2.5- Stroke III: Impairments Flashcards
When does a stroke patient experience flaccid paralysis?
very early due to cerebral shock (systems shut down)
What happens to muscles during flaccid paralysis?
- they can’t contract or initiate movement
* no reflex activity, atrophy of muscle, some fasciculation
How long does the period of low tone last?
It is very transient- lasts minutes to weeks. (48 hours is fairly common)
- longer it lasts the worse the prognosis
T or F: A PT should start therapy as soon as a patient goes into flaccid paralysis.
False.
Generally doesn’t pay to start PT until shock is over (can only position, can’t do much else)
First sign of flaccid paralysis recovery occurs _______ and works its way ______.
Tone increases first in ____________.
proximally to distally
shoulder and hip
What occurs as cerebral shock dissipates?
Spastic Paralysis
Spastic paralysis is characterized by __________.
exaggerated deep tendon reflexes and increased muscle tone
Normal reflexes becomes hyperreflexive _______>______. What causes this?
proximal > distal
loss of upper motor neuron influence (no more upper motor neuron inhibition) and abnormal processing of sensory info
Spastic paralysis clinical findings:
- increased resistance to _________
- _________ of deep tendon reflex
- Posturing of extremities into _______
- May eventually develop true ____ as a result
- passive stretch
- hyperreflexia
- synergies (muscles, specifically antigravity muscles, increase tone in characteristic patterns)
- contractures
Upper Extremity Flexion Synergy~
a. develops initially in _____ with _____ and ______ of ________
b. elbow _____, forearm _____, wrist and finger _____
a. develops initially in shoulder girdle with adduction and downward rotation of scapula
b. elbow flexion, forearm pronation, wrist and finger flexion
Lower Extremity Extensor Synergy~
a. pelvis ______, hip ______ and ______
b. knee ______, ankle ______, toes _____
a. pelvis retracts, hip adduction and IR
b. knee extension, ankle PF with supination, toes flex
What is the Ashworth Scale?
a clinical tool used to assess the presence of abnormal tone
What is the Brunstrom’s Stages of Recovery?
stages to describe the characteristic pattern of development of muscle tone and recovery
Brunstrom’s Stages of Recovery~
a. she believed that each patient passes through each stage but you don’t _____________
b. can get ________ and patient will not ______
a. don’t always see them
b. can get stuck in any stage and patient will not improve further
What is Paresis?
muscle weakness
What is Apraxia?
have motor capability to do a specific movement combination, but unable to put steps together (ex. ambulation, dressing)
What is:
force production on involved side decreases making initiation and control of movement, maintaining posture difficult
motor units atrophy and are easily fatigued
Parasis
T or F: The opposite side of the stroke is not affected.
False.
Opposite side of the stroke (“good side”) is also affected and becomes weaker from inactivity
Motor Planning Deficits~
a. difficulty __________________
b. most often with _______ hemisphere stroke (motor area)
a. difficulty sequencing movement properly
b. most often with left hemisphere stroke
What happens if Apraxia occurs in right hemisphere strokes? (most often in left hemisphere)
problems dressing because the right hemisphere has body image
What is proprioception?
affects posture and perception of being upright
Proprioception causes problems with ________ and ______. It also causes problems perceiving _______ (also affects weightbearing).
problems with balance and ADL’s
problems perceiving upright posture
What is Aphasia?
difficulty with language comprehension, oral expression, and use of symbols
Communication Problems: Aphasia
a. Broca’s - _______ communication
b. Wernicke’s - ___________ communication
c. Global - _____________ communication
a. Broca’s- expressive
b. Wernicke’s- receptive
c. Global- both types of communication
