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Neuro Rehab Test 2 > CVA Overview > Flashcards

CVA Overview Flashcards

1
Q

describe the percentage breakdown of general stroke recovery

A

10% full recovery, 25% minor impairments, 40% mod-severe, 10% nursing home, 15% death

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2
Q

what are the tasks associated with F.A.S.T.?

A
  • F - face - smile and tongue
  • A - arms - raise both arms
  • S - speech - repeat
  • T - time - 911
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3
Q

non modifiable RFs for stroke (5)

A
  • >55
  • African American
  • DM
  • Fam Hx of CVA
  • Female
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4
Q

what type of CVA is a lacunar stroke?

A

ischemic (infarct)

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5
Q

describe two types of common hemorrhagic CVAs and their usual cause

A

ICH usually d/t HTN and SAH usually d/t aneurysm

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6
Q

what kinds of strokes are more lethal? more disabling long term?

A

hemorrhagic are more lethal, but ischemic are more damaging long term.

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7
Q

what are 4 common presentations of an MCA infarct

A
  1. UE and face more involved than LE
  2. Aphasia (L MCA)
  3. Neglect (R MCA)
  4. visual issues (HH)
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8
Q

what is the common clinical manifestation of an ACA stroke

A

LE involved > UE

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9
Q

what are 2 common clinical manifestations of PCA stroke

A
  1. visual issues (HH and cortical blindness)
  2. thalamic (pain) syndrome
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10
Q

How do lacunar strokes typically present?

A

because they are small vessel strokes, they are specific to the infarct location.

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11
Q

What are two common clinical presentations of a vertebrobasilar artery stroke.

A
  1. cerebellar signs
  2. locked-in syndrome (brainstem effected)
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12
Q

define homonymous hemianopsia

A

(26%) - named for the side of visual field cut but cannot be accomodated in patients with neglect or inattention

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13
Q

what is forced gaze deviation

A

unopposed action of eye muscles causing deviation in the direction of intact musculature

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14
Q

what are three predictable movement findings in CNS pathology

A
  1. distal impairment > proximal
  2. bilateral motor involvement despite unilateral CNS damage.
  3. loss of fractionated movement (synergy)
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14
Q

what are three predictable movement findings in CNS pathology

A
  1. distal impairment > proximal
  2. bilateral motor involvement despite unilateral CNS damage.
  3. loss of fractionated movement (synergy)
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15
Q

T/F: Adults with CVA have similar strength on their UNINVOLVED side compared to adult controls

A

False: both paretic and nonparetic limbs show weakness and atrophy in CVA population

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16
Q

what are the six Brunstromm recovery stages

A
  1. flaccid
  2. spastic
  3. obligatory synergy
  4. deviations from synergy
  5. relative independence
  6. near normal
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17
Q

what are the three Bobath (NDT) sequential stages of recovery

A
  1. flaccid
  2. spastic
  3. relative recovery
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18
Q

What do the Brunstromm and Bobath models both agree on

A

generally predictable pattern of motor recovery with plateau happening at any stage

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19
Q

UE spasticity pattern

A

scap retractors, shoulder ADDUCTORS, INTERNAL ROTATORS, elbow flexors, FOREARM PRONATORS, and wrist and finger flexors

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20
Q

LE spasticity pattern

A

pelvic retractors, hip adductors, hip IR, hip and knee extensors, PFs, inverters, toe flexors

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21
Q

talk about neck and trunk spasticity

A

causes lateral flexion to the hemi side

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22
Q

spasticity is a response to ____________

A

passive elongation of the muscle

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23
Q

how do we assess tone (3)?

A
  1. Modified Ashworth
  2. Mod Tardeiu
  3. Narrative description
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24
Q

what is the modified ashworth scale for tone?

A

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

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25
Q

The modified tardeiu scale uses R1 and R1 to define tone, what does each of these values represent

A
  • R1 - angle of muscle reaction to fast stretch
  • R2 - full PROM - angle of muscle reaction to slow stretch
26
Q

how do you get the dynamic tone component of a muscle?

