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Neurorehabilitation > CVA > Flashcards

CVA Flashcards

1
Q

Function of the lobes: Frontal lobe (6)

A
  1. Judgement
  2. Emotion
  3. Motivation
  4. Memory
  5. Pre-motor cortex (plans mvmt, including speech)
    * Broca’s area
  6. Motor cortex (execute mvmt skills, including speech)
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2
Q

Function of the lobes: Parietal lobe (4)

A
  1. Sensory cortex
  2. Receive & appreciate info from the senses
  3. Provides sensory context (compare new info w/ past experiences)
  4. Understand symbolic language
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3
Q

Function of the lobes: Temporal lobe (3)

A
  1. Auditory cortex - receive “raw data”
  2. Wernicke’s area (understand auditory info, compares w/ past experiences)
  3. Visual-object recognition (persons, colors, etc.)
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4
Q

Function of the lobes: Occipital lobe (2)

A
  1. Visual cortex - receive “raw data”

2. Functions w/ parietal & temporal lobes to understand what is being seen

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5
Q

Function of the limbic system (7)

A

Functions with all other cortices for memory circuits, motivation olfaction, emotion, visceral tone, fear/frustration, anger, behavior

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6
Q

Progression/Recovery from CVA (typical first 6 mos - 4 stages)

A

Recovery dependent on extent of damage
0-2 wks: flaccidity
2-4 wks: incr. motor control, spasticity, focus on bilateral mvmts
2-4 mos: recovery slows, but still regaining function
4-6 mos: limited changes, abnormal mvmt becomes habitual

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7
Q

What is Constraint-Induced Mvmt Treatment (CIMT)?

A

Intensive program focused on using affected side. Restrain unaffected side. 5-6hrs/day. Use of incremental, repetitive tasks. Task-oriented approach

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8
Q

Deficits resulting from CVA lesions: Frontal lobe (12)

A
  1. Lack judgement
  2. Flat affect
  3. Possible memory deficits
  4. Spastic hemiparesis
  5. Loss of voluntary eye mvmt patterns
  6. Motor apraxia
  7. Expressive aphasia
  8. Personality changes
  9. Difficulty sequencing
  10. Perseveration
  11. Difficulty prob-solving
  12. Uncontrollable emotions
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9
Q

Deficits resulting from CVA lesions: Parietal lobe (9)

A
  1. Difficulty w/ academics (eg dyslexias)
  2. Difficulty naming objects
  3. R/L confusiom
  4. Impaired processing of tactile info
  5. Inability to focus visual attention
  6. Difficulty w/ eye-hand coordination
  7. Lack of awareness of body parts
  8. Impaired spatial orientation
  9. Dressing or constructional apraxia
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10
Q

Deficits resulting from CVA lesions: Temporal lobe (12)

A
  1. Receptive aphasia
  2. Disturbance of selective attention
  3. Difficulty identifying/categorizing objects
  4. Prosopagnosia (difficulty recognizing faces)
  5. STM loss
  6. Changes in sexuality
  7. Persistent talking
  8. Increased aggressive behavior
  9. Cortical deafness
  10. Visual-object agnosia or neglect
  11. Hallucinations or auras
  12. Possible seizures
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11
Q

Deficits resulting from CVA lesions: Occipital lobe (10)

A
  1. Vision defects
  2. Difficulty visually locating objects
  3. Difficulty identifying colors
  4. Hallucinations & visual distortions
  5. Word blindness
  6. Inability to recognize object mvmt
  7. Difficulty reading & writing
  8. Poor processing of visual stimuli
  9. Visual-object neglect
  10. Prosopagnosia
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12
Q

What arteries supply the frontal lobe?

A

Anterior cerebral artery

Middle cerebral artery

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13
Q

What arteries supply the temporal lobe?

A

Posterior cerebral artery

Middle cerebral artery

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14
Q

What arteries supply the parietal lobe?

A

Anterior cerebral artery

Middle cerebral artery

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15
Q

What arteries supply the occipital lobe?

A

Posterior cerebral artery

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16
Q

Two categories of CVA - What are they? Prevalence?

A

Ischemic - blocked oxygen supply - 80% of CVA

Hemorrhagic - bleeding in brain - 20% of CVA

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17
Q

What are the types of ischemic CVA? (4)

A
  1. Atheroma
  2. Thrombosis
  3. Embolus
  4. Steal
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18
Q

What’s an atheroma CVA?

A

Build up of plaque to restrict/occlude vessel (cholesterol & lipids)

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19
Q

What’s a thrombosis CVA?

