Exam 3- Stroke part 1 Flashcards
A stroke usually ___ but can ___
~usually appears suddenly
~can appear slowly
Some of the slow appearing strokes (2)
- ~TIAs,
- pin stroke,
- mini strokes
- ~hemorrhagic
2 main types of strokes
Ischemic/ Occlusive and Hemorrhagic
what is the most common type of stroke and by how much?
80% of strokes are occlusive
Hemorrhagic- some details (2 things associated with it)
~High blood pressure
~Associated with headaches
Hemorrhagic- Common types (5)
- ~berry aneurism
- ~AVM (arteriosus venous malformation)
- intracerebral hemorrhage
- cerebral hemorrhage
- subarachnoid hemorrhage
Hemorrhagic- what is berry aneurism?
an out pouching of the circle of willis
Hemorrhagic- what is AVM? (stands for and what it is)
abnormal connection of the artery and vein
(AVM = arteriovenous malformation)
Hemorrhagic- 3 courses for an aneurism
- It never bursts
- It is detected and fixed before it bursts
- Pick up on a scan when looking for it
- Pick it up on a another scan (looking at something different)
- ~it bursts and pt has CVA
2 ways to fix an aneurism
Clip and coil
Clip for an aneurism: when can it be used and how invasive is it?
- ~can be used for an aneurism that has or has not burst
- ~Need a craniotomy
Coil for an aneurism:
when can it be used?
what does it do?
and how invasive is it?
- ~for people for not ruptured~
- a birds nest of wire that fills the hole
- ~will cause the body to fill back in the aneurism
- ~Do not need a craniotomy
Hemorrhagic- how does it injure the brain? (5)
- ~cell starved of blood distal to bleed
- ~pressure on cells right at the site; usually occlude broken artery
- ~pressure away from the site; can act like a contra coup injury
- ~other arteries can be occluded
- ~may have uncal herniation and/or
- midline shift
Hemorrhagic- four typical characteristics of pt in PT
- ~wide spread injury/problems
- ~will be hard to decide where their symptoms came from
- ~will be younger
- ~rarely will fully recover
Occlusive- 2 types
~thrombolytic
~embolytic
Occlusive- what is Thrombolytic
Build up of plaque, etc that will cause a blockage in the artery
Occlusive- what is Embolytic?
Blood/plaque/ air/ fat/cancer breaks off and moves (and plugs the artery)
Occlusive- Embolytic- blood clot, three characteristics of emergency treatment
- the easiest embolytic occlusion to treat
- ~We can do a good a good job getting rid of blood clots with TPA tissue plasminogen activators- thins blood and gets rid of blood clots
- ~need to give tPA to someone within 3 hours
- ~More than 3 hours, the structures distally already starting to die
- ~Its not worth the risk to thin the blood that much after 3 hours
Occlusive- Embolytic- fat bock: what is a common source?
can caused post surgery
TIA
what does it stand for?
what defines it?
Transient ischemic attack
defined by: symptoms resolve within 24 hours
Six characteristics of a Major stroke
- ~Complete paralyze on one side
- ~High cortical processes loss
- ~Has come cognitive loss
- ~Speak problems
- ~Visual problems
- ~Much harder for pt to return to function
Three characteristics of a minor stroke
- ~Still the same person you were before- personality stays the same
- ~Steppage gait; foot drop; some limb paresis
- ~A little sensory or motor deficit; distal portion of the UE or LE
What is a shower stroke?
what is a common cause?
