CVA intro/syndromes Flashcards
CVA special considerations
Monitor vitals:
SBP: 90-200
DBP under 110
HR: 50-100.
Monitor INR.
DVT: 30-75% after stroke.
Respiratory Insufficiency: >90%.
Common Problems post-CVA
Seizures: 10% after ischemic, 34% after hemorrhagic.
Cognitive problems.
Dysphagia.
Visuospatial and perceptual disturbances.
Language deficits.
Dyspagia
Compensatory strategies: thicken liquids, chin tuck during swallow, small sips.
TreatmentL VitalSTIM NMES, biofeedback c mirror, posture/environment set up.
Generally treated by SLP, but must know whether you can give pt water.
Agnosia
The inability to recognize familiar objects using one or more of the sensory modalities, while often retaining the ability to recognize the same object using other sensory modalities
Anosognosia
the severe denial, neglect, and lack of awareness of the presence or severity of one’s deficits
Dysarthria
Muscle dysfunction leads to impaired verbal communication.
May affect: respiration, phonation, articulation, resonance.
Treatment: tongue and oral-motor exercises, functional speaking practice, posture.
Aphasia
DOMINANT hemisphere injury
Impairs the expression and/or understanding of language.
Broca’s aphasia
Expressive aphasia-may or may not be able to write it down.
Know what to say, cant get it out, may be able to piece together meaning.
Wernicke’s aphasia
Receptive aphasia: cant understand questions-can check understanding by seeing if pt can follow commands.
“word salad”
CVA presentations
Hemiplegia: lack of movement on one side of body.
Hemi-neglect: test with double simultaneous stimulation: may not recognize own are-treat with forced WB.
Pusher syndrome.
Apraxia.
Severe spasticity: not common immediately post stroke (usually 3 mo-1 yr post stroke).
Apraxia
Mild form: dyspraxia.
Loss of abilityo execute or carry out skilled movements and gestures despite having desire and physical ability to perfrom them.
Parietal lobe injury.
Various types.
Buccofacial or Orofacial apraxia
Most common.
Inability to carry out facial movements on command.
ex: pt cannot blow on command, but if given bubble wand, they can spontaneously blow
limb-kinetic apraxia
inability to make fine, precise movements with an arm or leg
Ideomotor apraxia
inability to make proper movement in response to a verbal command.
Ex: pt cannot walk if requested, but if asked to get something on other side of room, the will go get it.
Ideational apraxia
Inability to coordinate activities with multiple sequential movements.
ex: dressing, bathing, eatin
Verbal apraxia
difficulty coordinating mouth and speech movements on command
constructional apraxia
inability to copy, draw, or construct simple figures
Oculomotor apraxia
Difficulty moving eye on command
Shoulder-Hand Syndrome Stage 1–CRPS
limited shoulder ROM swelling of dorsum of hand shiny skin limited ROM in fingers hypersensitivity wrist extension painful
Shoulder-Hand Syndrome Stage 2
Hard to reverse Shoulder pain subsides, ROM increases Edema of hand subsides, but fingers more stiffer Hair and nails are coarse Sensitivity decreased Osteoporosis on X-ray
Shoulder-Hand Syndrome Stage 3
Progressive atrophy of bones, skin, muscle
Limitation of hands, wrists, and fingers increases.
Hand is painless but useless in a clawed position.
Shoulder-Hand Syndrome treatment
Reduce edema Maintain/increase ROM Maintain wrist extension ROM Encourage movement of involved shoulder Bed positioning.
Hemiplegic UE
Shoulder pain in 70-84% of stroke pts, but isnt normal-starts as pain with movement.
Capitate may dislocate with inappropriate support
Inferior shoulder subluxation
lack of active movement
downward rotation of the scapula
loss of passive locking mechanism
stretching of the soft tissue and capsule
–Graded by number of fingers that can fit in subluxed space
Anterior shoulder subluxation
new control is unbalanced
side bending of head toward affected side
downward rotated scapula pulled superiorly
extension of humerus with IR
Superior shoulder subluxation
Flexion syngergy shoulder elevation head of humerus pressed against acromion lack of isolated humeral movement may lead to impingement
Impingment c CVA
spasticity
superior subluxation
muslce imbalace
loss of SH rhythm
UE hemiplegic management
0/5 strength, 2 cm inf. subluxation
Sling for standing (GivMohr, Bobath) E-stim awareness of UE for bed mobility PROM c massage: limit ff to 90* WB use UE to stabilize
UE hemiplegic management
1-2/5 strength, 2 cm inferior sublux
PNF fluido c physical and mental practice WB sling for standing E-stim
UE hemi management
2-3/5 strength, no sublux
have pt ue arm for EVERYTHING
distal: self ROM, massage, isometrics
prox: AROM, theraband
PNF, WB, functional tasks
1-2/5 strength, mod ashworth 2, 1 cm sublux
E-stim AAROM prox WB isometrics distal PNF WB POE FES
3-4/5 strength, mod ash 2, p! c flex/abd
dont push through pain
encourage shoulder ER
scap taping
0-1/5 strength, mod ash 4
PROM for shoulder / WB to facilitate triceps rhythmic rotation POE tricep estim
