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96 Cards in this Set
- Front
- Back
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what are the signs of a stroke (acronym)
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F (face)= numbness
A (arms drifting) S (speech)= slurria cng T (time) blurred vision |
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what to do when see sxs of stroke
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get to ER because if thrombotic, given a anti-coagulant in 3hours
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an embolism indicates
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dynamic clot
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an thrombus indicates
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lodged in vessel
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pathophysiology of stroke
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irreversible cell damage neuronal death, ischemia (increase metabolic demands and activates destructive enzyme) edema (maxes @ 4 days up to 3 weeks, patients begin to recover once edema goes down. Concerned with increased ICP
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T/F: the more distal a clot the more impact
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False, the more proximal the more impact
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what is an intracerebral hemorrhage due to
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HTN
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what is a subarachnoid hemorrhage due to
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aneurysm
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which one is "better" to have
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hemorrhagic event has a better outcome IF you live through it.
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what are non-modifiable risk factors for stroke
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-age > 55
-male -african american (2X) -diabetes -family hx of stroke |
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what are some medical risk factors for stroke
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-hypercholesterolemia
-HTN -atrial fibrillation -CAD -heart disease |
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what are the lifestyle factors for stroke
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-smoking
-overweight -excessive alcohol |
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what is the acute management of CVA: CT scan
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if CT scan show NO hemorrhage, administer tPA (tissue plasminogen activator) which 4.5 hours of onset of symtoms.
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what types of somatosensory deficits may occur with stroke
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-local vs diffuse sensory changes
-proprioceptive losses - |
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what is the acute management of CVA: ischemic
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If ischemia can be antiplatelet therapy=asprin and plavix
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what is thalamic pain
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-is uncontrollable pain that is diffused in nature
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what is the acute management of CVA: cerebral edema
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steriods
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T/F: pain may be indirect impairment due to musculoskeletal/biomechanical changes
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True
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what is the acute management of CVA: seziures
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anticonvulsants (dilantin, phenobarbitol)
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what are some visual deficits that may be seen
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-hemonymous hemianopsia
-diplopia, decreased visual acuity -forced gaze deviation |
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what is forced gaze deciation
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unopposed action of eye muscles causes deviation in the direct of the intact mm.
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what motor deficits are associated with stroke
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-sequential recovery stages
-alterations in tone -weakness -abnormal synergy patterns -abnormal reflexes -paresis/plegia and atlered mm activation patterns -altered coordination -motor program deficits |
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Recovery time from stroke
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fasteset recovery in first few weeks, most of recovery in 1st 3 months but can see functional gains up to a year. After a year may see suttle improvements, but nothing dramatic.
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according to Bobath, what is the 3 stages of recovery
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-flaccid-> spastic -> relative recovery
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what are the signs of improvement from stroke
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reduced edema (will allow inhibited neurons to return to function), increased circulation
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according to Brunnstrom what are the 6 sequential stages of recovery
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-flaccid ->associated mvmnts/minimal voluntary contraction ->mvmnt synergies,increased spasticity-> decreased spasticity -> increase level of difficulty of mvmnt able to do -> able to coordinate
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what are the signs if the following is involved in the CVA:
anterior cerebral artery |
contralateral hemiparesis and sensory loss, LE>UE, emotional disturbances, gait apraxia, *may have urinary incontience, slowness, delay, motor inaction, contralateral grasp reflex, sucking reflex
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which muscles does spasticity typically develop in
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-antigravity mm (flexors in UE, extensors in LE)
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what are the signs if the following is involved in the CVA:
middle cerebral artery |
extensive neurological damage and lots cerebral edema -> increased ICP -> death, loss of consciousness, brain herniation. Most typical contralateral spastic hemiparesis and sensory loss of face UE & LE, UE>LE, aphasia, visual deficits, motors speech, receptive speech, apraxia, ataxia
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what can spasticity lead to
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decreased active movement, posturing and contractures
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what are the signs if the following is involved in the CVA:
internal carotid artery |
massive infarction because feeds ACA and MCA. Significant edema, uncal herniation, coma and death.
