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NCS Exam > CVA > Flashcards

CVA Flashcards

1
Q

Stats for ischemic and hemorrhagic stroke

A

Ischemic: 87%
Hemorrhagic: 13%

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2
Q

Mortality prognosis: 7/30/90 days

A

Higher mortality in hemorrhagic stroke

No difference after 3 months

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3
Q

Recurrence prognosis: 30 days/1 year/5 years/10 years

A

30 days = 3%
1 year = 11.1%
5 years: 25%
10 years: 40%

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4
Q

Cerebral thrombosis/embolism

A

Thrombosis - forms in the brain

Embolism - travels to the brain

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5
Q

Zone of injury: core ischemic + ischemic penumbra zones

A

Core ischemic - severe ischia with blood flow between 10-25% = death of neurons
Ischemic penumbra - regions surround severe, considered mild to moderate = where neuroplasticity is targeted

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6
Q

Crescendo TIA

A

2 occurrences within 24 hours
3 within 3 days
4 within 2 weeks

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7
Q

ABCD2 Prediction Rule

A 
Age >60 years 
Blood pressure >140/>90
Clinical presentation - unilateral weakness with or without speech impairment OR speech impairment without weakness
Duration >60 minutes OR 10-59 minutes
Diabetes
- higher score = more likely
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8
Q

Hemorrhagic risk factors

A

HTN
Alcohol and drug abuse
Use of anticoagulants
(not DM, obesity, previous stroke, oral contraceptives)

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9
Q

Saccular aneurysm

A

Roused or irregular swellings in arteries - commonly occurs at sides of vessel bifurcation

**>10 mm are at critical risk to rupture

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10
Q

Use of CT

A

Serves to rule out hemorrhagic stroke during initial evaluation of stroke; may identify ischemic lesion; ischemic lesion may not be detected in early hours after stroke

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11
Q

CT Angiogram

A

Provide clear images of cerebral blood vessels to allow identification of stenosis, occlusion, aneurysms, and vascular abnormalities

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12
Q

MRI

A

Detects edema in the sub-acute phase

More sensitive than CT scans but takes 1 hour to complete

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13
Q

Magnetic Resonance Angiogram

A

Can detect high grade atherosclerotic lesions and less common causes of ischemic stroke (vertebral after dissection, venous thrombosis, etc)

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14
Q

Positron Emission Tomograph (PET)

A

Imaging of regional blood flow and cerebral metabolism

**Used to determine the ischemic penumbra and where areas of tissue are reversible

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15
Q

tPA

A

Administered within 3 hours of sx onset (up to 4.5 hours in some patients)

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16
Q

MCA stroke

A
  • Contralateral weakness (UE/face)
  • Contralateral sensory impairment (UE/face)
  • Aphasia
  • Neglect
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17
Q

Lacunar stoke

A
  • **Deep branches of MCA; supplying the BG and IC

- Contralateral weakness

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18
Q

PCA stroke

A
  • *Supplies occipital lobe, inferior temporal lobe
  • Contralateral homonymous hemianopsia
  • Contralateral sensory impairment/weakness
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19
Q

ACA stroke

A
  • *Primary motor/sensory, supplementary motor, prefrontal cortex
  • Contralateral LE weakness/sensory
  • Frontal lobe behavioral abnormalities (poor judgement, attention, motivation, regulating emotions)
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20
Q

Watershed strokes

A
  • aka border zone infarcts
  • occur at the border areas between vascular territory where the tissue is furthest from vascular supply and thus more venerable to reductions in perfusion.
  • occur at distal branches of major cerebral arteries (MCA/ACA and MCA/PCA)
  • Results from hypoperfusion
  • Proximal arm and leave weakness with distal preservation of strength (man in a barrel syndrome)
  • Tend to occur in the elderly, who have a higher incidence of arterial stenosis and hypotensive episodes, as well as microemboli.
  • Can be associated with seizures , mild / progressive presentation
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21
Q

PICA stroke

A
  • *Cerebellum and medulla
  • LATERAL MEDUALLRY SYDNROME
  • Loss of pain/temp on contralateral side of body and ipsi face
  • Ipsi limb ataxia
  • Dizziness/diploplia/dysphagia/dysarthria
  • Horner’s syndrome
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22
Q

