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Neuromuscular PT 2 > CVA > Flashcards

CVA Flashcards

1
Q

List the warning signs of strokes

A
  • weakness: sudden loss of strength especially on one side of the body
  • trouble speaking: speaking or understanding
  • vision problems
  • headache
  • dizziness/sudden loss of balance
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2
Q

causes of CVA

A
  • ischemia or infarction
  • hemorrhage
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3
Q

Ichemic stroke

what is it and what causes it?

A
  • lack of blood supply and oxygen
  • causes: thrombus, atherosclerosis, embolus
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4
Q

Metabolic events of a stroke

just try to explain

A
  • ischemia
  • glutamate release from cell death
  • activation of calcium channels and release of internal calcium
  • increased glycolysis, increased intracellular water, activated protein enzymes
  • lactic acid, cell swelling, oxygen free radicals
  • all leads to more cell injury and death
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5
Q

types of strokes

ie mini vs major

A

TIA:

  • transient ischemic attack (ministroke) - SHOULD get treatment and further medical care if this occurs
  • lasts 15 minutes or less with residual deficits

major stroke:

  • deteriorating stroke
  • young stroke: caught early
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6
Q

Acute management

of TIA

A
  • imaging
  • medical management of comorbidities
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7
Q

acute management: ischemic stroke

A
  • thrombectomy
  • rt-PA
  • thrombectomy can be used when rt-PA is contraindicated or use alone
  • given TPA in the 1st 3 hours usually have no deficits but this medication causes an increased risk of bleeding
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8
Q

Hemorrhagic stroke

common causes

A
  • aneurysm
  • arteriovenous malformation: nidus forms which is an area of weakness due to arteries and veins not connecting well
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9
Q

hemorrhagic stroke

subarachnoid hemorrhage

A
  • delayed ischemic neurological deficit
  • usually described as the worst headache of their life
  • more global damage
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10
Q

hemorrhagic stroke

intracerebral hemorrhage

A
  • w/i the brain tissue
  • specific area and then goes more globally until its taken care off
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11
Q

secondary problems of hemorrhagic stroke

A
  • subdural hematoma
  • hydrocephalus
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12
Q

MCA CVA

A
  • most common stroke
  • most commonly results in greater UE involvement
  • sensory and motor involvement
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13
Q

Synergy patterns

UE flexion

A
  • scapular retraction
  • shoulder external rotation/abduction
  • elbow flexion
  • forearm supination
  • wrist flexion
  • finger flexion
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14
Q

Synergy patterns

LE extension

A
  • hip extension/IR/adduction
  • knee extension
  • ankle plantarflexion and inversion

PNF can help with synergies

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15
Q

Other MCA deficits

A
  • possible visual loss: homonymous hemianopsia
  • impaired conjugate gaze
  • perceputal deficits
  • impaired language
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16
Q

Left MCA CVA deficits

A
  • left is usually dominant hemisphere
  • important for language function
  • broca’s/expressive aphasia: knows what they want to say but cannot speak it (prefrontal lobe)
  • wernicke’s/receptive aphasia: parietal lobe; can speak but not understand speech and may say the wrong word
  • global aphasia: both expression and receptive
17
Q

right MCA CVA

A

neglect syndromes

  • left neglect: usually lacking sensory and motor on the left and neglect that side
  • right neglect: can happen but extremely rare

language deficits

  • doesnt get social cues/non verbal langaugae such as a change in tone, jokes etc

right MCA CVA = perceptual problems

18
Q

ACA CVA

A
  • weakness patterns: more LE than UE
  • sensory usually intact
  • personality changes due to frontal lobe involvement
  • abulia = no motivation
  • akinetic mutism: more severe; will stop moving and speaking
  • impaired executive function, perservation, pseudobulbar affect (controlling emotions)
19
Q

PCA CVA

A
  • weakness: no specific weakness but difficulty putting movements together
  • movement disorders due to PCA supplying much of the deep brain structures
  • visual field losses
  • thalamic pain syndrome: issues with using sensory information to change motor output; severe allodynia
20
Q

brainstem

medulla blood supply

A

Medulla:

  • medial (vertebral artery)
  • lateral (PICA)
  • Center (ASA)
21
Q

brainstem: pons

bloodsupply

A
  • basilar artery: full pons (locked in)
  • AICA: lateral inferior pons
  • short circumferential: lateral midpons
  • superior cerebellar artery: lateral superior pons
  • paramedian branches: medial pons, inferior, midpons, superior
22
Q

Lacunar infarcts

A
  • infarct of small penetrating vessels (small deficits)
  • common in basal ganglia, internal capsule, thalamus,brainstem
  • can result in pure motor or sensory signs
  • occurs deep within the brain
  • could have small deficits from this
23
Q

PT mangement of CVA

A
  • examination

Acute intervention:

  • prevent trauma to affects side: injury, subluxation, overstretching
  • incorporate side into functional activities (the earlier the better)
24
Q

treatment strategies

A
  • PNF/NDT
  • task-oriented approach
  • motor learning: what stage of learning are they in and what feedback to give
25
Q

Brunnstrom motor stages

A
  • stage 1: flaccid stage/no muscle tone can be sensed
  • stage 2: spastic stage/presence of muscle spascitiy of associated movement
  • Stage 3: synergy stage/presence of stereotyped of motor synergy
  • Stage 4: movement deviation from the basic synergies begin to break steriotyped of motor synergy
  • Stage 5: relative independence of the basic synergy
  • Stage 6: near normal stages

what to get them out of spacticity

26
Q

Souque’s phenomenon

A
  • Increased tone of involved arm above horizontal evokes an extension and abduction of fingers.
26
Q

Raimiste’s phenomenon

A
  • reaction in hemiplegia where applying resistance to the non-affected limb cuases a similar reaction in the affected limb
  • resistance to hip abduction or adductionof noninvolved extremity causes same motion in invovled leg
27
Q

homolateral synkinesis

A
  • assoicated problem
  • ask them to flex LE and they may flex UE
  • nonpurposive associated movements on affected side of hemiparetic subjects, triggered during voluntary movement.
28
Q

Contraversive pushing/ipsilateral pushing/pusher syndrome

A
  • left side is weak and pushes left
  • usually w/ left neglect
  • they usually feel like they are falling to the right side
  • they will push towards the hemiparetic side
29
Q

Shoulder subluxation

in CVA patients

A
  • want to prevent this from happening in CVA patients

treatments:

  • taping
  • electrical stimulation
  • weightbearing/PNF patterns
30
Q

Hemiplegic shoulder pain

characteristics

A

characteristics:

  • paralysis
  • tenderness over biceps or supraspinatus tendons
  • increases with PROM or dependent positions because it is being pulled down
31
Q

UE functions

post stroke

A
  • learned non-use: want to incorporate that side/change perception
  • maximizing hand function

Neuromuscular PT 2 (12 decks)

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