A

Blood material collects on arterial wall - obstruction

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20
Q

What’s an embolus CVA?

A

“glob” from atheroma or thrombosis breaks off, migrates, then blocks blood flow

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21
Q

What’s a steal CVA?

A

Shunts blood from another artery due to low pressure (occurs @ circle of willis)

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22
Q

What’s an aneurysm CVA?

A

Weakness in blood vessel breaks

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23
Q

What’s an arteriovenous malformation (AVM) CVA?

A

capillary bed all tangled - poor integrity, leaks

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24
Q

Deficits resulting from CVA lesions: Cerebellum (7)

A
  1. Impaired gross & fine motor coordination
  2. Lost ambulation
  3. Poor postural control
  4. Inability to make rapid mvmts
  5. Impaired control of eye mvmts
  6. Tremors or dizziness
  7. Slurred speech
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25
Q

Deficits resulting from CVA lesions: Brain stem (5)

A
  1. Impaired regulation of temp, heart rate, respiration
  2. Difficulty swallowing
  3. Difficulty w/ balance & mvmt
  4. Nausea & dizziness
  5. Impaired arousal & sleep regulation
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26
Q

Effects of Stroke - Involvement of: Internal Carotid Artery (3 primary, 5 dominant (L), 6 non-dominant (R)

A 
Contralateral hemiplegia
Contralateral hemianesthesia
Homonymous hemianopsia
LEFT SIDE
Aphasia
Agraphia/dysgraphia
Acalculia/Dyscalculia
R/L confusion
Finger agnosia
RIGHT SIDE
Perceptual dysfunction
Unilateral neglect
Anosognosia
Constructional/dressing apraxia
Attention deficits
Loss of topographic memory
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27
Q

Effects of Stroke - Involvement of: Middle Cerebral Artery (4 primary, 1 dominant (L), 5 non-dominant (R)

A 
*MOST COMMON
Contralateral hemiplegia - greater involvement of arm, face, & tongue
Sensory deficits
Homonymous hemianopsia
Deviation of head/neck toward affected side
DOMINANT HEMISPHERE (L)
Aphasia
NON-DOMINANT HEMISPHERE (R)
Anosognosia
Unilateral neglect
impaired vertical perception
Visual spatial deficits
Perseveration
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28
Q

Effects of Stroke - Involvement of: Anterior Cerebral Artery (1 primary, 5 possibilities)

A 
Contralateral LE weakness more severe than arm
POSSIBLE:
Apraxia
Mental changes
Primitive Reflexes
Incontinence 
Severe confusion/intellectual changes
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29
Q

Effects of Stroke - Involvement of: Posterior Cerebral Artery (12 possibilities)

A 
Affects are potentially broad & varied since this artery supplies the upper brainstem, temporal, & occipital lobes
POSSIBILITIES:
Sensory deficits 
Motor deficits
Involuntary mvmt disorders
Memory loss
Alexia
Astereognosis
Dysesthesia
Akinesthesia
Homonymous hemianopsia or quadrantanopia
Amonia
Topographic disorientation
Visual agnosia
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30
Q

Effects of Stroke - Involvement of: Cerebellar Artery System (7)

A 
Ipsilateral ataxia
Contralateral loss of pain & temp sensitivity
Ipsilateral facial analgesia
Dysphagia
Dysarthria
Nystagmus
Contralateral hemiparesis
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31
Q

What’s analgesia?

A

Inability to feel pain

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32
Q

Effects of Stroke - Involvement of: Vertbrobasilar Artery System (4)

A

Affects brainstem functions
Bilateral or crossed sensory & motor abnormalities
e.g. loss of proprioception, hemiplegia, quadriplegia, involvement of cranial nerves 3-7

33
Q

OT Evaluation of Ct w/ CVA:

A
  1. Review medical records
  2. Knowing affected area helps focus eval process
  3. Apply deficits to occupational profile
  4. Ct-centered assessment (e.g. COPM)
  5. Observation of functional tasks
  6. Standardized assessments
34
Q

Recovery from stroke: Timeframe of greatest improvement

A

The first 3-6 mos is the most crucial time period for recovery

35
Q

Adaptations for cts with CVA: Dressing

A
  1. One-handed dressing techniques
  2. Wear clothing with looser fit
  3. AE e.g. reacher
36
Q

Adaptations for cts with CVA: Shopping

A
  1. Powered mobility
  2. Ankle-foot orthotic & cane
  3. The internet
37
Q

Core Concepts for a Ct-Centered Eval (7)