Horner’s syndrome

A
  • *Damage to sympathetic trunk lateral to vertebral bodies
  • associated with PICA strokes
  • Ptosis (eyelid droop)
  • Decreased sweating
  • Miosis (pupil constriction)
  • symptoms are same side
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23
Q

AICA stroke

A
  • *Cerebellum and cranial nerves 7 and 8
  • LATERAL PONTINE SYNDROME
  • Ispi ataxia
  • Contralateral weakness/sensory
  • Dizziness/vertigo
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24
Q

Thalamic pain syndrome

A
  • Initially presents as numbness but evolves into a burning sensation
  • May be accompanied by allodynia
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25
Q

Visual tracts

A

Optic nerve - optic chiasm - opic tract - lateral geniculate nucleus - primary visual cortex

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26
Q

Right optic nerve lesion

A

Blindness of right eye

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27
Q

Optic chiasm lesion

A

Loss of temporal fields in both eyes = bitemporal hemianopsia

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28
Q

Lesion to uncrossed fibers from right eye

A

Loss of nasal field of right eye = right nasal hemianopsia

29
Q

Right optic tract lesion

A

Loss of left visual field (temporal field of left eye, nasal field of right eye) = left homonymous hemianopsia

30
Q

Lesion to the right optic radiation projecting directly to the occipital lobe

A

Loss of inferior quadrant of left visual field

31
Q

Lesion to right optic radiation in Meyer’s loop

A

Loss of superior quadrant of left visual field

32
Q

Lesion to entire right optic radiation

A

Loss of left visual field = left homonymous hemianopsia

33
Q

Lesion to medial surface of right visual cortex

A

Loss of left visual field with macular sparing

34
Q

Muscles not involved in synergies

A 
Finger extensors
Lats
Ankle evertors
Teres major
Serratus anterior 
**FLATS
35
Q

MAS

A

0 No tone
1 Slight increase in muscle tone, manifested by catch and release
1+ Slight increase in tone, manifested by catch and minimal resistance through less then half of range
2 Marked increase in tone through entire range but easily moved
3 Considerable increase in tone, passive movement difficult
4 Rigid

36
Q

Sogue’s phenomenon

A

Finger ext and abduction when arm is elevated above horizontal

37
Q

Raimiste’s phenomenon

A

Resisted hip abduction/adduction elicits abduction/adduction in contralateral limb

38
Q

Bilateral simultaneous extinction

A
  • Failure to respond to stimuli on affected side when both sides are stimulated concurrently (able to identify unilaterally though)
39
Q

Unilateral neglect brain involvement

A

R posterior inferior parietal lobe

40
Q

Anosognosia

A
  • *Associated with damage to R posterior insula

- Denial of sxs

41
Q

Somatotopagnosia

A
  • *Damage to the Right parietal or Right posterior temporal lobe
  • Lack of awareness of body structure and relationship of body part to one another in self or other.
  • aka body image or autotopagnosia
  • IE ask patient to point to elbow and they point to their knee. OR ask to perform LAQ and therapist demonstrates, but they perform marching
  • Treatment: increase sensory input to the desired joint
42
Q

Gerstmann syndrome

A
  • *Damage to parietal lobe of region of angular gyrus
  • Right-left discrimination disorder
  • Finger agnosia (inability to recognize, name, select, and differentiate own or another person’s fingers. Most common with middle 3 fingers. Will move as if fused together resulting in poor hand dexterity.
  • Agraphia (inability to write)
  • Acalculia (inability to calculate)
43
Q

Ideomotor apraxia

A
  • Difficulty planning or completing actions on command

- But can perform automatically

44
Q

Ideational apraxia

A
  • Difficulty conceptualizing and performing tasks, either on command or automatically
45
Q

Recommended parameters for resistance training

A

1- rep max at 60-80%
3 sets each, 8-10 exercises
3x per week for 6-12 weeks

46
Q

Contraindications to resistance training

A
  • Hemophilia and other blood disorders
  • Severely limited ROM
  • Severe osteoporosis
47
Q

