CVA Flashcards by Kristin Lawler

Risk Factors

HTN, Smoking , Obesity, SM, sedentary lifestyle, contreseptives w/ estrogen
OT push for primary care (lifestyle redesign)

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CVA Survivors

10 have no impairment
40 have mild residual deficits
40 have long teem disabilities
10 need instutional care

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Stroke Types: Ischemic

(Blockage in artery by clot, 87%)
Thrombotic: Stationary Clot
Embolic: traveling clot

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Stroke Types: Hemorrhagic

Weakened vessel ruptures 13%

Usually due to increased HTN results in major surgery

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Stroke Types: Transient Ischemic Attack

(TIA)

Sx. Resolve in 24 Hrs.

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Lacunar Infarct : Deficits

Small holes
Pure motor ataxic of sensory loss
Good prognosis

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Anterior Cerebral Artery Infarct: ACA Deficits

Contralateral UE hemiparesis 
Sensory loss LE > UR or face 
LE Paralysis 
Frontal lobe damage 
Apraxia 
Aphasia 
Neglect 
**Sx. also include denile, decreased safety awarnesss, insight, propioseptive input in BLE
Apraxia is noted by hesitation use hand over hand A 
Use blocked practice

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Middle Cerebral Artery : MCA Deficits

Most common, more complicated, tx involves a lot of sensory input 
*Vision screens are very important 
Sensory loss of face and Ue > LE 
Contralateral hemiplegia 
Homonymous Hemianopsia (loss of 1/3 of visual) 
Aphasia 
Apraxia  
*Body scheme 
*Spatial Relations 
*Agnosia 
*Impulsivity

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Posterior Cerebral Artery Infarct: PCA Deficits

More rare 
**Contralateral sensory loss 
homonyous hemianopsia 
contralatral 
hemiplegia

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Vertebral-Basilar Artery: VBA Deficits

Locked in syndrome 
LOC 
Brainstem or cranial nerve damage 
hemi or quadriplegia 
memory loss 
agitation 
comatose or vegetative state

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Acute Medical Management

Airway protection
Restore cerebral circulation : thrombolytic therapy, antiplatelet drugs, anticoagulation drugs, neuroprotective agents
Maintain BP
Correct Anemia

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The Hemi Arm: Decreased postural tone and control

Can be weakness or sensory based

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Hemi Arm: Decreased biomechanical alignment

Can be either increased or decreased tone which affect scapular alignment

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Hemi Arm: Inefficent muscle recruitment

Either increased or decreased tone

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Hemi Arm: Decreased automatic adjustments & reactions

Difficulty with WS and decreased fluididty & mvmt

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Hemi Arm: Pain

Pain in sh. sublexations, gravity & poor handeling

Sh, Pain types

Joint paint (where is pain coming from, what type aka harp dull)
Muscle pain (affected by speed of stretch)
Altered sensativity pain (tholamic pain) = distroffla program aka load and carry
Sh. hand syndrome ( CRPD) = increase pt mvmt
Brachial plexus traction (poor handeling)
Rotator cuff tear (ask about sh. hx) related to quick mvmts = use moist heat
Adhesive Changes = decreased AROM

Sh. Pain Eval

Hx.
Age
Transfer Techniques (avoid using sh to mobilize)
Activity level (HEP for stretching & ROM)
Available mvmt
Eval of Pain : nature, location, elements that intensify & deminish pain.

Sh Pain Eval : Visual Inspection

Posture 
Atrophy 
Early signs of RSD 
GH malaignmant 
neglect 
tone 
PROM 
Motor Performance

Sh. Pain Tx

Normalize tone 
Proper handling 
ROM 
Functional use 
Sh. support 
address primary pain causes

Sh. Subluxation

Partial Dislocation or separation of joint surfaces

Causes of Subluxations

Abnormal scapular position
Loss of bilateral muscle firing
Weakness
Spasticity

Inferior Subluxation

Scapula = Downward rotation
Humerus = IR, ADD, below inferior lip
Elbow = ext, pronation
(pic of guy in W/C)

Inferior Subluxation TX ideas

ROM & Scap mobility
Rotate Scap upward & hold hand placement to maintain correct alignment
Trays/Armrest (pt must be able to unstrap it)
Support affected Sh. so gravity does not continue to over stretch muscles
Use estim tapping

Anterior Subluxation

Scapula = Downward rotation, elevated, wining, Humerus = hyper /, IR, humeral head inf & FWD Elbow = flex, either pron or sup (pic of old lady in black unitard)

Anterior Subluxation Tx Ideas

``` Dont allow arm to be behind back Dont go to far Fwd use FF in Sh. Increase tricep activity Pt. education Bed positioning ```

Superior Subluxation

Scpula = elevated, ABD Humerus = IR, ABD, humeral head lodged under acromion Elbow - sup & wrist flexion (Guy with his back turned in the pic)

Superior Subluxation Tx Ideas

Teach FF vs HZ ABD or pt will get tendonitis Teach prevenative motions to avoid tendonitis Start with FF lower bc it is easier

Subluxation Reducation

Moblize Realign Activate

Sh. Slings: Pros

``` Protection Control Prevention Pressure Relief Support ```

Sh Slings : Cons

``` Learned nonuse Shortness of soft tissue dependence immoblize fails to correct malaignmeent interferes w/ normal mvmt Interfers w/ function blocks sensory input hinders balance physcological message ```

UE Tx Principles

``` hand leads motion teach visual tracking of UE Use common objects dissociation of hand variety vertical orientation challange BOS work at highest functional level practice ```

Characteristic Deficits

``` Motor Sensory Cognitive Perceptual Emotional Speech/Language ```

CVA Evaluation

``` Medical Hx Social HX Chief complaint Impact of disability on lifestyle COmmunication Cognitive Status Mobility Sensation Pain Posture ```

CVA Evaluation Continued

``` ADL's Visual status perception Motor control Voulntary movement patterns ROM Coordination Balance ```

CVA Eval Continued Again

``` Quality of mvmt strength endurance equipment gait ```

CVA Tx focus

Optimize positioning Increase ADL performance Promote & Optimize use of hemioaretic side Promote and Optimize use of hemiparetic side Optimize good biomechanics Optimize Voulntary Control

CVA Tx focus continued

``` Mazimize perception and cognition Remidial approach or Adaptive Approach Opitmize postural control Facilitate emotional adjustment to stroke Enhance pt. motivation in rehab Education pt, family & Caretakers ```