(3 points)
- ~Lots of little strokes all over
- ~Occlusive, sometimes when a clot breaks off a lot of little clots will break off too
- ~Can occur after surgeries when you are trying to prevent/correct for a stroke-
- endarterectomy (plaque build up in the carotids)
- ~The plaque can lead to a shower stroke if all the plaque is not sucked up
some Diagnosis Tests to test for possible stroke (3)
- ~Echocardiogram- did it happen from a build up of blood settling in the heart
- ~CT/ MRI
- ~Carotid US- did it happen form a build up from plaque in the carotids
12 risk factors for stroke
- ~Birth control
- ~smoke
- ~high blood pressure
- ~diabetes
- ~high cholesterol
- ~sedentary
- ~history of CVA
- ~A-fib
- ~age
- ~postmenopausal
- ~drinker
- ~African American
anterior cerebral artery syndrome- symptoms (7)
- ~Contralateral issues
- ~LE more than UE- hemiparesis and hemisensory loss
- ~More apraxia (inability to perform a task)
- ~Problems with imitation and bimanual tasks
- ~Slowness, delay, lack of spontaneity, motor inaction
- ~High risk of Incontinence issues
- ~Higher risk of skin break down
middle cerebral artery syndrome- symptoms (8)
- ~80% have MCA
- ~80% of MCA have occlusive
- ~UE worse than LE- hemiparesis and hemisensory loss
- ~Aphasia (problems with speak)- motor speech impairment
- ~Perception deficits
- ~Limb-kinetic apraxia
- ~Homonymous hemianopia (be able to draw this);
- Unilateral neglect (think of Bob)
posterior cerebral artery syndrome- symptoms (3)
- ~Visual issues
- *homonymous hemianopsia
- *can be bilateral homonymous hemianopsia with some degree of macular sparing
- *visual agnosia
- *prosopagnosia
- ~Cerebellar issues- balance and coordination
- ~Memory defect
locked in syndrome is the same as _______, and two characteristics
Vertebrobasilar stroke
- ~They can feel and hear everything
- ~They can understand
Stroke on the Right- symptoms (10)
- ~Visual problems
- ~Unilateral defect
- ~Impulsive
- ~Poor judgment
- ~Quick with movements
- ~Unaware of impairments
- ~Rigid in their thoughts (stubborn)
- ~Emotional with negative emotions (and expressing them) and get upset with constructive criticism
- ~Have problem with time;
- trouble with spatial awareness
Stroke on the Left- symptoms (7)
- ~Right motor issues
- ~Speak issues (know problems with W and B; Express and receptive)
- ~Local aphasia
- ~Disorganized
- ~Slow and cautious;
- overly aware of their impairments
- ~They think they are doing horrible/ afraid/ etc;
- have to talk them into doing something
- ~Have some processing delays
bilateral hemipshere stroke symptoms (5 major)
- ~Visual- homonymous hemianopsia
- ~Lability- unstable personality (person can be crying and they don’t have a reason to)
- Affective:
- ~Apathy,
- irritable,
- anxiety,
- depression
- Cognitive
- ~Confusion,
- short attention span,
- loss of memory
- ~Inability to preform executive functions
When people are recovering from a stroke, they will often ask…
When am I going to get better?
Recovering from a stroke: what are some things that are going on that are helping (4)
- Blood flow
- ~Angiogenesis,
- collateral blood flow helps with recovery
- ~Thinning the blood,
- keeping the inflammatory response down
- ~Pts are going to sleep a lot!
- ~Neuroplasticity- need stimulus (we will help to cause it) to help cause new connections and strengthen the old ones
- ~Have to start moving them fast so that something will start to form in the brain
Recovering from a stroke: what is something that will help if they are flaccid?
why?
what should you be careful of?
- ~go into weight bearing to cause compression in jts
- ~will get them to have muscle firing
- ~Be careful to make sure that when you are doing this that the pt is in proper alignment so that they do not have impingements later
Roods techniques- types (10)
when performed they can be ______ or ________.
***Can be facilitative or inhibitory
- ~Stretch
- ~Jt manipulation
- ~Cutaneous touch
- ~Ice
- ~Heat
- ~Vestibular
- ~Auditory
- ~Visual
- ~Gustatory
- ~Olfactory
Roods techniques- Facilitative
- ~To increase the threshold- excitatory inputs
- ~produces contraction
Roods techniques- Inhibitory
~To decrease the threshold ~relaxation
Roods techniques- 3 type of Stretch techniques
- ~quick
- ~repetitive
- ~CMP (continuous passive motion)
- ~Prolonged
Roods techniques- Quick Stretch:
what is it/how does it work?
facillitaive or inhibitory?
- ~will jar the muscle a little bit to cause a contraction
- ~facilitative
Roods techniques- repetitive stretch
what is it/how does it work?
facillitaive or inhibitory?