Results of functional task practice (FTP) and power training

A
  • Both FTP and power improve movement accuracy with fewer sub movements and reduced reach patio ratio
  • FTTP: Shoulder flexion and elbow extension AROM decreased and there was increased trunk displacement = compensations
  • POWR: Shoulder flexion and elbow extension AROM increased were associated with decreased trunk displacement = more normal movement patterns
  • Perform POWER training then FTTP
48
Q

Dose effect on cerebral blood flow (CBF)

A

Moderate intensity increases CBF

Low intensity decreases CBF

49
Q

Requirements of CIMT

A
  • 20 degrees wrist ext
  • 10 degrees finger ext
  • no cognitive or sensory deficits
50
Q

CIMT training protocol

A

6 hrs per day for 2 weeks

constraint for 90% waking hours

51
Q

Balance and self-efficacy conclusions

A
  • Women reported lower levels of balance self efficacy
  • Number of co-morbid conditions didn’t effect balance self-efficacy
  • Lower balance self-efficacy in those with cognitive impairments
  • Functional walking capacity contributed little to perception of health unlike balance-efficacy
52
Q

Intensity of balance training

A
  • 2-3x/week sufficient

* *90 minutes, 5x week NOT recommended

53
Q

NMES improvements

A
  • Gait speed but not other functional activities
  • Shoulder pain/sub-luxation
  • Improves motor impairment in UE especially with acute stroke and mild symptoms
54
Q

Unilateral neglect and visual scanning

A
  • 20 hours of reading task

- Improvements remain at 1 year follow-up

55
Q

Unilateral neglect and sensory awareness and spatial organization

A
  • 20 hours of locating light touch

- Improvements noted over control

56
Q

Unilateral neglect and external/internal stimulus

A
  • Loud auditory sound or knocking on desk to promote attenuation
  • Improvement in attention to task, 2/4 measures
57
Q

Unilateral neglect and visual and movement imagery

A
  • Visualize items in home and spell words backwards
  • Imagine the examiner changing posture
  • Improvements lasted at 6 month follow-up
58
Q

Unilateral neglect and prisms/patching

A
  • Possible improvement, more likely compensatory/improvement in awareness vs functional improvement
59
Q

StrokEDGE II Acute Care

A
  • Orpington Prognostic Scale
  • PASS
  • STREAM
60
Q

Orpington Prognostic Scale

A

Scoring of cognition, balance, proprioception, and motor function

**Ranges from 1.6-6.8

61
Q

Orpington Prognostic Scale cut-off scales

A

Mild to moderate: <3.2
Moderate to severe: 3.2-5.2
Severe of major deficit: >5.2

62
Q

Functional Reach

A

Less then 15 centimeters indicates fall risk

63
Q

StrokEDGE II Inpatient/Outpatient Rehab

A
  • Fugl-Meyer Assessment of Motor Performance
  • FIM
  • PASS
  • Stroke Impact Scale
  • STREAM
64
Q

Fugl-Meyer Assessment of Motor Performance

A

Evaluates and measures recovery post-stroke

FIVE DOMAINS:
1. Motor function
2. Sensory function
3. Balance
4. Joint ROM
5. Joint Pain
MAX SCORE 226 points
65
Q

Stroke Impact Scale

A
  • 59 items based on 1-5 Likert scale (1: could not do at all, 5: not difficult at all)
  • Lower the score the higher the impact
66
Q

Cecorticate rigidity

A

UE flexed, LE extended, demonstrates a lesion superior to the red nucleus (midbrain)

67
Q

decerebrate rigidity

A

UE and LE extended, demonstrates a lesion inferior to the red nucleus (mid brain)

68
Q

BWSTT vs HEP program (LEAPS trial)

A
  • no significant differences between locomotor training on treadmill vs HEP
  • no difference between early locomotor training ( 2 months post stroke) and late training (6 months post stroke)
69
Q

Research supported and not supported interventions of unilateral spatial neglect

A

Supported: visual scanning training with use of anchor (reading), light touch stimuli and estimating size of plexiglass rods, visual imagery (asked to described objects in home, visualize a word and spell it), and movement imagery (asked to verbally describe change in posture of the examiner).
somewhat supported: loud auditory sound and verbal command to attend to task progressing to patient providing their own cue
No well supported: trunk rotation to lengthen left posterior neck muscles, use of caloric stimulation, and use of prisms and patching. All have temporarily affects

NCS Exam (13 decks)

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