CVA Flashcards
Post CVA considerations
Resting SBP
Resting DBP
Rest HR
90
50
the chances for having a DVT post cvs is
30-75 percent
what are common problems post CVA
seizures cognitive problems dysphagia visuospatial and perceptual disturbances language deficits
compensatory strategies for dysphagia
thickening liquids
chink tuck during swallow
small sips
treatment for dysphagia
vitalSTIM NMES
Biofeed with mirror
posture/environmental set up
visuospatial and perceptual disorders
- attention deficits and distractibility
- homonymous hemianopsia and other visual field cuts
- body scheme (somatagnosia) and body image disorders/difficulty with R/L discrimination
- depth, distance, or vertical perceptual deficits
what is agnosia
the inability to recognize familiar objects using one or more of the sensory modalities, while often retaining the ability to recognize the same object using other sensory modalities
what is anosognosia?
the severe denial, neglect, and the lack of awareness of the presence or severity of one’s deficits
anosognosia is most in _____ hemi’s
left
what is dysarthria?
muscle dysfunction that leads to impaired verbal communication
dysarthria may affect what 4 things?
respiration
phonation
articulation
resonance
what is the treatment of dysarthria?
tongue and oral motor exercises
functional speaking practice
posture
aphasia is a _______ hemisphere injury, and it impairs the _______ and _______ of language
dominant
expression, understanding
what are the different types of aphasia
brocas, wernickes, global
what is apraxia?
can’t perform a task despite having the desire and the physical ability to perform them. The patient is unable to accomplish the task even though the instructions are understood.
apraxia is found with _______ lobe injury
parietal
what is the most common form of apraxia? what are examples of this apraxia?
buccofacial or orofacial
licking lips, whistling
what is limb-kinetic apraxia
inability to make fine, precise movements with an arm or leg
what is ideomotor aparxia and provide an example?
inability to make proper movement in response to a verbal command
can’t walk…asked to get coffee and they can
what is ideational apraxia?
inability to coordinate activités with multiple sequential movements such as dressing,eating and bathing
what is verbal apraxia?
difficulty coordinating mouth and speech movements on command
what is constructional apraxia?
inability to copy, draw, or construct simple figures
what is oculomotor apraxia?
difficulty moving the eyes on command
what is the speed of a household ambulator
.4 m/sec
what is the speed of a household ambulator
.4 m/sec
what is the speed of a household ambulator
.4 m/sec
to be a community amlbulator, one must have the ability to:
navigate changes in terrain avoid obstacles endure distance manage lighting changes manage visual and auditory distraction manage load carrying handle weather changes walk with sufficient velocity
to be a community amlbulator, one must have the ability to:
navigate changes in terrain avoid obstacles endure distance manage lighting changes manage visual and auditory distraction manage load carrying handle weather changes walk with sufficient velocity
to be a community amlbulator, one must have the ability to:
navigate changes in terrain avoid obstacles endure distance manage lighting changes manage visual and auditory distraction manage load carrying handle weather changes walk with sufficient velocity
what is the speed of a limited community ambulator
.4-.8 m/sec
what is the speed of a limited community ambulator
.4-.8 m/sec
what is the speed of a limited community ambulator
.4-.8 m/sec
what is the walking velocity for a community ambulatory?
1.2-1.4 m/sec
what is the walking velocity for a community ambulatory?
1.2-1.4 m/sec
what is the walking velocity for a community ambulatory?
1.2-1.4 m/sec
what is the velocity needed to cross a street at a spotlight?
1.2 m/sec velocity for 13-27 m
the ability to negotiate 7-8 curbs independently
what is the velocity needed to cross a street at a spotlight?
1.2 m/sec velocity for 13-27 m
the ability to negotiate 7-8 curbs independently
what is the velocity needed to cross a street at a spotlight?
1.2 m/sec velocity for 13-27 m
the ability to negotiate 7-8 curbs independently
Shoulder pain occurs in ____-____ percent of patients with stroke. Is this normal?
70-84%
no it is not normal
Shoulder pain occurs in ____-____ percent of patients with stroke. Is this normal?
70-84%
no it is not normal
Shoulder pain occurs in ____-____ percent of patients with stroke. Is this normal?