Repetitive stretch
- can place a vibrator over the muscle belly
- > 100 Hz is Facilitatory
- < 100 Hz is Inhibitory
- CPM, continuous passive motion, fits in this category
Roods techniques- CPM stretch
what is it/how does it work?
facillitaive or inhibitory?
continuous passive motion stretch-
it is a type of repetitive stretch using < 100 Hz
- it is inhibitory (< 100 Hz)
Roods techniques- prolong stretch
what is it/how does it work?
facillitaive or inhibitory?
- ~Serial casting-
- you will put the person at the end range, recast and move them farther into the range
- ~trying to get spasticity to release
~inhibitory
Roods techniques- three Jt manipulation types
- ~traction
- ~low grade manipulations
- ~approxiations
Roods techniques- Jt manipulation Traction
what is it/how does it work?
facillitaive or inhibitory?
creates space and relaxes muscles
inhibitory
Roods techniques- Jt manipulation Low grade
what is it/how does it work?
facillitaive or inhibitory?
movements relax muscles/reduce pain (grade 1-2)
inhibitory
Roods techniques- Jt manipulation Approximation
what is it/how does it work?
facillitaive or inhibitory?
compression in joint causes co-contraction of surrounding muscles
facillitative
Roods techniques- Cutaneous touch types (2)
- ~Quick touch
- ~Maintain touch
Roods techniques- Cutaneous touch light/quick
what is it/how does it work?
facillitaive or inhibitory?
Cutaneous Touch (must have sensation there)
- light stroke usually helps with posture
- touch over the muscle belly- contracts the muscle
facillitative
Roods techniques- Cutaneous touch maintained
what is it/how does it work?
facillitaive or inhibitory?
Cutaneous Touch (must have sensation there)
- Maintaining touch will relax muscle (with a little pressure is nice)
- same way that swaddling works (and tight clothing in peds rehab)
- Hug
- calmed the muscle- relaxation
inhibitory
Roods techniques- 2 Ice types
~quick strokes
~prolonged
Roods techniques- Ice quick
what is it/how does it work?
facilitative or inhibitory?
quick cutanious strokes causes contraction
facilitative
Roods techniques- Ice prolonged
what is it/how does it work?
facilitative or inhibitory?
If you leave ice on skin long enough it causes relaxation
inhibitory
Roods techniques- Heat
what is it/how does it work?
facilitative or inhibitory?
heat Relaxes them
inhibitory (never used to provoke muscles)
Roods techniques- 3 Vestibular types
- ~rocking
- ~spinning
- ~bouncing on the ball
Roods techniques- Vestibular: rocking
facilitative or inhibitory?
inhibitory (relaxes us)
Roods techniques- Vestibular: spinning
facilitative or inhibitory?
causes contractions
facilitative
Roods techniques- Vestibular: bouncing on the ball
what is it/how does it work?
facilitative or inhibitory?
Bouncing on the ball (could either excite or inhibit)
- ~Softly- relaxes (inhibitory)
- ~Hard- contractions (and jt approx.) - excitatory
Roods techniques- 2 Auditory types
~loud
~soft
Roods techniques- Auditory loud
facilitative or inhibitory?
facilitative / contractions
Roods techniques - auditory: soft
facilitative or inhibitory?
relaxes (inhibitory)
Roods techniques- 2 Visual types
~bright
~soft
Roods techniques- Visual: bright
facilitative or inhibitory?
Bright loud colors- awake/ contraction
facillitative
Roods techniques- Visual: soft
facilitative or inhibitory?
asleep/ relaxation
inhibitory
Roods techniques- 2 examples of Gustatory types
~sour
~sweet
Roods techniques- Gustatory sour
facilitative or inhibitory?
Sour, etc- wake up/ contraction
facillitative
Roods techniques- Gustatory sweet
facilitative or inhibitory?
Chocolate, etc- relaxation
inhibitory
Roods techniques- two examples of Olfactory types
~bleach
~nice smells
Roods techniques - olfactory types: bleach
facilitative or inhibitory?
Bleach, etc- wake up/ contraction
facillitative
Roods techniques- Olfactory: nice
facilitative or inhibitory?
Relaxing smells (coffee :) )
inhibitory
