CVA Flashcards
TIA
Transient ischemic attack:
Briefly episode of neuro dysfunction caused by a focal disturbance of brain or retinal ischemia, w/ clinical symptoms lasting less than 1 hour and WITHOUT EVIDENCE OF INFARCTION
Mini stroke
Very minor stroke
Small lesion size -> minimal to no functional deficit
CVA management - clot
Restore blood flow and perfusion to damaged area
TPA, asprin and other anti-coagulants
Carotid endarterectomy, angioplasty, stents
CVA management - bleed
Control bleeding, reduce pressure in brain
Transfusion of clotting product
Bed rest
Surgical BV repair
TPA
Plasminogen activator
Pt must be >18 yo w/ dx of CVA and symptoms <3hours
Contras: internal bleeding, minor stroke, heparin w/in 48 hours
CVA- AVA
Not very common Contra hemiplegia (LE>EU) Minimal sensory loss Apraxia (L inf parietal, frontal, corpus callosum) Cog. Deficits Aphasia (broca’s)
CVA- MCA
Most common site
Contra hemiplegia w/ hemisensory loss UE>LE Head/eye deviation toward side of lesion Homogenous hemianopia contralateral Global aphasia Inattention/neglect
CVA - PCA
Contralateral hemisensory loss
Contralateral homogenous hemaniopshia
Unilateral neglect
CVA - lacuna infarction
Small vessel
Affect subcortical structures
Can be pure motor, pure sensory, silent
20% of all strokes
Good outcome b/c few deficits
Low mortality
CVA - cerebellar
Ipsi hemiparesis
May have gen. Weakness/decrease tone in trunk
Poor extensor strength
Impaired coordination (dysmetria, ataxia)
Impaired proprioception
> 1 TIA w/in 1 week
30% greater risk of stroke w/in the week
NIH stroke scale
Neurologist performs
Decision making related to use of thrombolytic therapy
NIH stroke scale scoring
<5 mild
5-14 moderate
15-24 moderate to severe
>25 neuro impairment
NIHSS D/c predictions
<5 d/c home
6-13 d/c to rehab
>13 strongly assoc w/ rehab
NIHSS cutoff for function
Initial score of 7 found to be important cut off - 45% functionally normal at 48 hours
VCA functional assessments
Mobility - FIM, transfers 5x sit to stand, STREAM
Gait - analysis, speed, 6 min walk test
Balance - romberg, berg, TUG, FGA, ABC
CVA testing
Functional! Get them upright and allow them to move so you see what they’re actually capable of
Supine hip extensor test
Not true mmt, gross functional assessment
Knock one grade off formal MMT
Supine hip extensor test grade 5
Netural pelvis, full hip ext
Supine hip extensor test grade 4
Hip flexion before pelvis elevates
Supine hip extensor test grade 3
Full elevation of leg w/out lift of pelvis
Good resistance
Supine hip extensor test grade 2
Full elevation of leg w/out lift of pelvis,
Poor resistance
Upright motor control - hip and knee flexion grades
Strong- >60, 3x in 10 sec
Mod- 30-60, 3x in 10 sec
Weak - no motion/<30, 3 takes over 10 sec
Upright motor control - ankle flexion
Strong - at least 0 deg of DF 3x in 10 sec
Weak - no motion/ less than right angle OR 3 reps in >10 sec
Upright motor control -hip ext grades
Weak - uncontrolled trunk flex
Mod - unable to maintain fully erect trunk
Strong - pt remains erect trunk at end of available hip flex range
Upright motor control knee ext
Strong - able to hold weight and stand into full knee ext
Mod - able to hold weight but not stand on the one left
Weak - knee collapses
Upright motor control test - ankle ext
Strong - lift heel of floor w/ neutral knee
Mod - pt can control knee and ankle in neutral
Weak - knee collapse, knee wobble, ext thrust
UE flex synergy
Scap retraction Shoulder AB, ER Elbow flex Forearm sup Wrist/finger flex
LE flexion synergy
Hip flex, AB, ER
Knee flex
Ankle DF
UE ext synergy
Shoulder IR
Elbow ext
Pronation
LE ext synergy
Hip ext, ad, IR
Knee ext
PF
Cause of synergy
Lack of voluntary muscle control
Spasticity
Weakness
