back 25

Decreased independence in any motor activity (ADL, speech, mobility), decreased ability to learn new tasks or skills.

Front 26

Neurological Impairments/Risks following stroke: Cognitive deficits

Back 26

Decreased independence in ADL, IADL; decreased ability to learn new techniques; decreased social interactions.

Front 27

Neurological Impairments/Risks following stroke: Depression

Back 27

Decreased motivation, participation in activity; decreased social interaction.

Front 28

CVA effects of the left hemisphere

Back 28

- receptive and expressive language deficits
- difficulty reading and writing
- difficulty performing arithmetic
- difficulties in learning new information
- Apraxia, left/right confusion
- Behavior: slow, cautions, easily frustrated, decreased motivation.

Front 29

CVA effects of the right hemisphere

Back 29

- visual-spatial and perceptual deficits
- left-sided neglect
- swallowing deficits, slurred speech
- difficulty with abstract thinking
- short attention span
- Behavior: Impulsivity, denial of deficits, inappropriate comments, excessive talking.

Front 30

CVA effect cerebellar

Back 30

- coordination and balance deficits
- eye movement deficits: nystagmus, ocular dysmetria, poor pursuit
- abnormal head and torso reflexes
- dysarthric and monotonous speech
- ataxic movements, disorders of gait
- dizziness, nausea, vomiting, headache

Front 31

Self care assessments following CVA

Back 31

1. Barthel Index
2. Functional Independence Measure

Both are well known and widely used in stroke research. They are both also recommended by the Post Stroke Rehabilitation Clinical Practice Guideline.

Front 32

IADL assessments following CVA

Back 32

Recommended by the Post Stroke Rehabilitation Clinical Practice Guideline:
1. Frenchay Activities Index
2. Philadelphia Geriatric Center Instrumental Activities of Daily Living Scale.

Front 33

Postural adaptation assessments following CVA

Back 33

Recommended by the Post Stroke Rehabilitation Clinical Practice Guideline:
1. Berg Balance Scale.

Capacities can also be observed during the performance of meaningful functional activities.

Front 34

Upper extremity function assessment following CVA

Back 34

- Sensation
- Mechanical and physiological deterrents to movement
- Presence and degree of active or voluntary movement including strength, endurance, and coordination
- The extent of function resulting from movement

Front 35

Common Impairments in Sitting Posture Seen After CVA: Head & Neck

Back 35

Normal: Neutral

Abnormal:
- Forward
- Flexed to weak side
- Rotated away from weak side

Front 36

Common Impairments in Sitting Posture Seen After CVA: Shoulder

Back 36

Normal:
- Symmetrical height
- Aligned over pelvis

Abnormal:
- Uneven height
- Involved shoulder retracted

Front 37

Common Impairments in Sitting Posture Seen After CVA: Spine, trunk

Back 37

Normal:
- Straight from posterior view
- Appropriate lateral curves
- Lateral trunk muscle lengths equal bilaterally

Abnormal:
- Curved from posterior view
- Thoracic kyphosis
- Shortened lateral trunk muscles on one side, elongation on opposite side.

Front 38

Common Impairments in Sitting Posture Seen After CVA: Arms

Back 38

Normal:
- Not used to maintain static upright posture
- Relaxed

Abnormal:
- Use of stronger arm to maintain upright posture
- Increased or decreased muscle tone in involved arm

Front 39

Common Impairments in Sitting Posture Seen After CVA: Pelvis

Back 39

Normal:
- Symmetrical weight bearing through both ischial tuberosities
- Neutral to slight anterior pelvic tilt
- Neutral rotation

Abnormal:
- Asymmetrical weight bearing
- Posterior pelvic tilt
- One hip retracted forward

Front 40

Common Impairments in Sitting Posture Seen After CVA: Legs

Back 40

Normal:
- Hips at 90 degrees of flexion
- Knees aligned with hips; hips in neutral adduction or abduction and internal or external rotation.
- Feet under knees
- Feet flat on floor, able to bear weight.

Abnormal:
- Hips in more extension
- Hips adducted so that knees touch or involved hip externally rotated so knees wide apart.
- Feet in front of knees
- Feet not flat on floor; unable to bear weight.

Front 41

Acute Phase of Stroke Rehabilitation

Back 41

Stroke rehabilitation begins as soon as the diagnosis of stroke is established and life threatening problems are under control.

Length of stay in acute hospital beds is typically just long enough for necessary diagnostic tests, for initiation of appropriate medical treatment, and for making decisions and planning next phase of treatment.

Front 42

Early mobilization and return to self care

Back 42

Patients with acute stroke should be mobilized as soon after admission as is medically feasible.

The patient should be encouraged to perform self care as soon as medically feasible and, if necessary, should be offered compensatory training to overcome disabilities.

Front 43

Discharge planning in stroke rehabilitation

Back 43

Discharge planning should begin at the time of admission. Goals are to determine the need for rehabilitation, arrange the best possible living environment, and ensure continuity of care after discharge.

Front 44

Pressure sores in stroke rehab

Back 44

It is estimated that up to 21% of patients with stroke develop pressure sores.

