CVA Flashcards
What is Brunnstrom Stage 1
Flaccidity - absent associated rxns, tonic & phasic reflexes
What is Brunnstrom Stage 2
Associated reactions and/or beginning spasticity (no volitional movement)
What is Brunnstrom Stage 3
Synergy stage (volitional movement dominated by synergy)
What is Brunnstrom Stage 4
Movements deviating from the basic synergies
What is Brunnstrom Stage 5
Relative Independence of the Basic Synergies
What is Brunnstrom Stage 6
Near normal
What is the UE Extension synergy
Scapular - depression and/or protraction Shoulder - adduction and IR elbow - extension forearm- pronation wrist + hand - wrist extension and mass finger flexion
Which synergy is more common in…
1) UE
2) LE
1) Flexion synergy
2) Extension synergy
What synergy do you test for first in UE? Why?
You place them into the flexion synergy and test the EXTENSION synergy first - because the flexion synergy is more common you do not want it to dominate and make them unable to complete extension
What synergy do you test for first in LE? Why?
You place them into the extension synergy pattern and test the FLEXION synergy first - because the extension synergy is more common you do not want it to dominate and make them unable to complete flexion
What is the UE flexion synergy?
Scapular - elevation and/or retraction Shoulder - abduction and ER elbow - flexion forearm - supination wrist and hand - wrist flexion and mass finger flexion
What is the LE flexion synergy
Hip - Flexion, abduction, ER
Knee - flexion
ankle - DF
foot - inversion and mass flexion of toes
What is the LE extension synergy
Hip - extension, adduction, IR
Knee - extension
ankle - PF
foot- inversion and mass extension of toes (more common toe flexion)
What Brunnstrum stage do you typically start clinical testing at?
Stage 4 and then adjust up or down based on patient response
In the Left eye, where does light from __ visual field
a) Left
b) Right
a) nasal aspect
b) temporal aspect
What is the anatomy of the visual pathway
Light hits the back of retina
Optic nn starts
Some cross @ optic chiasm, others do not
From there travel through optic tract to lateral geniculate nucleus (LGN)
They synapse w/optic radiation that course through to occiput (primary visual cortex)
Through Parietal or Temporal lobe
What does a lesion of the optic nerve cause?
Ipsilateral total blindness
What does an injury at the optic chiasm cause
Bilateral heteronymous hemianopsia (Can see medial halves of eye)
Lesions that cause CL homonymous hemianopsia
Optic tract, both radiations, and/or occipital lobe
What is CL homonymous hemianopsia
Loss of one visual field in both eyes (ex damage on R side would cause loss of Left visual field on both eyes)
What is CL lower quadratic anopsia
Loss of CL lower quadrant due to damage of optic radiations through the parietal lobe
What is CL upper quadratic anopsia
Loss of CL upper quadrant due to damage of optic radiations through the temporal lobe
What is CVA
A sudden loss of neurological function caused by an interruption of the blood flow to the brain
How many Americans are killed by stroke each year
130k
How many people have a stroke in the US each year?
795k
T or F: Stroke is the leading cause of death in the US
False - it is the 5th
T or F: Stroke is the leading cause of long-term disability in the US?
True
What percent of strokes are 1st incidence? Recurrence?
77% and 23%
How much does stroke cost each year
Approx 34 billion
What are non-modifiable risk factors?
Age Gender Race TIAs Sickle cell anemia
What are modifiable risk factors
High BP High Cholesterol A fib Diabetes Mellitus Cigarette Smoking Obesity Poor diet Physical inactivity Carotid or other artery disease
List the 2 types of Ischemic Stroke
Cerebral thrombus
Cerebral embolism
What is the most common type of stroke
Ischemic Stroke
List the 2 types of stroke
Hemorrhagic
Ischemic
What is an AVM
A cluster of abnormally formed blood vessels - have potential to rupture and cause bleeding in the brain
What is an aneurysm
Ballooning of a weakened blood vessel
What are some signs of a MCA stroke
CL hemiparesis and sensory impairment (arm>leg)
Wernicke’s and Broca’s aphasia
Apraxia
Damage to internal capsule or basal ganglia
CL homonymous hemianopsia
What are ACA stroke signs?
CL hemiparesis and sensory impairment (Leg> arm)
Loss of bowel/bladder
Apraxia
Mental impairment w/perseveration
What is perseveration
Do the same thing or say the same words repeatedly
What is PCA stroke
CL homonymous hemianopsia CL hemiparesis Dyslexia Memory deficits Topographical disorientation Cranial nerve III palsy Thalamic Syndrome Pain & temp sensory loss Ataxia, athetosis or choreiform movements Visual agnosia
What is thalamic syndrome
Sensory impairment in all modalities - pain and paresthesia (abnormal sensation)
What is athetosis
a symptom characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, rams, legs, neck and tongue
What are choreiform movements
Involuntary, forcible, rapid, jerky movements which are mostly manifestations of BG disease
What are symptoms of Vertebral Artery CVA
Ataxia Vertigo Nausea Vomiting Nystagmus Impaired pain and temp in IPSI face Horner's syndrome Dysphagia Sensory impairment in CL arm, trunk & leg
What is horner syndrome
a combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body - usually results in decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face
What is Basilar Artery stroke signs
Coma Quadriplegia "Locked in syndrome" Bilateral cerebellar ataxia Thalamic Pain syndrome Diplopia or other visual field deficits including blindness
What is the Henneman Principle
There is an order to unit to motor unit recruitment when Gradual Control of Tension is important
What is the order of motor recruitment (gradual)
Small to Large
I (SO, S) IIA (FOG, FR) IIB (FG, FF)
