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Neuro > 2.5- Stroke III: Impairments > Flashcards

2.5- Stroke III: Impairments Flashcards

1
Q

When does a stroke patient experience flaccid paralysis?

A

very early due to cerebral shock (systems shut down)

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2
Q

What happens to muscles during flaccid paralysis?

A
  • they can’t contract or initiate movement

* no reflex activity, atrophy of muscle, some fasciculation

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3
Q

How long does the period of low tone last?

A

It is very transient- lasts minutes to weeks. (48 hours is fairly common)

  • longer it lasts the worse the prognosis
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4
Q

T or F: A PT should start therapy as soon as a patient goes into flaccid paralysis.

A

False.

Generally doesn’t pay to start PT until shock is over (can only position, can’t do much else)

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5
Q

First sign of flaccid paralysis recovery occurs _______ and works its way ______.

Tone increases first in ____________.

A

proximally to distally

shoulder and hip

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6
Q

What occurs as cerebral shock dissipates?

A

Spastic Paralysis

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7
Q

Spastic paralysis is characterized by __________.

A

exaggerated deep tendon reflexes and increased muscle tone

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8
Q

Normal reflexes becomes hyperreflexive _______>______. What causes this?

A

proximal > distal

loss of upper motor neuron influence (no more upper motor neuron inhibition) and abnormal processing of sensory info

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9
Q

Spastic paralysis clinical findings:

  1. increased resistance to _________
  2. _________ of deep tendon reflex
  3. Posturing of extremities into _______
  4. May eventually develop true ____ as a result
A
  1. passive stretch
  2. hyperreflexia
  3. synergies (muscles, specifically antigravity muscles, increase tone in characteristic patterns)
  4. contractures
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10
Q

Upper Extremity Flexion Synergy~

a. develops initially in _____ with _____ and ______ of ________
b. elbow _____, forearm _____, wrist and finger _____

A

a. develops initially in shoulder girdle with adduction and downward rotation of scapula
b. elbow flexion, forearm pronation, wrist and finger flexion

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11
Q

Lower Extremity Extensor Synergy~

a. pelvis ______, hip ______ and ______
b. knee ______, ankle ______, toes _____

A

a. pelvis retracts, hip adduction and IR

b. knee extension, ankle PF with supination, toes flex

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12
Q

What is the Ashworth Scale?

A

a clinical tool used to assess the presence of abnormal tone

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13
Q

What is the Brunstrom’s Stages of Recovery?

A

stages to describe the characteristic pattern of development of muscle tone and recovery

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14
Q

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

a. don’t always see them

b. can get stuck in any stage and patient will not improve further

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15
Q

What is Paresis?

A

muscle weakness

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16
Q

What is Apraxia?

A

have motor capability to do a specific movement combination, but unable to put steps together (ex. ambulation, dressing)

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17
Q

What is:

force production on involved side decreases making initiation and control of movement, maintaining posture difficult

motor units atrophy and are easily fatigued

A

Parasis

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18
Q

T or F: The opposite side of the stroke is not affected.

A

False.

Opposite side of the stroke (“good side”) is also affected and becomes weaker from inactivity

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19
Q

Motor Planning Deficits~

a. difficulty __________________
b. most often with _______ hemisphere stroke (motor area)

A

a. difficulty sequencing movement properly

b. most often with left hemisphere stroke

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20
Q

What happens if Apraxia occurs in right hemisphere strokes? (most often in left hemisphere)

A

problems dressing because the right hemisphere has body image

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21
Q

What is proprioception?

A

affects posture and perception of being upright

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22
Q

Proprioception causes problems with ________ and ______. It also causes problems perceiving _______ (also affects weightbearing).

A

problems with balance and ADL’s

problems perceiving upright posture

23
Q

What is Aphasia?

A

difficulty with language comprehension, oral expression, and use of symbols

24
Q

Communication Problems: Aphasia

a. Broca’s - _______ communication
b. Wernicke’s - ___________ communication
c. Global - _____________ communication

A

a. Broca’s- expressive
b. Wernicke’s- receptive
c. Global- both types of communication

25
Q

________ - difficulty articulating words due to weakness and incoordination of speech muscles.

A

Dysarthria

26
Q

Flaccid dysarthria - _______ voice

Spastic dysarthria - ________ voice

A

Flaccid- “breathy” voice

Spastic- irregular voice

27
Q

Facial deficits are often associated with _____________.

A

cranial nerve involvement

28
Q

What causes facial asymmetries?

