CVA Flashcards
what ratio of deaths associated with CVD were due to stroke in 2018?
1 in 6 deaths from CVD were due to stroke
how often does someone in the US have a stroke? how often does someone die from a stroke?
every 40 seconds; every 4 minutes
about how many people per year have a stroke in the US
about 800,000
what percentage of strokes are ischemic?
87%
how much does stroke-related care cost the US each year?
about $46 billion
how does high BP relate to stroke
77% of first time stroke patients have a BP > 140/90
how does heart rhythm relate to stroke?
A fib increases risk of stroke 5x
how much can mod-vigorous activity reduce risk of ischemic stroke
mod-vigorous exercise can reduce risk of ischemic stroke by 35%
what are guidelines for activity to reduce risk of ischemic stroek
- 150 min of mod intensity or 75 min of vigorous activity
- paired with strength 2x/wk
how does smoking influence stroke risk
current smokers have a 2-4x higher risk compared to quitters > 10 years
are ischemic strokes thrombolytic or embolic in nature?
trick question: they can be either
what can cause hemorrhagic strokes (4)
- uncontrolled HTN
- trauma
- AVM
- ruptured aneurysm
describe the area of a stroke as it relates to pathophysiology
core of irreversible cell damage surrounded by a penumbral area of potentially reversible damage
how does neuronal death occur, generally
focal lesion leading to destructive enzyme activation, increased metabolic demands, and edema
briefly comment on edema as it relates to strokes
it maxes out at 4 days but can persist up to 3 weeks creating concern with increased ICP
the NIHSS is done in the ER and on the floor, describe its scoring as it relates to severity
0 - no stroke 0-4 - minor stroke 5-15 - moderate stroke 16-20 moderate to severe stroke 21-42 severe stroke
complete the following sentence
each minute of large vessel ischemic stroke untreated, close to ________ neurons die
two million
how is ischemic CVA typically managed
recanalization via IV r-tPA or TNK within 3 hours of onset of symptoms or catheter embolectomy if patient arrives outside of r-tPA window
very important question
if a hemorrhagic CVA, how long after admission until we evaluate
patient must have a stable CT before initiating therapy
very important question
if an ischemic w/o r-tPA CVA, how long after admission until we evaluate
when the patient is stable usually 24-72 post
very important question
if an ischemic with r-tPA CVA, how long after admission until we evaluate
24 hours post completion of transfusion
when is stroke recovery fastest
within the first few weeks
when does the majority of neurologic recovery take place
first 3-6 months
T/F: functional gains can continue beyond 6 months after a stroke
true
what are two theories of stroke recovery
- reduction in local swelling/damaged tissue improves local circulation to restart previously inhibited neurons
- neuroplasticity - functional reorganization of the CNS
how do dedicated stroke units impact mortality rate and discharge to home with independence?
dedicated stroke units decrease mortality rate by 18% and increase discharge to home with independence by 20%
what is the major conclusion of the AVERT trials?
there is no additional benefit to providing out of bed PT to patients before 24 hours after stroke.
bottom line, start PT 24 hours after stroke and medical clearance
what is the exception to the 24 hour VER (very early rehab) rule
proceed with caution BUT contraindicated for patients with ICH and severe strokes
increased OOB frequency shows 13% improvement in ability to walk at 3 mo and decreased mortality
in what patient population do we typically see lacunar infarcts
patients with DM and HTN
how can you generalize about sensory function and strokes?
localized sensory deficits suggest cortical lesion of the sensory homunculus and diffuse sensory deficits suggest a deeper lesion in the thalamus/basal ganglia
what is the motor sequential recovery stages of a stroke
flaccidity –> hyperreflexia/spasticity/synergies –> isolated movement
how long can flaccidity last after a stroke
hours, days, or weeks
in which muscle groups do we expect spasticity to develop
anti-gravity muscles
what is the UE flexion synergy pattern
scap retraction/elevation shoulder abduction shoulder ER elbow flexion forearm supination wrist and finger flexion
what is the LE extension synergy pattern
hip extension, adduction, and IR
knee extension
ankle PF and inversion
toe PF
describe reflexes during the flaccid stage
hypotonic and areflexic
describe reflexes during the spastic stage (3)
- hypertonic and hyperreflexic
- clonus
- cutaneous/primitive/tonic reflexes may emerge
for hemiplegia/paresis, initially there is nothing wrong with the muscle, but over time, what happens?
decrease # motor units, altered patterns and force generation, denervation, and atrophy
what are 3 consequences of a stroke that affects muscles of respiration
atelactasis, pneumonia, and aspiration
what is a primary consequence of a cerebellar or basal ganglia lesion
ataxia/proprioception
important question
how does a L hemisphere CVA impact motor programming
- pt has difficulty SEQUENCING new activities (ideomotor, ideational, constructional, and dressing apraxias)
important question
how does a R hemisphere CVA impact motor programming
pt has difficulty maintaining/sustaining postures and movements (MOTOR IMPERSISTENCE)
what terms are synonymous with receptive and expressive aphasia
receptive = fluent expressive = nonfluent
what is anosognosia
denial of presence of disability usually accompanied by sensory loss and hemianopsia
what are common cognitive/behavioral changes in a L CVA (R hemiplegic patient)
- sequencing error
- negativity and depression
- slow and uncertain
- can appraise their deficits
what are common cognitive/behavioral changes in a R CVA (L hemiplegic patient)
- impulsive
- poor judgement
- euphoric
- overestimate their ability
T/F: we want to encourage stroke patients to use their UNINVOLVED side as much as possible to make up for their losses on their stroke side
false, we want to avoid compensatory movements
what are the names of two specific hemiparetic assessment tools
fugl-meyer and Motor Assessment Scale
what are the names of two specific functional assessment tools
Barthel Index and Functional Independence Measure (FIM)
what are the main, early goals of stroke rehab
- maintain ROM and prevent deformity
- promote active movements esp of the involved side
- improve trunk control, symmetry, and balance
- improve cardiopulmonary function
what can you do to maintain ROM and prevent deformities in the stroke population
position the extremities using pillows, rolls, and arm troughs
what can you do to promote awareness, active movements, and use of the hemiplegic side
sensory stimulation techniques and encourage bilateral activities
what can you do to improve trunk control, symmetry, and balance
balance training such as
- equal weight bearing in sitting
- sitting and standing balance activities
- weight shifting
what can you do to improve functional mobility
early and frequent functional mobility training such as
- scooting, rolling, and supine to sit
- transfers in BOTH directions
what can you do to improve initiation of self care activities
ADL retraining such as incorporating motor tasks into function
what can you do to improve cardiopulmonary function
diaphragmatic strength exercises and trunk stretches if tight
what are three facilitation techniques
- quick stretch
- tapping muscle belly
- approximation and weight bearing
what are three inhibition techniques
- slow rhythmic rotation
- static stretch with tendon pressure
- weight bearing
