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
2
Q
causes of CVA
A
- ischemia or infarction
- hemorrhage
3
Q
Ichemic stroke
what is it and what causes it?
A
- lack of blood supply and oxygen
- causes: thrombus, atherosclerosis, embolus
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
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
6
Q
Acute management
of TIA
A
- imaging
- medical management of comorbidities
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
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
9
Q
hemorrhagic stroke
subarachnoid hemorrhage
A
- delayed ischemic neurological deficit
- usually described as the worst headache of their life
- more global damage
10
Q
hemorrhagic stroke
intracerebral hemorrhage
A
- w/i the brain tissue
- specific area and then goes more globally until its taken care off
11
Q
secondary problems of hemorrhagic stroke
A
- subdural hematoma
- hydrocephalus
12
Q
MCA CVA
A
- most common stroke
- most commonly results in greater UE involvement
- sensory and motor involvement
13
Q
Synergy patterns
UE flexion
A
- scapular retraction
- shoulder external rotation/abduction
- elbow flexion
- forearm supination
- wrist flexion
- finger flexion
14
Q
Synergy patterns
LE extension
A
- hip extension/IR/adduction
- knee extension
- ankle plantarflexion and inversion
PNF can help with synergies
15
Q
Other MCA deficits
A
- possible visual loss: homonymous hemianopsia
- impaired conjugate gaze
- perceputal deficits
- impaired language
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
Brunnstrom motor stages
- **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
Souque's phenomenon
- Increased tone of involved arm above horizontal evokes an extension and abduction of fingers.
26
Raimiste's phenomenon
- 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
homolateral synkinesis
- 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
Contraversive pushing/ipsilateral pushing/pusher syndrome
- 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
Shoulder subluxation
| in CVA patients
- want to prevent this from happening in CVA patients
treatments:
- taping
- electrical stimulation
- weightbearing/PNF patterns
30
Hemiplegic shoulder pain
| characteristics
characteristics:
- paralysis
- tenderness over biceps or supraspinatus tendons
- increases with PROM or dependent positions because it is being pulled down
31
UE functions
| post stroke
- learned non-use: want to incorporate that side/change perception
- maximizing hand function
