CVA

Question 1

List the warning signs of strokes

Answer 1

• 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

Question 2

causes of CVA

Answer 2

• ischemia or infarction
• hemorrhage

Question 3

Ichemic stroke

what is it and what causes it?

Answer 3

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

Question 4

Metabolic events of a stroke

just try to explain

Answer 4

• 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

Question 5

types of strokes

ie mini vs major

Answer 5

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

Question 6

Acute management

of TIA

Answer 6

• imaging
• medical management of comorbidities

Question 7

acute management: ischemic stroke

Answer 7

• 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

Question 8

Hemorrhagic stroke

common causes

Answer 8

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

Question 9

hemorrhagic stroke

subarachnoid hemorrhage

Answer 9

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

Question 10

hemorrhagic stroke

intracerebral hemorrhage

Answer 10

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

Question 11

secondary problems of hemorrhagic stroke

Answer 11

• subdural hematoma
• hydrocephalus

Question 12

MCA CVA

Answer 12

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

Question 13

Synergy patterns

UE flexion

Answer 13

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

Question 14

Synergy patterns

LE extension

Answer 14

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

PNF can help with synergies

Question 15

Other MCA deficits

Answer 15

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

Question 16

Left MCA CVA deficits

Answer 16

• 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

Question 17

right MCA CVA

Answer 17

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

Question 18

ACA CVA

Answer 18

• 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)

Question 19

PCA CVA

Answer 19

• 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

Question 20

brainstem

medulla blood supply

Answer 20

Medulla:

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

Question 21

brainstem: pons

bloodsupply

Answer 21

• 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

Question 22

Lacunar infarcts

Answer 22

• 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

Question 23

PT mangement of CVA

Answer 23

• examination

Acute intervention:

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

Question 24

treatment strategies

Answer 24

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

Question 25

Brunnstrom motor stages

Answer 25

• 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

Question 26

Souque’s phenomenon

Answer 26

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

Question 26

Raimiste’s phenomenon

Answer 26

• 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

Question 27

homolateral synkinesis

Answer 27

• 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.

Question 28

Contraversive pushing/ipsilateral pushing/pusher syndrome

Answer 28

• 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

Question 29

Shoulder subluxation

in CVA patients

Answer 29

• want to prevent this from happening in CVA patients

treatments:

• taping
• electrical stimulation
• weightbearing/PNF patterns

Question 30

Hemiplegic shoulder pain

characteristics

Answer 30

characteristics:

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

Question 31

UE functions

post stroke

Answer 31

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