Chp 18 stroke Flashcards
How do we define
Acute onset of neurological dysfunction due to abnormality in cerebral circulation with resultant signs and symptoms that correspond to involvement of focal areas of the brain
Focal neuro deficits m
Etiology of a stroke ( think like plaque formation)
Atherosclerosis- plaque formation with accumulation of lipids, fibrin, complex carbs, calcium deposits on arterial walls which leads to narrowing of blood vessels.
Lesions occur at origin of common carotid artery, transition into middle cerebral artery, junction of vertebral arteries with basilar artery
ust persist for at least 24 hours
Motor deficits characterized by paralysis (hemiplegia) or weakness (hemiparesis) typically on the side of the body opposite the site of the lesion
Reversible ischemic neuro deficit (3 weeks)
What are the 2 main mechanisms resulting in stroke?
Ischemic 61-81 %(lack of cerebral blow flow) , result of thrombus, embolism, or conditions producing low systemic perfusion pressures
ABI (atherothrombotic brain/ cerebral infarction), CE (embolus)
Hemorrhagic 12-24 % (abnormal bleeding in extravacular areas as result of vessel rupture or trauma), results in increased intracranial pressure with injury to brain tissue & restricted distal blood flow
Intracerebral H, nontraumatic cerebral H= aneurysm, Subarachnoid H, Arteriovenous malformations AVM
How do we categories stroke
Etiology Thrombosis, embolus, hemorrhage Management Transient ischemic attack, minor stroke, major, deteriorating, young (<45 years) Anatomical Specific vascular territory
Types of hemorrhages
Etiology Thrombosis, embolus, hemorrhage Management Transient ischemic attack, minor stroke, major, deteriorating, young (<45 years) Anatomical Specific vascular territory
Ways to recognize stroke
Recognizing early warning signs
Sudden severe headaches with no known cause
Sudden weakness or numbness of the face, arm, or leg on one side of the body
Loss of speech, trouble talking or understanding speech
Sudden dimness or loss of vision particularly in only one eye
Unexplained dizziness, unsteadiness or sudden falls
Vascular Syndromes (Anterior Cerebral Artery syndrome) (Middle cerebral artery syndrome) (Posterior Cerebral Artery Syndrome) (Vertiblar Basilar artery syndrome)
Anterior Cerebral Artery Syndrome - supplies medial aspect of the cortex usally contralatereal LE hemiparesis or hemisesnory UE usally spared and unrinary incontinence, abulia -akinetic mutism slowness delay, Contralateral grasp reflex, sucking reflex. delay lack of spontaneity
Middle cerebral Artery Syndrome- supplies lateral aspects of cerebral hemisphere, internal capsule, corona radiata, globus pallidus, caudate nucleus, putamen O’S table 18.2 pg 712
motor speech impairment contralateral UE and face LE is usally spared opposite anterior global aphasia - just think of a rapper- dumb and trouble talking preceptual decifits- unilateral neglect loss of congujate gaze
Posterior Cerebral Artery Syndrome- alot of vision shit just think about its location like contralateral homonymous hemianopsia bilateral visual agnosia- memory defect topographic disorentation dyslexia ( thats me :/ )
Vertiblar Basilar Artery syndrome- locked in syndrome the freaking worst - quadriplegia bilateral cranial nerve palsy upward gaze is sparred. coma reticular activating system, cognition is spared.
Primary impairments usally lost after a stroke
Somatosensory deficits
Pain
Visual deficits
Speech & language (r hemiplegia)
Aphasia : Wernicke fluent/ comprehension, Broca nonfluent/expressive, Global
Dysphagia- swallowing issues
Dysarthria- jaw and tongue movement issues
Perceptual dysfunction (l hemi)- unilateral neglect, anosognosia, r-l discrim
Cognitive dysfunction- attention, memory, confabulation, perseveration, dementia, delirium
Emotional lability- PBA pseudobulbar affect
Affective disorders
Behavioral hemisphere differences- R hemi: com problems, l hemi: impulsive Table 18.6 p 725
Seizures
Hydrocephalus- accumulation of Cerebral spinal fluid within the cranial cavity
Bladder & bowel
Motor decifits
Motor deficits-
Stages of Motor Recovery Box 18.2 p 719
alterations in tone
stage 1 - flaccidity immediatlye following the acute episdoe lower stage the worst the condition
stage 2- minimal voulantary movement and spascity begins to develop
stage 3- Has voulntary control but, may nor exhibit the correct movement pattern or movement syenergy can become very rigid in this stage
stage 4- some movement combinations that do follow the paths of ethier synergy are mastered spascity beings to decline
stage 5- more difficult patterns can be learned and as the basic limb synergies lose thier dominance over motor acts
stage 6- spascity dissappears individual movements become normal and possible and coordination approaches normal
abnormal synergy patterns Table 18.5 p 721 ( Obligatory)
Abnormal reflexes- associated reflexes (unintentional movements resulting from intentional movement)
Paresis & altered muscle activation
Postural control & balance – pusher syndrome (to weaker side)
Motor programming deficits (left CVA/ R hemi) apraxia
Ideomotor (not on command), ideational ( none)
abnormal synergy patterns Table 18.5 p 721 ( Obligatory)
Abnormal reflexes- associated reflexes (unintentional movements resulting from intentional movement)
Paresis & altered muscle activation
Postural control & balance – pusher syndrome (to weaker side)
Motor programming deficits (left CVA/ R hemi) apraxia
Ideomotor (not on command), ideational ( none)
Indirect impairments & complications
Thrombophlebitis & Venous thromboembolism (DVT- Homan’s sign) (Pulmonary embolism)
Skin breakdown
Decreased flexibility
Shoulder subluxation & pain
Reflex sympathetic dystrophy RSC- shoulder hand syndrome- stages1-3
Deconditioning
Functional disabilities
Cardiac
Pulmonary issues- decreased respiratory output, aspiration
Examination Box 18.3 p 730ery following a stroke
Brunstrom- Box 18.2 pg 719
Sequential recovery stages of hemiplegia
Bobath 3 main recovery stages
Flaccid stage, spastic stage, stage of relative recovery
how long does it take to recover from a stroke
Weeks
1 : months resolution of diachesis
6 months
Years: function induced plasticit
Elements of Neurological Examination Box 18.3 p 730 (includes freaking everything you can think of checking )
patient client history, systems review, test and measures
Level of consciousness- Glasgow Coma Scale, Rancho Levels of Cognitive Functioning Scale
Cognitive Dysfunction- Mini Mental Status Examination
Functional Mobility- box 18-4 gait deviations pg 734, 18.5 p 735
10 meter walk, 6 minute walk, emory functional amb profile, walkie talkie test
Functional Assessments- Barthel Index & Functional Independence Measure (FIM)
Stroke Assessment- Postural control
Fugel -Meyer Assessment of Physical Performance (FMA)
Motor Assessment Scale (MAS)
Berg Balance
Postural assessment scale for stroke patients
Functional reach
Timed up and go
CTSIB/LOS
Acute Rehab Interventions
Strategy development
Feedback
Practice
Motor Relearning Programme for Stroke
Analysis task
Practice missing components
Practice task
Transference of training
