CVA Flashcards
Controllable Causes of CVA
Diet high in salt, fat, sugar
Stress both internal (stressful situations at home) and external (environmental temp. related)
Stimulant Use/Illegal drug use
Inactivity
Not taking meds as prescribed
Use of contraceptives for some women
Diabetes Unmanaged
Excessive Alcohol consumption
Smoking
Non-controllable Causes of CVA
Age – older
Genetics
Race
Gender
Diabetes
Heart Disease
Previous CVA
Hypertension
Atherosclerosis
Post Surgery blood clots
Embolic Stroke
blood clot - after surgery - during sleep
Thrombotic Stroke
most common type of CVA
Hemorrhagic Stroke
massive damage - challenges in the integrity of the artery creating a brst
Lacunar Stroke
small infarcts at the end of the capillaries - creates balance and coordination issues
(looks different than typical RLCVA)
Aneurysm
associated with smoking and younger people
- artery wall forms a balloon like protrusion that bursts
TIA Transient Ischemic Attack
3 types:
1. only one episode, brief, resolved within hours to days - no others
2. warning signs of the big stroke
3. multiple mini strokes - leading to disability
Prevention methods for CVA
1) Regular check ups with your physicians
2) Diet and exercise
3) stop smoking
4) Dont drink excessively or take illegal drugs
5) look for alternative birth control methods
6) monitor BP and HR regularly
7) take meds as prescribed
8) manage stress
L CVA characteristics
- Right Hemiplegia
- Language /aphasia
- more serious
- labile
R CVA characteristics
- Left Hemiplegia
- perceptual issues
- neglect
- impulsivity
- indifferent
- dont recognize their problem
Global Aphasia
unable to understand or produce speech
Expressive Aphasia
Broccas aphasia - difficulty producing speech
Receptive Aphasia
Wernickie’s Aphasia - difficulty understanding language and speech
Anomic Aphasia
most minimal challenges - least amount of disability - difficulty naming things (best prognosis for recovery)
Precautions for CVA
- Avoid MMT and strengthening of spastic muscles
-protect affected extremities - Avoid Fatigue
- Monitor and protect against subluxation
- Adress edema issues
- Prevent contracture
- Monitor for Autonomic Abnormalities - dizziness, sweating, cold and clammy skin, bowel and bladder issues
- Monitor for diabetic reactions
- monitor for signs of stroke
- observe aspiration precautions when indicated
- Observe intake and output precautions
- monitor for dehydration
- observe falls precaution
- Monitor HR and BP
- Prevent decubiti
- Prevent DVT
How to address issue with edema for CVA
See edema treat edema: position elevation, retrograde massge, air splint, taping, sleeves
What is subluxation and how does it happen
Subluxation is separation of joints when there are no stimulation or movement coming from the muscles. Prevent it by using slings for subluxation.
Most difficult UE movement to recover following CVA
Warnings signs of CVA
1) Numbness, weakness, one side of the body - burning or tingling in the face arm and or leg
2) Loss of speech or trouble talking or understanding speech
3) Vision problems particularly in one eye- dim or loss of vision
4) Dizziness, unexpected falls
5) Swallowing difficulties, choking, coughing with anything ingested
6) Severe headache (thunderclap), nausea, vomiting,
7. cognitive: loss of consciousness, lethargy, extreme fatigue, confusion
Brunstrom Stage 1
Flaccid - no movement of UE
Equipment: edema glove, subluxation sling, positioning cushion, possible resting hand splint, commu board, elastic stockings
Transfers: Lateral Transfer
Use of UE as stabilizer
Brunstrom Stage 2
Movement with Reflexive activity - start synergy pattern of UE into flexion with reflex action such as sneezing, coughing
Equipment: edema glove, subluxation sling, positioning cushion, possible resting hand splint, commu board, elastic stockings
Transfers: Lateral possibly SPT transfer
Use of UE as stabilizer
Brunstrom Stage 3
Height of spasticity - with UE in synergy pattern when voluntary movement is initiated.
Equipment: WC lap tray, wedge cushion with high end in front to simulate hip flex, abduction splint
Transfers: bent pivot or stand pivot turn transfer (strong side leading)
Use of UE as gross assist
Brunstrom Stage 4
UE deviating fromk synergy - can move UE into flex and abd of shoulder - pronate and supinate with elbow at 90 flex, external rotation and internal rotation (reach on opposite ear), hand extension of fingers and lateral pinch
Equipment: lap tray on WC, cushion for prevention of skin breakdown
Transfers: Stand pivot turn transfer to either side
Use of UE as gross assist
Brunstrom Stage 5
UE can move to all ROM with stress can feel tone, hand can open into extension as a group, tripod pinch possible
Equipment:
Transfers: may perform SPT or transfer with an assistive device
Use of UE as gross assist