A
  1. Ct’s are uniquely qualified to make decisions re: their occupational functioning
  2. Offer ct active role in defining goals & outcomes
  3. Ct-therapist relationships = interdependent
  4. OTs help enable ct’s to meet their own goals
  5. Eval/intervention focusing on contexts in which the ct lives, role, interests, & culture
  6. Ct is “prob-definer” for transition into “prob-solver”
  7. Allow ct to eval their own perf & set personal goals
38
Q

Standardized Tools to use with CVA (only some of the possibilities) (13)

A
  1. The Arnadottir OT Neurobehavioral Eval (A-ONE)
  2. The Assessment of Motor & Process Skills (AMPS)
  3. The Canadian Occupational Performance Measure (COPM)
  4. The NIH Stroke Scale
  5. Canadian Neurological Scale
  6. Rankin Scale
  7. Barthel Index
  8. Kohlm Eval of Living Skills (KELS)
  9. Functional Independence Measure (FIM)
  10. Berg Balance Scale
  11. Stroke Impact Scale
  12. Tinetti Test
  13. Motricity Index
39
Q

What does The Arnadottir OT Neurobehavioral Eval (A-ONE) measure? AKA?

A

Objectively documents the way that dysfunction of ct factors (e.g. left-sided neglect, apraxia, & spatial dysfunction) affects self-care & mobility tasks.
AKA ASL-focused Occupation-based Neurobrhavioral Eval

40
Q

What does The Assessment of Motor & Process Skills (AMPS) measure?

A

Uses IADLs to evaluate underlying perf skills related to the completion of various IADLs (e.g. reaching, grasping, & posture) & process skill dysfunction (e.g. using items & searching & locating)

41
Q

What does Kohlm Eval of Living Skills (KELS) measure?

A

Living skills eval that includes ratings of 17 tasks (e.g. safety awareness, money mgmt, phone book use, meds mgmt)

42
Q

What does Functional Independence Measure (FIM) measure?

A

Measure of disability in performing BADLs that includes 18 items scored on a 7-pt scale; includes subscores for motor & cognitive function; perf areas include self-care, sphincter control, mobility, locomotion, cognition, & socialization

43
Q

What does Barthel Index measure?

A

Measure of disability in performing BADL (0-100), includes 10 items: bowels, bladder, feeding, grooming, dressing, transfer, toileting, mobility, stairs & bathing

44
Q

What does Rankin Scale measure?

A

Global disability scale w/ 6 grades indicating disability

0 = no symptoms, 6 = dead

45
Q

What does Tinetti Test measure?

A

Balance & gait in older adults

46
Q

What does Motricity Index measure?

A

Measures impairments in limb strength

47
Q

What approaches does evidence-based treatment support?

A

Use of functional activities as the therapeutic change agent (e.g. task-oriented approaches). Use of task-oriented approaches have better functional outcomes as well as overall health-related quality of life.

48
Q

Principles of task-oriented approaches (5)

A
  1. Help ct’s adjust to role & task perf limitations by exploring new roles & tasks
  2. Create an enviro that includes the common challenges of everyday life
  3. Practice functional tasks identified as important by the ct to find effective & efficient strategies for performance
  4. Provide opportunities to practice outside of therapy time (e.g. homework assignments)
  5. Minimize ineffective & inefficient mvmt patterns
49
Q

Functional limitations commonly observed post CVA: impairment secondary to poor trunk control (6)

A
  1. Dysfunction of limb control
  2. Increased risk for falls
  3. Impaired ability to interact with the enviro
  4. Dysphagia
  5. Decreased ind. w ADLs
50
Q

Tx interventions post CVA to increase ct’s ability to perform seated tasks(7)

A
  1. Est. neutral yet active starting alignment *neutral to slight anterior pelvic tilt
  2. Reaching activities from active posture
  3. Use external cues (eg verbal tactile physical) to maintain posture
  4. Maintain trunk ROM via proper positioning & exercises
  5. Practice dynamic weight shifts *reaching tasks beyond arms length
  6. Activities that strengthen the trunk
  7. Compensatory strategies & enviro adaptations when necessary
51
Q

Examples of interventions for wheelchair sitting post CVA w: poor trunk stability (4)

A
  1. Lateral supports
  2. Lumbar rolls
  3. Chest straps
  4. Tilt in space frames
52
Q

Adaptive equipment post CVA with poor trunk stability (2)

A
  1. Reachers

2. Long-handled equipment

53
Q

Functional limitations commonly observed post CVA: impairment secondary to inability to perform tasks while standing (4)