A

weakness of facial muscles, eye muscles, and muscles around the mouth

29
Q

Facial asymmetries limits ability to ________ and may cause ________ or ___________.

A

limits ability to make facial expressions (social problem) and may cause drooling (social problem) or food to pocket in cheeks.

30
Q

What is Dysphagia?

A

inability to swallow

  • may aspirate into lungs with any food or drink
31
Q

Lower motor Cranial Nerve VII involvement~

a. can’t protect ___________
b. lack of ___________ - can cause infection

A

a. can’t protect eye by closing

b. lack of tearing and closing

32
Q

Cardiopulmonary~

a _________% decrease in lung capacity due to decrease in __________, _______, & _______

A

30-40% decrease due to decrease in chest expansion, decreased function of diaphragm, and fatigue

  • reduced vital capacity- must increase respiratory rate to compensate
  • shallow breathing can lead to pneumonia
33
Q

Why do stroke patients have decreased cardiac function?

A

because of a reduced activity level

**significant fatigue with patients

34
Q

Reflexes~

  1. Primitive reflexes-
  2. Deep tendon reflexes-
  3. Spinal level reflexes (withdrawal)-
A
  1. Primitive- lost soon after birth may return
  2. Deep tendon- decreased during flaccid stage, exaggerated during spasticity
  3. Spinal level- function may remain (even in flaccid limbs) but not purposeful
35
Q

How can a patient regain control of incontinence?

A

early weightbearing (bridging, standing)

36
Q

Neglect- CVA in _________ lobe

A

parietal

  • don’t recognize impaired side of body
  • impaired perception of vertical
37
Q

______________ - involuntary persistence of the same motor response regardless of stimulation or its duration
* may repeat same action over and over

A

Motor preservation

38
Q

_______________________ - right CVA

*actively lean and push towards affected side

*___________ & _____________ to the right

*absences of _______________

*______________ deficits

A

Pusher Syndrome

cervical rotation and lateral flexion

tactile awareness

visual

39
Q

What happens if you try to redistribute weight on a patient with Pusher Syndrome? What side of the body has increased weightbearing?

A

they will resist

they have increased weightbearing on the left

40
Q

Patients with Pusher Syndrome have problems with ______ - they push back and away with uninvolved extremities.

A

transfers

41
Q

Where does a stroke happen to cause intolerable burning pain, often long after stimulus has been removed?

A

in the Thalamus

called Thalamus Pain Syndrome

42
Q

What are the two traditional treatment approaches?

A
  1. Neurodevelopmental Theory (NDT)

2. Proprioceptive Neuromuscular Facilitation (PNF)

43
Q

Name a non-traditional approach to therapy treatment.

A

Constraint Induced Movement Therapy (Forced non-use)

44
Q

What is Constraint Induced Movement Therapy?

A

forcing the use of the involved side by taking away use of uninvolved side

*uninvolved extremity (most often UE) is restrained 90% of the day for 10-14 days

45
Q

What is “Shaping”?

A

repetitive actions gradually made harder as improvements occur

46
Q

T or F: Constraint Induced Movement Therapy and Shaping are the same thing.

A

False.

They are different but can be used together

47
Q

Constraint Induced Movement Therapy~

research finds increased _____ and _____ of movement and increased use in _______

A

increased quality and skill of movement and increased use in real life

48
Q

What are the 2 theories on why Constraint Induced Movement Therapy works?

A
  1. overcome learned non-use after stroke

2. use dependent cortical reorganization (theory is to force area of cortex to take over damaged area of cortex)

49
Q

How might dependent cortical reorganization work? (3 ways)

A

a. remaining connections are strengthened
b. silent pathways are unmasked (thru repetition)
c. increased axonal sprouting to overcome gaps

50
Q

Why might the Constraint Induced Movement Therapy positive results exist?

A

research had very inclusive criteria

  • must have some ROM of hand/wrist
  • no excessive spasticity
  • no serious cognitive deficits
  • willing to be compliant
51
Q

TPA is still the gold standard but what 3 methods were discussed to increase the rate of perfusion to the affected stroke area.

A
  1. mechanical clot retrieval (go up, grab it, pull it out)
  2. suction devices
  3. intra-arterial ultrasound (to bust the clot up_
52
Q

____________________ - designed to limit the natural cascade that occurs after an injury

A

Neuroprotective therapies

53
Q

Neuroprotective therapies~

  • limit the over-aggressive actions of the ____ cells
  • some of these drugs are delivered ____, some are inserted via ____ right into the area of the brain which has been damaged
A
  • glial cells

* some delivered IV, some inserted via catheter

Neuro (30 decks)

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