Nbcot Review Ch 5: Cva

Front 1

Aphasia

Back 1

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

Front 2

Global Aphasia

Back 2

Loss of all language skills.

Front 3

Broca's Aphasia

Back 3

Speech apraxia
- Good auditory comprehension, but trouble speaking, speaking slowly with frequent misarticulations (agrammatism)

Front 4

Wernicke's Aphasia

Back 4

Impaired auditory comprehension. Person speaks fluently and is well-articulated, but has running speech composed of words in a meaningless sequence (word salad).

Front 5

Anomic Aphasia

Back 5

Impairment in word retrieval (happens in all forms of aphasia, but if word retrieval is only problem then it is called anomic aphasia)

Front 6

Apraxia

Back 6

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

Front 7

Backward chaining

Back 7

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 8

Hemiparesis

Back 8

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

Front 9

Hemiplegia

Back 9

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

Front 10

Hemorrhage

Back 10

Bleeding resulting from the rupture of a blood vessel.

Front 11

Learned non-use

Back 11

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 12

Ischemia

Back 12

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 13

Homonymous Hemianopsia

Back 13

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

Front 14

Postural adaptation

Back 14

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

Front 15

Shoulder subluxation

Back 15

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

Front 16

Tx to reduce shoulder subluxation

Back 16

Focus on achieving trunk alignment and scapula stability in a position of upward rotation (the scapula's natural movement)

Front 17

Progression of Stroke

Back 17

Acute Stage: Low Tone (can have edema, overstretching of the GH joint, shortening of muscles that are passively positioned, overstretching of antagonists of previous muscles, risk of joint and soft-tissue injury during ADL and mobility tasks).

Progresses to state of increased or excessive tone (clonus, stereotypical posturing of trunk and limbs, hyperactive stretch reflexes, increased resistance to PROM. This may occur within days or months of the stroke.

Front 18

Progression of Stroke: problems if spasticity is not managed

Back 18

Problems if spasticity not managed: deformity of limbs (esp distal UE), maceration of palm tissue, pain syndromes, impaired ability to manage BADL tasks, esp UE dressing and bathing of affected hand and axilla when flexor posturing present, loss of reciprocal arm swing during gait movements.

Front 19

Tx in the Spastic Stage.

Back 19

Teach positioning that will provide prolonged elongation of the overactive muscles and will prevent contracture
1. weight bearing on extended arm
2. supine, hands behind head while allowing elbows to drop toward bed (LLPS)
3. lying on protracted scapula
4. support involved wrist with more functional hand and reaching down toward floor with both hands
5. cradle affected arm with stronger arm, lifting to chest level, gently raising and lowering (below 90) and abd or add arm. (Don't clasp hands and lift overhead = pain, impingement, stress carpal ligaments)

Front 20

Unilateral neglect

Back 20

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

Front 21

2 types of Cerebrovascular accident (CVA) (Stroke)

Back 21

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 22

Transient Ischemic Attack

Back 22

A Temporary stroke that only lasts a few minutes
- Occurs when the blood supply to part of the brain in briefly interrupted.
- Symptoms: numbness/weakness in face, arm, or leg (esp one side of body); confusion or difficulty talking/understanding speech; trouble seeking in one or both eyes; difficulty walking, dizziness, and/or loss of balance and coordination.
- Most symptoms disappear within an hour, may persist for up to 24 hours.

Front 23

Intrinsic recovery

Back 23

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

Front 24

Adaptive recovery

Back 24

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 25

Motor recovery in patients with hemiparesis

Back 25

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

Front 26

Aspects of functional recovery

Back 26

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

Front 27

Neurological Impairments/Risks following stroke: Hemiplegia/Hemiparesis

Back 27

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

Front 28

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

Back 28

- 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 29

Neurological Impairments/Risks following stroke: Aphasia

Back 29

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

Front 30

Neurological Impairments/Risks following stroke: Dysarthria

Back 30

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

Front 31

Neurological Impairments/Risks following stroke: Somatosensory deficits

Back 31

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

Front 32

Neurological Impairments/Risks following stroke: Incontinence

Back 32

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

Front 33

Neurological Impairments/Risks following stroke: Dysphagia

Back 33

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

Front 34

Neurological Impairments/Risks following stroke: Apraxia

Back 34

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

Front 35

Neurological Impairments/Risks following stroke: Cognitive deficits

Back 35

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

Front 36

Neurological Impairments/Risks following stroke: Depression

Back 36

Decreased motivation, participation in activity; decreased social interaction.

Front 37

CVA effects of the left hemisphere

Back 37

- 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 38

CVA effects of the right hemisphere

Back 38

- 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 39

CVA effect cerebellar

Back 39

- 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 40

Self care assessments following CVA

Back 40

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 41

IADL assessments following CVA

Back 41

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

Front 42

Postural adaptation assessments following CVA

Back 42

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 43

Upper extremity function assessment following CVA

Back 43

- 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 44

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

Back 44

Normal: Neutral

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

Front 45

Common Impairments in Sitting Posture Seen After CVA: Shoulder

Back 45

Normal:
- Symmetrical height
- Aligned over pelvis

Abnormal:
- Uneven height
- Involved shoulder retracted

Front 46

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

Back 46

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

Abnormal:
- Curved from posterior view
- Thoracic kyphosis (hunched back)
- Shortened lateral trunk muscles on one side, elongation on opposite side.
- Trunk rotation

Front 47

Common Impairments in Sitting Posture Seen After CVA: Arms

Back 47

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
- Shoulder pro/retraction

Front 48

Common Impairments in Sitting Posture Seen After CVA: Pelvis

Back 48

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 49

Common Impairments in Sitting Posture Seen After CVA: Legs

Back 49

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 50

Acute Phase of Stroke Rehabilitation

Back 50

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 51

Early mobilization and return to self care

Back 51

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 52

Discharge planning in stroke rehabilitation

Back 52

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 53

Pressure sores in stroke rehab

Back 53

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 54

Maintaining skin integrity in stroke rehabilitation

Back 54

- 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 55

Maintaining soft tissue length

Back 55

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 56

Splinting

Back 56

Low Tone Stage:
- maintaining joint alignment, protecting tissues from shortening or overstretching, preventing injury to the extremity, serving as additional tx for edema control. May also provide palmar arch support and maintain neutral wrist deviation and neutral wrist.

Spasticity:
- maintain soft tissue length, provide low load prolonged stretch (LLPS), place muscles at resting lengths of both sides of the joints, attempt distal relaxation by promoting proximal alignment

Front 57

Recommended Bed Positioning for Patients with Hemiplegia: Supine Positioning

Back 57

- 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 58

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

Back 58

- 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 59

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

Back 59

- 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 60

Fall prevention in Stroke Rehabilitation

Back 60

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 61

Patient and family education during acute phase of stroke rehabilitation

Back 61

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 62

Rehabilitation phase of stroke rehab

Back 62

- 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 63

Left Hemisphere

Back 63

- 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 64

Right Hemisphere

Back 64

- 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 65

Ashworth Tone Scale

Back 65

0 No increase in muscle tone
1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
2 More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
3 Considerable increase in muscle tone, passive movement difficult
4 Affected part(s) rigid in flexion or extension