A
  1. Increased fall risk
  2. Poor functional outcomes
  3. Difficulties in ADL, IADL, work & leisure
54
Q

Factors contributing to poor standing post CVA (4)

A
  1. Fear of falling/knee buckling
  2. Weakness in LE
  3. Spasticity impeding proper alignment (eg plantar flexion spasticity)
  4. Perceptual dysfunction
55
Q

Specific factors that contribute to poor standing post CVA (4)

A
  1. Ankles - weakness, ROM, & proprioception deficits
  2. Hips - poor ability to restore equilibrium
  3. Stepping - widened stance
  4. Loss of postural reactions
  5. Inability to weight bear/shift
56
Q

Tx strategies to improve ct ability to perform chosen tasks while in standing (5)

A
  1. Est. symmetrical base of support & proper alignment
  2. Est. ability to weight bear & weight shift through the affected LE (grade as needed, eg sit on high stool 1st)
  3. Encourage dynamic reaching activities to develop task specific weight shifting
  4. Use the enviro to grade task difficulty & provide support
  5. Use of graded functional tasks - duration, speed, difficulty
57
Q

Functional limitations commonly observed post CVA: impairment secondary to deficits in communication (2)

A
  1. Aphasia

2. Dysarthria

58
Q

Tx strategies used with language impairment post CVA (9)

A
  1. Encourage speech
  2. Reassure ct it’s a common part of the disability
  3. Let one person talk at a time
  4. Give extra time for ct response
  5. Phrase Q’s so they’re easy to respond to (yes/no, either/or)
  6. Use visual cues & gestures
  7. Never force a response
  8. Be concise
  9. Don’t rush communication.
59
Q

Functional limitations commonly observed post CVA: impairment secondary to deficits in neurobehavioral or cognitive-perceptual (11)

A
  1. Deficits in spatial relations
  2. Spatial neglect
  3. Body neglect
  4. Motor apraxia
  5. Ideation all apraxia
  6. Organization & sequencing
  7. Attention
  8. Figure ground
  9. Initiation
  10. Visual agnosia
  11. Problem solving
60
Q

Tx approaches for neurobehavioral deficits post CVA: compensatory & adaptive approach (10)

A
  1. Repetition of tasks
  2. Top-down
  3. Emphasize intact skill training
  4. Use enviro or task modification to support optimal perf
  5. Emphasize modification
  6. Choice of avidity driven by perf challenges, not by component deficits
  7. Stress symptoms not cause
  8. Ct-driven compensatory strategies
  9. Caregiver-therapist enviro adaptations
  10. Task specific & not generalizable
61
Q

Tx approaches for neurobehavioral deficits post CVA: restorative & remedial approach (8)

A
  1. Restoration of component skills
  2. Bottom- up approach
  3. Deficit specific
  4. Targets cause of symptoms & emphasizes components
  5. Assumes transfer of training will occur
  6. Assumes improved component perf will result in increased skill
  7. Choice of activity driven by component deficits
  8. Research demonstrates short-term results with skills generalizable to very similar tasks
62
Q

Tx approaches for neurobehavioral deficits post CVA: combo approach (4)

A
  1. Rejects dichotomy btwn compensatory & restorative approaches
  2. Uses optimally relevant occupations & enviro as tx modality to challenge components
  3. Choice of tx driven by tasks relevant to ct needs
  4. Rejects use of contrived activities
63
Q

Functional limitations commonly observed post CVA: inability to perform tasks secondary to UE dysfunction (9)

A
  1. Pain
  2. Contracture & deformity
  3. Loss of selective motor control
  4. Weakness
  5. Superimposed orthopedic limitations
  6. Loss of postural control to support UE control
  7. Learned nonuse
  8. Loss of biomechanical alignment
  9. Inefficient & ineffective mvmt patterns
64
Q

What should the primary focus be on re: UE limitations post CVA?

A

Eval & intervention should focus on ct’s ability to integrate UE into the performance of functional tasks

65
Q

Ways to use UE during functional performance (8)

A
  1. Weight bearing through hand/forearm during ADLs & mobility tasks - can be used as postural support, as an aid during transitional mvmts, & for preventing falls
  2. Moving objects across a surface with a static grasp (e.g. ironing, polishing furniture, open/close drawer) - strengthens muscles needed to reach in space
  3. Reach & manipulation
  4. Use objects of different sizes/shapes to encourage control of the hand during reach & manipulation
  5. Choose activities that are appropriate to the ct’s level of motor control
  6. Use constraint-induced mvmt techniques
  7. Specific training the arm to be used in weight bearing, reach, & manipulation within contexts of ADLs/mobility
  8. Grade tasks appropriately (# degrees of freedom, level of antigravity control, & resistance required)
66
Q

