Chapter 3. Cerbrovascular Accidents (CVA) Flashcards
Define STROKE
Sudden, FOCAL neurologic deficit, resulting from ISCHEMIA (clogged blood vessel) or HEMORRHAGE (ruptured blood vessel)
What are (3) Etiologys of a CVA
- Thrombosis (solid mass of platelets and/or fibrin that forms locally in a vessel-clogging blood flow)
- Embolus (a piece of a thrombus that has broken free and is carried toward the brain by the bloodstream-blood clot, air bubble, piece of fatty deposit
- Hemorrhage (ruptured blood vessel in brain)
It is important to know if you have a __ or ___ before giving a drug against CVA
-HEMORRHAGE or CLOT
What is the Mechanism of a Stroke
- Atherosclerosis is formation of PLAQUE
- vessel narrowing
- stenosis (abnormal narrowing) ulceration of lesions, thrombus, EMBOLI
What percentage of formation of clot is in Cerebral arteries or smaller branches in a THROMBUS?
60%
-can still have COME Collateral formation
What is collateral formation
Extra PATHWAYS for blood to flow during a Thrombus etc.
-survival technique by the body
WHERE does an embolism come from and WHAT is it
- 16% comes from heart, internal carotid, or carotid sinus
- it is a dislodged thrombus
What is the most common place for a stroke
MCA- Middle Cerebral Artery
How do Thrombus form
Forms from platelet adhesion and coagulations, leading to ischemia with infarct
What is a Hemorrhage
abnormal bleeding due to vessel rupture
Is there a chance to develop new Collaterals when an EMBOLISM is formed
No, because the embolism happens so quickly
A Thrombus can lead to ___ and then further on even lead to an __
- ischemia with infarct
- Embolism
WHAT occurs within hours, peaks at 4 days due to tissue necrosis/rupturing of cell membranes and can push against your pons (breathing center), making it extremely hard to breath
Cerebral edema (swelling in the brain)
What is the acronym for TIA and what is the possible cause
- Transic Ischemic Attack
- Transient Systemic Arterial hyoptension
What are some symptoms/signs of ANTERIOR Cerebral Artery Infarct
- LEFTside neglect
- Contralateral hemiparesis (LE)
- Sensory loss (LE)
- Incontinence
- Apraxia (can’t move arm)
What are some symptoms/signs of MIDDLE Cerebral Artery Infarct (most common!!)
- Contralateral hemiplegia (UE)
- Sensory deficit (UE and face)
- Homonymous Hemianopsia (loss of half of the field of view in both eyes)
- If left hemi»aphasia
- if right hemi» neglect on left side
What are the 2 possibilities for an Internal Carotid Artery Infarct
- Comma
- Death
What is ‘Contralateral Hemianesthesia’ in POSTERIOR Cerebral Artery
Contralateral (opp. side of body)
-anesthesia on one side of the body
‘Locked in syndrome’ comes from which artery infarct; and what is it?
VERTEBRAL Artery Infarct
- can last for months/weeks/years
- quadraplegia
- only has vertical gaze
- can’t speak, yet full consciousness
What are the (5) Artery infarcts?
- Anterior
- Middle
- Posterior
- Internal
- Vertebral
What is Ashworth’s Scale for Grading SPASTICITY for 0 and 4
0- no increase in tone
4-affected parts RIGID in FLEXION or EXTENSION
What is Brunnstrom Synergy Pattern for UPPER extremity flexion
- scapular retraction
- shoulder external rotation
- shoulder abduction to 90 degrees
- elbow flexion
- forearm supination, wrist and finger flexion
What is Brunnstrom Synergy Pattern for LOWER extremity extension
- hip extension
- adduction and internal rotation
- knee extension
- anke plantar flexion and inversion
Define Dysarthria
Difficulty speaking (but physically) -may have affected respiration, articulation, possible impaired chewing/swallowing
Define Dysphasia/Aphasia
Difficulty speaking- but it affects the BRAINSTEM
What are some LEFT hemisphere Motor Programming deficits
- apraxia
- difficulty in squencing
- difficulty initiating movement
- harder to learn task
What is a RIGHT hemisphere Motor Programming deficits
-difficulty in sustaining movement/posture
What are some COGNITIVE and BEHAVIORAL deficits
- orientation
- attention
- STM
What are 5 deficits with a stroke?
- Speech and Language
- Motor Programming
- Cognitive and behavioral
- Perceptual
- Psychological
What are 3 Psychological difficulties after a stroke
- frustration
- depression
- anxiety
What is RSD and what does it stand for?
- Reflex Sympathetic Dystrophy
- warm, red,glossy skin
- stiffness
What are (5) early CVA Rehab Goals
- mouth and breathing exercises
- maintain ROM
- increase trunk control, symmetry
- increase functional mobility
- initiate self-care
What are 3 way to treat spasticity
- dont tuch palm/sole of foot
- heat
- tapping/stroking antagonist muscle
What is an AFO
Ankle Foot Orthotic: mots COMMON lower extremity brace
What are 2 important factors in the Acute Phase sessions in Rehab
-Keep it SHORT and FREQUENT
What are (4) treatments techniques used in the ACUTE Phase
- TACTILE (frequent contact, diff. materials)
- PROPRIOCEPTIVE, KINESTETHIC AND VESTIB STIM (position, keep head in midline, frequent body position changes
- VISUAL STIM (decorate room with familiar objects)
- AUDITORY STIM (speaking to patient)
What are some treatment techniques in the SUBACUTE Phase for agitated patients ?
- human contact
- familiar voices (sudden loud voices should be avoided)
- excessive sensoy stim should be avoided due to confusion
INHIBITION techniques appropriate for SUBACUTE PHASE
- wrap limbs in warms blankets
- slow rocking
- have patient in “reflex inhibiting postures”- have sternum and lumbar spine allignment
Know 2 inhibition techniques for the lower extremity (to break up spasticity)
- hip and knee flexion
- ankle dorsiflexion and eversion
- exactly opp. of Brunnstrum Synergy Pattern
List 2 techniques for general inhibition for stroke patients
- calm colours
- change positions Gradually
What are (4) Goals at a LATE Phase of Rehab
- Increase cognitive skills
- Improve patients time management skills
- Improve patients Fine motor coordination
- Increase the patients speed of performance
What is one of the most important factor in the LATE Phase of Rehab
-provide a PURPOSE for each activity
What are 5 ways in which to refine motor control
- biofeedback
- electrical stim
- cutaneous (skin) stim
- PNF
- Joint mobility