70-84%
no it is not normal
_____ is common in UE strokes with the presentation of downward rotation of the scapula with the glenoid fossa moving vertical to downward
subluxation
_____ is common in UE strokes with the presentation of downward rotation of the scapula with the glenoid fossa moving vertical to downward
subluxation
_____ is common in UE strokes with the presentation of downward rotation of the scapula with the glenoid fossa moving vertical to downward
subluxation
what can cause impingement?
marked spasticity
superior subluxation
muscle imbalance
loss of scapulohumeral rhythm
what can cause impingement?
marked spasticity
superior subluxation
muscle imbalance
loss of scapulohumeral rhythm
what can cause impingement?
marked spasticity
superior subluxation
muscle imbalance
loss of scapulohumeral rhythm
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation, then what two slings could be used?
GivMohr sling
Bobath Sling
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation, then what two slings could be used?
GivMohr sling
Bobath Sling
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation, then what two slings could be used?
GivMohr sling
Bobath Sling
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation then what types of treatments can be used?
e-stim to reduce subluxation teach awareness of UE bed mobility PROM with massage with FLX limited to 90 degrees Weight bearing Use UE to stabilize objects
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation then what types of treatments can be used?
e-stim to reduce subluxation teach awareness of UE bed mobility PROM with massage with FLX limited to 90 degrees Weight bearing Use UE to stabilize objects
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation then what types of treatments can be used?
e-stim to reduce subluxation teach awareness of UE bed mobility PROM with massage with FLX limited to 90 degrees Weight bearing Use UE to stabilize objects
if patient is 1-2/ shoulder strength, hypotonia, and 2 cm inferior subluxation, what treatments can be used?
e-stim sling for standing PNF scapular patterns Fluidotherapy w/ physical and mental practice Weight bearing (isometric contractions)
if patient is 1-2/ shoulder strength, hypotonia, and 2 cm inferior subluxation, what treatments can be used?
e-stim sling for standing PNF scapular patterns Fluidotherapy w/ physical and mental practice Weight bearing (isometric contractions)
if patient is 1-2/ shoulder strength, hypotonia, and 2 cm inferior subluxation, what treatments can be used?
e-stim sling for standing PNF scapular patterns Fluidotherapy w/ physical and mental practice Weight bearing (isometric contractions)
if patient is 2-3/5 prox>distal strength, normal tone, no subluxation then what should patient do?
Use are for EVERYTHING Distal UE -self ROM, massage, isometrics Prox UE -AROM, theraband PNF patterns Weight bearings Functional Tasks (CIT)
if patient is 2-3/5 prox>distal strength, normal tone, no subluxation then what should patient do?
Use are for EVERYTHING Distal UE -self ROM, massage, isometrics Prox UE -AROM, theraband PNF patterns Weight bearings Functional Tasks (CIT)
if patient is 2-3/5 prox>distal strength, normal tone, no subluxation then what should patient do?
Use are for EVERYTHING Distal UE -self ROM, massage, isometrics Prox UE -AROM, theraband PNF patterns Weight bearings Functional Tasks (CIT)
1-2/5 prox>distal strength Modified Ashworth=2
1 cm anterior subluxation
E-stim for subluxation AAROM proximally WB isometrics distally PNF WB prone on elbows Aggressive PROM to shoulder capsule FES Manual support and guidance Bi-manual activities Use arm in stabilizing activities
1-2/5 prox>distal strength Modified Ashworth=2
1 cm anterior subluxation
E-stim for subluxation AAROM proximally WB isometrics distally PNF WB prone on elbows Aggressive PROM to shoulder capsule FES Manual support and guidance Bi-manual activities Use arm in stabilizing activities
1-2/5 prox>distal strength Modified Ashworth=2
1 cm anterior subluxation
E-stim for subluxation AAROM proximally WB isometrics distally PNF WB prone on elbows Aggressive PROM to shoulder capsule FES Manual support and guidance Bi-manual activities Use arm in stabilizing activities
3-4/5 prox>distal strength Modified Ashworth=2 Pain with shoulder flex/ABD AROM >120
don't have patient push through pain!
Enforce shoulder ER
-PRE
shoulder ER and depression
Scapular ADD and retraction
Scapular Taping3-4/5 prox>distal strength Modified Ashworth=2 Pain with shoulder flex/ABD AROM >120
don't have patient push through pain!