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what alterations tone may occur
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-flaccidity -> spasticity
-spasticity -loss of autonomic postural tone.anticipatory postural control |
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what are the signs if the following is involved in the CVA:
posterior cerebral artery |
visual agnosia, prosopagnosia, memory, spontaneous pain, involuntary movements/tremor Weber's syndrome Diffused sensory indicates a deeper lesion->thalamus
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what does it mean for "loss of autonomic postureal tone/anticipatory postural control
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-inability to stabilize trunk and proximal joints
-affects alignment, balance, increase falls risk |
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What is the modified ashworth
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-0=no increasein muscle tone
-1=slight increase,catch and release -1+=slignt increase, catch and resist -2=more marked increase, but mvoe easily -3=considerable increase, passive motion difficult -4=affected parts rigid |
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WIth paresis/plegia what are some changes that occur at the mm level
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-decrease # of motor units
-altered recruitment & firing patterns -denervation -muscle atrophy -increase fatigability |
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What is learned nonuse
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because of difficulty with using affect extremity, learn how to do everything with other.
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what are components to assess when assessing strength in a pt with a CVA
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-spontaneous volitional movement?
-directed functional movement? -ability to isolate joint movement? -MMT? -specific outcome measures |
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what will a UMN lesion show
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will show spared mvmnt of upper face
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Visual agnosia is:
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can't recognize others
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what will a LMN lesion show
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will show upper and lower facial paralysis
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prosopagnosia is:
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difficulty naming people on sight
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T/F: synergy patterns allow isolated movements
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FALSE, they are so strong that isolated mvmnts are impossible
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Weber's syndrome is:
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oculomotor palsy
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What mm should you EXPECT to be absent
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-lats
-teres major -serratus anterior -finger extensors -ankle everters |
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describe the flexion UE synergy
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-scap retraction/elevation
-shoulder ab/ER -elbow flexion -forearm supination -wrist and finger flexion |
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describe the extension UE synergy
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-scapular protraction
-shoulder AD/IR -Elbow extension -forearm pronation -wrist and finger flexion |
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T/F: You have wrist and finger flexion in both flexion and extension synergy patterns for UE
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True
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describe the flexion LE synergy
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-hip flexion, AB,ER
-knee flexion -ankle DF -ankle IN |
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What is the synergy pattern for extension
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-hip extension, ad, IR
-knee extension -ankle PF -ankle IN |
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T/F: ankle eversion is in both synergy patterns for the LE
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FALSE, ankle IN is in both
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for UE synergies which is the dominant one
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flexion
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for LE synergies which is the dominant one
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extension
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what leads to incoordination
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cebellar or basal ganglia lesions or proprioceptive loss
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when does hyporeflexia occur
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during flaccid stage
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when does hyperreflexia occur
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during spastic stage
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what cutaneous reflexes may occur after CVA
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-babinski, beevors, CST
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what is associated reactions
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-abnormal automatic unintentional responses of involved limb with action in another part of the body
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what is souques phenomenon
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elevation of hemi UE above horizontal with elbow extended may elicit extension/abduction response of the fingers
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what is raimiste's phenomenon
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resistance to AB or AD produces a similar response in the opposite limb in both UE and LE
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what is homolateral limb synkinesis
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describes mutual dependency between hemiplegiclimbs; flexion of UE elicits flexion of LE
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SXS seen with patients with a L CVA:
motor |
difficulty sequencing new activities, inability to transfer out of wheelchair. Apraxia (can't carry out purposeful movements)
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what does soques phenomenon doe
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makes easier to /, horizontal posture
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SXS seen with patients with a L CVA:
cognitive |
difficulty processing info in a sequential manner. Negative/depressed, anxious, slower, cautious, uncertain, realistic in their appraisal of their problems
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what does raimiste's phenomenon do
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when working B- has overflow?
