CVA Overview Flashcards
describe the percentage breakdown of general stroke recovery
10% full recovery, 25% minor impairments, 40% mod-severe, 10% nursing home, 15% death
what are the tasks associated with F.A.S.T.?
- F - face - smile and tongue
- A - arms - raise both arms
- S - speech - repeat
- T - time - 911
non modifiable RFs for stroke (5)
- >55
- African American
- DM
- Fam Hx of CVA
- Female
what type of CVA is a lacunar stroke?
ischemic (infarct)
describe two types of common hemorrhagic CVAs and their usual cause
ICH usually d/t HTN and SAH usually d/t aneurysm
what kinds of strokes are more lethal? more disabling long term?
hemorrhagic are more lethal, but ischemic are more damaging long term.
what are 4 common presentations of an MCA infarct
- UE and face more involved than LE
- Aphasia (L MCA)
- Neglect (R MCA)
- visual issues (HH)
what is the common clinical manifestation of an ACA stroke
LE involved > UE
what are 2 common clinical manifestations of PCA stroke
- visual issues (HH and cortical blindness)
- thalamic (pain) syndrome
How do lacunar strokes typically present?
because they are small vessel strokes, they are specific to the infarct location.
What are two common clinical presentations of a vertebrobasilar artery stroke.
- cerebellar signs
- locked-in syndrome (brainstem effected)
define homonymous hemianopsia
(26%) - named for the side of visual field cut but cannot be accomodated in patients with neglect or inattention
what is forced gaze deviation
unopposed action of eye muscles causing deviation in the direction of intact musculature
what are three predictable movement findings in CNS pathology
- distal impairment > proximal
- bilateral motor involvement despite unilateral CNS damage.
- loss of fractionated movement (synergy)
what are three predictable movement findings in CNS pathology
- distal impairment > proximal
- bilateral motor involvement despite unilateral CNS damage.
- loss of fractionated movement (synergy)
T/F: Adults with CVA have similar strength on their UNINVOLVED side compared to adult controls
False: both paretic and nonparetic limbs show weakness and atrophy in CVA population
what are the six Brunstromm recovery stages
- flaccid
- spastic
- obligatory synergy
- deviations from synergy
- relative independence
- near normal
what are the three Bobath (NDT) sequential stages of recovery
- flaccid
- spastic
- relative recovery
What do the Brunstromm and Bobath models both agree on
generally predictable pattern of motor recovery with plateau happening at any stage
UE spasticity pattern
scap retractors, shoulder ADDUCTORS, INTERNAL ROTATORS, elbow flexors, FOREARM PRONATORS, and wrist and finger flexors
LE spasticity pattern
pelvic retractors, hip adductors, hip IR, hip and knee extensors, PFs, inverters, toe flexors
talk about neck and trunk spasticity
causes lateral flexion to the hemi side
spasticity is a response to ____________
passive elongation of the muscle
how do we assess tone (3)?
- Modified Ashworth
- Mod Tardeiu
- Narrative description
what is the modified ashworth scale for tone?
0 = no increase in tone
1 = slight increase in catch and release
1+ = slight increase in catch and resist
2+ = marked increase in tone but easily moved
3+ = passive motion difficult
4+ rigid
The modified tardeiu scale uses R1 and R1 to define tone, what does each of these values represent
- R1 - angle of muscle reaction to fast stretch
- R2 - full PROM - angle of muscle reaction to slow stretch
how do you get the dynamic tone component of a muscle?
Modified Tardeiu Scale (R2 - R1 = x)
Describe synergy as three tenants
- loss of fractionated movement in a predictable pattern
- 2 synergies per limb
- appears with volitional movement
Describe the UE flexion synergy
- Scap retraction and elevation
- GH ABER
- elbow flexion and supination
- wrist and finger flexion
Describe the UE extension synergy
- scap protraction
- GH ADIR
- elbow extension and pronation
- wrist and finger flexion
when someone has spasticity and moves in synergy, the spasticity pattern will ________
dominate the movement at the SHOULDER and FOREARM
What is the dominant synergy pattern of the UE? LE?
- UE - flexion
- LE - extension
Describe the LE flexion synergy
- Hip FABER
- Knee flexion
- Ankle DF and inversion
Describe the LE extension synergy
- Hip EXADIR
- Knee extension
- Ankle PF and inversion
which two movements/muscle groups are difficult for stroke patients to recover
finger extensors and ankle everters
what is learned non-use
Acutely after CNS injury, there is no reward for efforts using the extremity, so we stop trying to use it, leading to risk of delayed recovery.
Four reflexes that may arise as a result of CNS injury
ATNR, STNR, STLR, and PSR
what are associated reactions?
movements that occur as a result of a sneeze, cough, etc.
What is Souques Phenomenon?
An associated reaction that may be therapeutic: elevation of the hemi UE above horizontal with the elbow extended may elicit finger ext/abd
What is Raimiste’s Phenomenon
an associated reaction that may be therapeutic: resistance to abd/add on either side produces the same phenomenon on the other side
what is homolateral limb synkinesis
an associated reaction that may be therapeutic: mutual dependency between hemi limbs (i.e. flexion of the R UE elicits flexion of the R LE.)
T/F: spasticity is a contraindication to Therex
false
what outcome measure would be best to assess strength in a stroke (hemi) patient?
Fugl-Meyer
T/F: The patient may demonstrate associated reactions even during the flaccid stage
true
How do you tell the difference between a UMN and LMN lesion affecting the face?
UMN will knock out contralateral upper and LMW will knock out ipsilateral - in other words, UMW will spare the lower face
How do you tell the difference between CB and sensory ataxia?
A true CB ataxia will be considerably worse if the patient is asked to close their eyes
Four ways to test to ataxia/coordination
RAM, dysdiadochokinesia, finger to nose, heel to shin
classic categories of apraxias most often seen with L hemi
- ideational (can’t understand task, tools, or sequence)
- ideamotor (understand but can’t execute, may spontaneously use tool correctly)
what does the parietal lobe do
visuospatial processing and internal representation of spatial relationships for successful imitation of gestures
what is a good outcome measure to use to assess balance in the stroke population
miniBest
what are the three types of aphasias
- fluent - Weirnicke’s receptive aphasia
- nonfluent - Broca’s expressive aphasia
- global - impaired comprehension and expression
About ⅓ of stroke patients have depression but its more common in which hemisphere of CVA?
L CVA
what is a secondary neurological impairment that may impact mental status during treatment over time? (uncommon)
hydrocephalus
what percentage of stroke patients 6-12 months can ambulate independently w or w/o AD?
up to 80%
T/F: Most strokes spontaneously recover in 3-6 months
true
National Average LOS at IRF
14 days
what happens in the hours (up to a week) following a stroke
resolution of ischemic prenumbra
what happens in days-months after a stroke
resolution of diaschesis (area distal to infarct impacted by miscommunication from effected area)
what is the order of CNS reorganization following a stroke
- neurotransmitter alterations
- inhibition release of ipsilateral alternating pathways
- synaptogenesis
why do we start with the trunk
proximal neurological redundancy as well as “stability aids mobility”
T/F: pharmocologic intervention is the only method that has lasting/long term impact on tone
true
8 ways to facilitate movement
- resistance
- quick stretch
- tapping
- stroking
- joint approximation
- joint traction
- icing
- voice (sharp, loud)
5 ways to inhibit unwanted movement
- prolonged stretch
- sustained pressure
- slow rocking/rotational movement
- warmth
- voice (quiet, soothing)