A

Modified Tardeiu Scale (R2 - R1 = x)

27
Q

Describe synergy as three tenants

A
  • loss of fractionated movement in a predictable pattern
  • 2 synergies per limb
  • appears with volitional movement
28
Q

Describe the UE flexion synergy

A
  • Scap retraction and elevation
  • GH ABER
  • elbow flexion and supination
  • wrist and finger flexion
29
Q

Describe the UE extension synergy

A
  • scap protraction
  • GH ADIR
  • elbow extension and pronation
  • wrist and finger flexion
30
Q

when someone has spasticity and moves in synergy, the spasticity pattern will ________

A

dominate the movement at the SHOULDER and FOREARM

31
Q

What is the dominant synergy pattern of the UE? LE?

A
  • UE - flexion
  • LE - extension
32
Q

Describe the LE flexion synergy

A
  • Hip FABER
  • Knee flexion
  • Ankle DF and inversion
33
Q

Describe the LE extension synergy

A
  • Hip EXADIR
  • Knee extension
  • Ankle PF and inversion
34
Q

which two movements/muscle groups are difficult for stroke patients to recover

A

finger extensors and ankle everters

35
Q

what is learned non-use

A

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.

36
Q

Four reflexes that may arise as a result of CNS injury

A

ATNR, STNR, STLR, and PSR

37
Q

what are associated reactions?

A

movements that occur as a result of a sneeze, cough, etc.

38
Q

What is Souques Phenomenon?

A

An associated reaction that may be therapeutic: elevation of the hemi UE above horizontal with the elbow extended may elicit finger ext/abd

39
Q

What is Raimiste’s Phenomenon

A

an associated reaction that may be therapeutic: resistance to abd/add on either side produces the same phenomenon on the other side

40
Q

what is homolateral limb synkinesis

A

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.)

41
Q

T/F: spasticity is a contraindication to Therex

A

false

42
Q

what outcome measure would be best to assess strength in a stroke (hemi) patient?

A

Fugl-Meyer

43
Q

T/F: The patient may demonstrate associated reactions even during the flaccid stage

A

true

44
Q

How do you tell the difference between a UMN and LMN lesion affecting the face?

A

UMN will knock out contralateral upper and LMW will knock out ipsilateral - in other words, UMW will spare the lower face

45
Q

How do you tell the difference between CB and sensory ataxia?

A

A true CB ataxia will be considerably worse if the patient is asked to close their eyes

46
Q

Four ways to test to ataxia/coordination

A

RAM, dysdiadochokinesia, finger to nose, heel to shin

47
Q

classic categories of apraxias most often seen with L hemi

A
  • ideational (can’t understand task, tools, or sequence)
  • ideamotor (understand but can’t execute, may spontaneously use tool correctly)
48
Q

what does the parietal lobe do

A

visuospatial processing and internal representation of spatial relationships for successful imitation of gestures

49
Q

what is a good outcome measure to use to assess balance in the stroke population

A

miniBest

50
Q

what are the three types of aphasias

A
  • fluent - Weirnicke’s receptive aphasia
  • nonfluent - Broca’s expressive aphasia
  • global - impaired comprehension and expression
51
Q

About ⅓ of stroke patients have depression but its more common in which hemisphere of CVA?

A

L CVA

52
Q

what is a secondary neurological impairment that may impact mental status during treatment over time? (uncommon)

A

hydrocephalus

53
Q

what percentage of stroke patients 6-12 months can ambulate independently w or w/o AD?

A

up to 80%

54
Q

T/F: Most strokes spontaneously recover in 3-6 months

A

true

55
Q

National Average LOS at IRF

A

14 days

56
Q

what happens in the hours (up to a week) following a stroke

A

resolution of ischemic prenumbra

57
Q

what happens in days-months after a stroke

A

resolution of diaschesis (area distal to infarct impacted by miscommunication from effected area)

58
Q

what is the order of CNS reorganization following a stroke

A
  • neurotransmitter alterations
  • inhibition release of ipsilateral alternating pathways
  • synaptogenesis
59
Q

why do we start with the trunk

A

proximal neurological redundancy as well as “stability aids mobility”

60
Q

T/F: pharmocologic intervention is the only method that has lasting/long term impact on tone

A

true

61
Q

8 ways to facilitate movement

A
  1. resistance
  2. quick stretch
  3. tapping
  4. stroking
  5. joint approximation
  6. joint traction
  7. icing
  8. voice (sharp, loud)
62
Q

5 ways to inhibit unwanted movement

A
  1. prolonged stretch
  2. sustained pressure
  3. slow rocking/rotational movement
  4. warmth
  5. voice (quiet, soothing)

Neuro Rehab Test 2 (11 decks)

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