UE Complications/Interventions Post CVA (9)

A
  1. Subluxation
  2. Abnormal skeletal muscle activity
    a. Flaccidity
    b. Spasticity
  3. Prevent pain syndrome & contracture
  4. Protect unstable joints
  5. Maintain soft tissue length
  6. Positioning programs
  7. Soft tissue elongation
  8. Splinting
  9. Ct education
67
Q

Precautions to take with shoulder subluxation (2) & focus of tx

A
  1. Support flail shoulder in bed, wheelchair (use pillows to maintain alignment)
  2. Support while standing (hands in pockets or taped)
  3. Focus of tx = achieving trunk alignment & scapula stability in position of upward rotation
68
Q

Complications secondary to abnormal skeletal muscle activity after stroke (flaccidity stage) (5)

A
  1. Edema
  2. Overstretch of the glenohumeral joint capsule
  3. Shortening of muscles due to positioning in shortened positioned (e.g. resting hand in lap)
  4. Over-stretching of antagonist muscle (related to #3)
  5. Risk of joint & soft tissue injury during ADLs & mobility tasks
69
Q

Complications secondary to abnormal skeletal muscle activity after stroke (spasticity stage) (6)

A
  1. Deformity
  2. Maceration of palm tissue (softening)
  3. Possible masking of underlying selective motor control
  4. Pain syndromes
  5. Impaired ability to manage BADLs (dressing, bathing)
  6. Loss of reciprocal arm swing during gait
70
Q

What is low-load prolonged stretch? (LLPS)

A

Tx if soft tissue shortening/lengthening-associated changes have already occurred. Involves placing the soft tissues in question on submaximal stretch for prolonged periods. May include splinting, casting, & positioning programs.

71
Q

Main uses of splints post CVA during low-tone stage (4)

A
  1. Maintaining joint alignment
  2. Protecting the tissues from shortening/stretching
  3. Preventing injury to the extremity
  4. Adjunct to help control edema
72
Q

What specific structures is splinting used for post CVA?

A
  1. Palmar arch support
  2. Maintain neutral wrist deviation
  3. Maintain neutral wrist between flex/ext
    * In most cases, the fingers do not require splinting
73
Q

Ct education for low-tone stage (2) & high-tone stage (1)

A

LOW TONE:
1. Teach ct’s & caregivers/family to protect the joints
2. & maintain full ROM
HIGH TONE:
1. Teach positioning that will provide elongated of overactive muscles & prevent contracture

74
Q

How to protect unstable joints post CVA (what to protect against, 2 motions to beware of)

A

Protect against subluxation & impingement

Main concern is upward rotation of the scapula & external rotation of the shoulder

75
Q

Examples of positions that may be prescribed during leisure or self-care activities to protect unstable joints & maintain ROM (6)

A
  1. Weight bearing on extended arm
  2. In supine, hands behind head while allowing elbows to drop toward bed (stretches internal rotators)
  3. In supine, pillow protracting the scapula & under the elbow to promote glenohumeral alignment
  4. Lying on a protracted scapula to maintain stretch of retractors & scapulothoracic mobility
  5. Support involved wrist with more functional hand & reach toward floor with both hands (to elongate muscles that tent to shorten)
  6. Cradling the affected arm with the stronger arm, lifting it to chest level, & gently raising & lowering, & adducting & abducting
76
Q

Interventions for visual impairments secondary to stroke (5) & adaptations (5)

A 
INTERVENTIONS 
1. Eye calisthenics
2. Fixations
3. Scanning
4. Visual motor techniques
5. Bilateral integration
ADAPTATIONS
1. Use of prisms
2. Driving adaptations
3. Reading adaptations
4. Changes in lighting
5. Enlarged print
77
Q

Strategies used by OTs for psychosocial support post CVA (6)

A
  1. Foster internal locus of control related to recovery
  2. Use therapeutic activities to improve self-efficacy or confidence in the performance of specific activities
  3. Promoting the use of adaptive coping strategies such as seeking social support, info seeking, positive reframing, & acceptance
  4. Promote success in chosen occupations to promote success
  5. Encourage social support/support groups
  6. Use occupations to promote social participation
78
Q

Tx goals for someone with cerebellar dysfunction (3)

A
  1. Strengthen proximal muscles
  2. Improve postural responses
  3. Increase stability

Neurorehabilitation (5 decks)

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