Those most at risk are:

Comatose
Malnourished
Obese
Incontinent
Severe paralysis or muscle Spasticity

Front 45

Maintaining skin integrity in stroke rehabilitation

Back 45

- Use proper transfer and mobility techniques to avoid undue skin friction
- Recommend appropriate positioning for bed and sitting and participating in scheduled position changes as needed.
- Assist with wheelchair and seating selection and adaptation
- Teach patient and caregiver precautions to avoid injury to insensitive skin and involved side of body
- Watch for signs of skin pressure or breakdown, especially over bony areas, and alert nursing or other medical staff as appropriate.

Front 46

Maintaining soft tissue length

Back 46

Contractures may result from the immobilization following stroke. Preventative measures include:

1- Bed positioning.
2- Protection of weak UE during treatment
3-Controlled and frequent movement of body parts (passive, or active assisted ROM)

Front 47

Recommended Bed Positioning for Patients with Hemiplegia: Supine Positioning

Back 47

- Head and neck slightly flexed
- Trunk straight and aligned
- Involved UE supported behind scapula and humerus with small pillow or towel, shoulder protracted and slightly flexed and abducted with external rotation, elbow extended or slightly flexed, forearm neutral or supinated, wrist neutral with hand open.
- Involved lower limb with hip forward on pillow, nothing against soles of feet.

Front 48

Recommended Bed Positioning for Patients with Hemiplegia: Lying on Unaffected Side

Back 48

- Head and neck neutral and symmetrical
- Trunk aligned
- Involved UE protracted with arm forward on pillows, elbow extended or slightly flexed, forearm and wrist in neutral, and hand open
- Involved lower extremity with hip and knee forward, flexed, and supported on pillows.

Front 49

Recommended Bed Positioning for Patients with Hemiplegia: Lying on the Affected Side

Back 49

- Head and neck neutral and symmetrical
- Trunk aligned
- Involved UE protracted forward and externally rotated with elbow extended or slightly flexed, forearm supinated, wrist neutral, and hand open.
- Involved LE with knee flexed
- Uninvolved LE with knee flexed and supported on pillow.

Front 50

Fall prevention in Stroke Rehabilitation

Back 50

Treatment that helps to prevent falls includes detecting and removing environmental hazards, optimizing motor control, recommending appropriate adaptive devices and teaching safety measures to the patient and family.

Front 51

Patient and family education during acute phase of stroke rehabilitation

Back 51

As the period after stroke is stressful, emotional, and tiring for both the patient and family, education during the acute stage should be brief, simple, and reinforced as needed with repetition or appropriate learning aids.

Front 52

Rehabilitation phase of stroke rehab

Back 52

- Rehab choices depend on person's condition, social support, and community resources.
- To qualify for further treatment in a rehab program, patient must be medically stable, have at least one functional disability, have sufficient endurance to sit supported for one hour, and be able to learn and participate actively in therapy.
- During this phase, patient and family are focused on getting better and are usually more concerned with regaining lost function than on adapting to chronic disability.

Front 53

Frontal Lobe

Back 53

Precentral gyrus: primary motor cortex for voluntary muscle activation.

Prefrontal cortex: controls emotion, judgement

Broca's area: controls motor aspects of speech

Front 54

Parietal Lobe

Back 54

Postcentral gyrus: primary sensory cortex for integration of sensation

Receives fibers conveying touch, proprioceptive, pain and temperature sensations from opposite side of body.

Front 55

Temporal Lobe

Back 55

Primary auditory cortex: receives/processes auditory stimuli

Associative auditory cortex: processes auditory stimuli

Wernicke's area: language comprehension

Front 56

Occipital Lobe

Back 56

Primary visual cortex: receives/processes visual stimuli

Visual association cortex: processes visual stimulation

Front 57

Insula

Back 57

Deep within lateral sulcus, associated with visceral function

Front 58

Limbic system

Back 58

Phylogenetically oldest part of the brain, concerned with instincts and emotions contributing to preservation of the individual.

Basic functions include feeding, aggression, emotions, and endocrine aspects of sexual response.

Front 59

Left Hemisphere

Back 59

- Movement of right side of body
- Processing of sensory information from right side of body
- Visual reception from right field
- Visual verbal processing
- Bilateral motor praxis
- Verbal memory
- Bilateral auditory reception
- Speech
- Processing of verbal auditory information

Front 60

Right Hemisphere

Back 60

- Movement of left side of body
- Processing of sensory information from left side of body
- Visual reception from left field
- Visual spatial processing
- Left motor praxis
- Nonverbal memory
- Attention to incoming stimuli
- Emotion
- Processing of nonverbal auditory information
- Interpretation of abstract information
- Interpretation of tonal inflections

Front 61

Glasgow Coma Scale: Best Eye Response

Back 61

Eyes opening spontaneously- 4
Eyes opening to speech- 3
Eyes opening in response to pain-2
No eye opening- 1

Front 62

Glasgow Coma Scale: Best Verbal Response

Back 62

Oriented (patient responds coherently and appropriately to questions such as the patients name and age, where they are and why, year month, etc. )- 5
Confused (patient responds to questions coherently but there is some disorientation and confusion)- 4
Inappropriate words (random or exclamatory speech, but not conversational exchange )- 3
Incomprehensible sounds (Moaning, but no words) -2
None- 1

Front 63

Glasgow Coma Scale: Best Motor Respose

Back 63

Obeys commands (the person does simple things as asked) -6
Localizes to pain (purposeful movements towards changing painful stimuli) -5
Withdraws from pain (pulls part of body away when pinched) -4
Flexion in response to pain (decorticate response) -3
Extension to pain (decerebrate response) -2
No motor response -1