Enforce shoulder ER
-PRE
shoulder ER and depression
Scapular ADD and retraction
Scapular Taping3-4/5 prox>distal strength Modified Ashworth=2 Pain with shoulder flex/ABD AROM >120
don't have patient push through pain!
Enforce shoulder ER
-PRE
shoulder ER and depression
Scapular ADD and retraction
Scapular Taping0-1/5 prox strength Modified Ashworth=4 Unable to isolate muscle groups
PROM to maintain shoulder ext WB with inhib to biceps and facil to triceps Rhythmic rotation for spasticity Prone on elbows WB Scapular retraction E-stim to triceps
0-1/5 prox strength Modified Ashworth=4 Unable to isolate muscle groups
PROM to maintain shoulder ext WB with inhib to biceps and facil to triceps Rhythmic rotation for spasticity Prone on elbows WB Scapular retraction E-stim to triceps
0-1/5 prox strength Modified Ashworth=4 Unable to isolate muscle groups
PROM to maintain shoulder ext WB with inhib to biceps and facil to triceps Rhythmic rotation for spasticity Prone on elbows WB Scapular retraction E-stim to triceps
Shoulder-Hand syndrome incidence? first signs? Followed by? Pain when?
12-25% of patients with UE pain
hand edema and tenderness
localized tenderness in the shader during ROM activities
Pain primarily with movement
Shoulder-Hand syndrome incidence? first signs? Followed by? Pain when?
12-25% of patients with UE pain
hand edema and tenderness
localized tenderness in the shader during ROM activities
Pain primarily with movement
Shoulder-Hand syndrome incidence? first signs? Followed by? Pain when?
12-25% of patients with UE pain
hand edema and tenderness
localized tenderness in the shader during ROM activities
Pain primarily with movement
Shoulder-Hand syndrome
Later stages
____changes of the fingers
muscle ___and ____ occur
skin changes
sympathetic vasomotor changes (warmth,redness, glossy skin)
tropic
atrophy and contracture
(atrophy of thenar and hypothenar muscles)
cool, cyanotic, and damp
Shoulder-Hand syndrome
Later stages
____changes of the fingers
muscle ___and ____ occur
skin changes
sympathetic vasomotor changes (warmth,redness, glossy skin)
tropic
atrophy and contracture
(atrophy of thenar and hypothenar muscles)
cool, cyanotic, and damp
Shoulder-Hand syndrome
Later stages
____changes of the fingers
muscle ___and ____ occur
skin changes
sympathetic vasomotor changes (warmth,redness, glossy skin)
tropic
atrophy and contracture
(atrophy of thenar and hypothenar muscles)
cool, cyanotic, and damp
what is the speed of a household ambulator
.4 m/sec
to be a community amlbulator, one must have the ability to:
navigate changes in terrain avoid obstacles endure distance manage lighting changes manage visual and auditory distraction manage load carrying handle weather changes walk with sufficient velocity
what is the speed of a limited community ambulator
.4-.8 m/sec
what is the walking velocity for a community ambulatory?
1.2-1.4 m/sec
what is the velocity needed to cross a street at a spotlight?
1.2 m/sec velocity for 13-27 m
the ability to negotiate 7-8 curbs independently
Shoulder pain occurs in ____-____ percent of patients with stroke. Is this normal?
70-84%
no it is not normal
_____ is common in UE strokes with the presentation of downward rotation of the scapula with the glenoid fossa moving vertical to downward
subluxation
what can cause impingement?
marked spasticity
superior subluxation
muscle imbalance
loss of scapulohumeral rhythm
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation, then what two slings could be used?
GivMohr sling
Bobath Sling
if pt has 0/5 strength, hypotonia/flaccidity, 2 cm inferior subluxation then what types of treatments can be used?
e-stim to reduce subluxation teach awareness of UE bed mobility PROM with massage with FLX limited to 90 degrees Weight bearing Use UE to stabilize objects
if patient is 1-2/ shoulder strength, hypotonia, and 2 cm inferior subluxation, what treatments can be used?
e-stim sling for standing PNF scapular patterns Fluidotherapy w/ physical and mental practice Weight bearing (isometric contractions)
if patient is 2-3/5 prox>distal strength, normal tone, no subluxation then what should patient do?