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SXS seen with patients with a R CVA:
motor |
role in sustaining movement/posture R CVA patient show motor impersistence inability to maintain upright sitting
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what does homolateral limb synkinesis do
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used for when a pt can't find a movement you use the other extremity on the same side to help them find the movement
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SXS seen with patients with a R CVA:
cognitive |
difficulty grasping whole picture, quick, impulsive, euphoric, overestimates their ability while minimizing problems, safety concern because of poor judgment
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what is the difference of cerebellar ataxia vs sensory ataxia
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-sensory ataxia is indicated
-cerebellar ataxia is uncontrolled mvmnt |
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when the Right hemisphere is affected what motor programming deficits are seen:
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-maintain posture
-big role in SUSTAINING movement/postire |
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shoulder dysfunction in flaccid stage
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proprioceptive impairment, lack of tone, paralysis, decreased proximal support of shoulder, ligaments and capsule shoulder's sole support, traction/gravity pull humerus down and out.
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when the Left hemisphere is affected what motor programming deficits are seen:
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-big role in SEQUENCING
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list the apraxias that are seen in pts with stroke
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-Ideomotor apraxia
-ideational apraxia -constructional apraxia -dressing apraxia |
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Test and measures for CVA
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observation, mental status, communication ability, sensation, perception, joint mobility, functional mobility, gait, motor control=tone, reflexes, voluntary movement patterns, motor planning ability, postural control and balance coordination.
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what is ideomotor apraxia
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pt can't "pretend" to do things. But can do tasks with appropriate props
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whatis ideational apraxia
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pt can't do tasks, even with props, can't conceptualize or spontaneously
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what is contructional apraxia
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when pt can't put pieces of things together even with props
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what are the early warning signs of stroke
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sudden numbness, weakness in face, arm, leg especially one side of body, sudden confusion, trouble speaking or understanding. Sudden trouble seeing 1 or both eyes. Sudden trouble walking, dizziness, LOB, or coordination, severe headaches. Less common: nausea, vomiting, fever, brief LOC
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what is dressing apraxia
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when they try to dress themselves, they don't do it correctly, and don't understand that they did it incorrectly
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T/F: the worse the stroke the worse the apraxia
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False, Julie saw worse apraxias with less severe strokes
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what type of disturbances in postural control and balance may occur
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-loss of anticipatory postural control
-righting, equilibrium and protective extensor reactions are commonly impaired -hesitancytoWB on involved side -falls |
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Describe: fluent aphasia
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AKA wernicke's, receptive aphasia, wrong context
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Describe:
nonfluent aphasia |
AKA broca's, expressive aphasia, stutter
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Describe:
Global aphasia |
impaired comprehension and expression
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describe:
dysarthria |
motor speech disorder
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Describe: dysphagia
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swallowing disorder
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what are some perceptual deficits that may be seen
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-visuospatial distortions
-anosognosia -pusher syndrome |
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what are some cognitive, behaviors and emotional changes that may be affected
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-orientation
-attention -memory -learning -confabulation(spontaneous narrative of events that never happened) -perservation (not correcting problem just doing the same thing constantly -disinhibition (pt not acting like themselves) |
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what are typical finding for pts with L CVA
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-difficulty processing info in a linear, sequential manner
-negative, anxious, depressed -slower, cautious,concern -realistic in their appraisal of their problems |
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what are the typical findings for pts with R CVA
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-difficulty in grasping whole idea, gesalt, overall picture
-indifferent, quick, impulsive, euphoric -overestimate their abiliiies while minimizing their problems -big safety concern due to poor judgment |
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Is depression more common in L or R CVA
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L CVA
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what % of pts with a CVA have depression
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1/3
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Name secondary impairments for the musculoskeletal system
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-decreased ROM, contractures,joint deformity, shoulder dysfunction
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Name secondary impairments for the
neurological |
hydrocephalous
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Name secondary impairments for the
cardiovascular/pulmonary |
DVT, deconditioning, aspiration,pneumonia
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Name secondary impairments for the
integumentary |
skin breakdown
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