Use are for EVERYTHING Distal UE -self ROM, massage, isometrics Prox UE -AROM, theraband PNF patterns Weight bearings Functional Tasks (CIT)
1-2/5 prox>distal strength Modified Ashworth=2
1 cm anterior subluxation
E-stim for subluxation AAROM proximally WB isometrics distally PNF WB prone on elbows Aggressive PROM to shoulder capsule FES Manual support and guidance Bi-manual activities Use arm in stabilizing activities
3-4/5 prox>distal strength Modified Ashworth=2 Pain with shoulder flex/ABD AROM >120
don't have patient push through pain!
Enforce shoulder ER
-PRE
shoulder ER and depression
Scapular ADD and retraction
Scapular Taping0-1/5 prox strength Modified Ashworth=4 Unable to isolate muscle groups
PROM to maintain shoulder ext WB with inhib to biceps and facil to triceps Rhythmic rotation for spasticity Prone on elbows WB Scapular retraction E-stim to triceps
Shoulder-Hand syndrome incidence? first signs? Followed by? Pain when?
12-25% of patients with UE pain
hand edema and tenderness
localized tenderness in the shader during ROM activities
Pain primarily with movement
Shoulder-Hand syndrome
Later stages
____changes of the fingers
muscle ___and ____ occur
skin changes
sympathetic vasomotor changes (warmth,redness, glossy skin)
tropic
atrophy and contracture
(atrophy of thenar and hypothenar muscles)
cool, cyanotic, and damp
____ will die from a stroke
1/3
____-___ % of acute strokes have recurrences. Within 5 years post-stroke, recurrence is ____ percent with _____ being more high than ______.
25-35
40%
men
women
what ethnics group are at higher prevalence of strokes
African American>hispanic american> caucasian
what are risk factors for having a stroke
hypertension high serum cholesterol obesity heavy ETOH use cocaine use smoking diabetes mellitus heart disease
what are the three stroke classifications?
thrombic, embolic, and cerebral hemorrhage
what are the two causes for thrombotic CVA?
ASCHD (Arteriosclerotic coronary heart disease) and HTN
What is the difference between a CVA and TIA
a TIA is a brief episode that causes the same symptoms as a stroke but less severe and the symptoms are usually temporary or reversible. Cause is usually due to a partial obstruction of blood to the brain.
CVA or stroke is caused by an event that causes more permanent damage to a larger region of the brain.Cause is usually blockage of a major vessel that feeds the brain.
In TIAs, it is indicative of _________ disease, possible _______, and transient systemic ______ ______.
thrombolytic
vasospasm
arterial hypotension
the main goal for medical management of a Thrombotic CVA and TIA is
to improve circulation ASAP
Embolic CVA is a sign of ______. It originates from what 3 places?
cardiac disease
heart, internal carotid artery, carotid sinus
In a embolic CVA the branches of the ______ are most commonly affected and have a ______ outcome.
MCA
poorer
the 3 ways to medically manage an Embolic CVA is
prevention
long-term anticoagulant therapy
surgery
what are the 3 main causes for a Hemorrhagic CVA?
HTN, Ruptured saccular aneurysm, AV malformation
how is the recovery time of a hemorrhagic CVA vs the other two forms?
Blood re-absorbed over 6 to 8 months making it a quicker recovery
Hemorrhagic CVA medical management
hypertensive by prevention and HTN management
Ruptured aneurysm by surgery
left brain damage may result in
right side paralysis
speech and memory defects
cautious and slow behavior
right brain damage may result in
left side paralysis
perceptual and memory defects
quick and impulsive behavior
three commonalties that are found between right and left sided brain damage are
sensory dysfunction
visual field defect
cognitive impairment
MCA
hemiplegia of contralateral side
if on the dominant side then global aphasia
ACA
infarction here is uncommon
if both segments come from a single anterior cerebral stem then both sides of the body are affected, Contralateral hemiparesis and sensory lost are seen in the lower extremities
ICA
clinical picture depends if cause of ischemia is thrombus, embolus, or low blood flow.
the cortex supplied by the MCA is affected most but the ACA can be affected too. With the collateral circulation from the circle of willis, the occlusion may be Aysmptomatic
PCA
if proximal, signs include thalamic syndrome including abnormal sensation of pain, temp, proprioception and touch.
Personality changes
PICA
wallenberg syndrome: vertigo, nausea,
