Exam 3- Stroke part 1 Flashcards
1
Q
A stroke usually ___ but can ___
A
~usually appears suddenly
~can appear slowly
2
Q
Some of the slow appearing strokes (2)
A
- ~TIAs,
- pin stroke,
- mini strokes
- ~hemorrhagic
3
Q
2 main types of strokes
A
Ischemic/ Occlusive and Hemorrhagic
4
Q
what is the most common type of stroke and by how much?
A
80% of strokes are occlusive
5
Q
Hemorrhagic- some details (2 things associated with it)
A
~High blood pressure
~Associated with headaches
6
Q
Hemorrhagic- Common types (5)
A
- ~berry aneurism
- ~AVM (arteriosus venous malformation)
- intracerebral hemorrhage
- cerebral hemorrhage
- subarachnoid hemorrhage
7
Q
Hemorrhagic- what is berry aneurism?
A
an out pouching of the circle of willis
8
Q
Hemorrhagic- what is AVM? (stands for and what it is)
A
abnormal connection of the artery and vein
(AVM = arteriovenous malformation)
9
Q
Hemorrhagic- 3 courses for an aneurism
A
- 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
10
Q
2 ways to fix an aneurism
A
Clip and coil
11
Q
Clip for an aneurism: when can it be used and how invasive is it?
A
- ~can be used for an aneurism that has or has not burst
- ~Need a craniotomy
12
Q
Coil for an aneurism:
when can it be used?
what does it do?
and how invasive is it?
A
- ~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
13
Q
Hemorrhagic- how does it injure the brain? (5)
A
- ~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
14
Q
Hemorrhagic- four typical characteristics of pt in PT
A
- ~wide spread injury/problems
- ~will be hard to decide where their symptoms came from
- ~will be younger
- ~rarely will fully recover
15
Q
Occlusive- 2 types
A
~thrombolytic
~embolytic
16
Q
Occlusive- what is Thrombolytic
A
Build up of plaque, etc that will cause a blockage in the artery
17
Q
Occlusive- what is Embolytic?
A
Blood/plaque/ air/ fat/cancer breaks off and moves (and plugs the artery)
18
Q
Occlusive- Embolytic- blood clot, three characteristics of emergency treatment
A
- 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
19
Q
Occlusive- Embolytic- fat bock: what is a common source?
A
can caused post surgery
20
Q
TIA
what does it stand for?
what defines it?
A
Transient ischemic attack
defined by: symptoms resolve within 24 hours
21
Q
Six characteristics of a Major stroke
A
- ~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
22
Q
Three characteristics of a minor stroke
A
- ~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
23
Q
What is a shower stroke?
what is a common cause?
(3 points)
A
- ~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
24
Q
some Diagnosis Tests to test for possible stroke (3)
A
- ~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
25
12 risk factors for stroke
1. ~Birth control
2. ~smoke
3. ~high blood pressure
4. ~diabetes
5. ~high cholesterol
6. ~sedentary
7. ~history of CVA
8. ~A-fib
9. ~age
10. ~postmenopausal
11. ~drinker
12. ~African American
26
anterior cerebral artery syndrome- symptoms (7)
1. ~Contralateral issues
2. ~LE more than UE- hemiparesis and hemisensory loss
3. ~More apraxia (inability to perform a task)
4. ~Problems with imitation and bimanual tasks
5. ~Slowness, delay, lack of spontaneity, motor inaction
6. ~High risk of Incontinence issues
7. ~Higher risk of skin break down
27
middle cerebral artery syndrome- symptoms (8)
1. ~80% have MCA
2. ~80% of MCA have occlusive
3. ~UE worse than LE- hemiparesis and hemisensory loss
4. ~Aphasia (problems with speak)- motor speech impairment
5. ~Perception deficits
6. ~Limb-kinetic apraxia
7. ~Homonymous hemianopia (be able to draw this);
8. Unilateral neglect (think of Bob)
28
posterior cerebral artery syndrome- symptoms (3)
1. ~Visual issues
* \*homonymous hemianopsia
* \*can be bilateral homonymous hemianopsia with some degree of macular sparing
* \*visual agnosia
* \*prosopagnosia
2. ~Cerebellar issues- balance and coordination
3. ~Memory defect
29
locked in syndrome is the same as \_\_\_\_\_\_\_, and two characteristics
Vertebrobasilar stroke
1. ~They can feel and hear everything
2. ~They can understand
30
Stroke on the Right- symptoms (10)
1. ~Visual problems
2. ~Unilateral defect
3. ~Impulsive
4. ~Poor judgment
5. ~Quick with movements
6. ~Unaware of impairments
7. ~Rigid in their thoughts (stubborn)
8. ~Emotional with negative emotions (and expressing them) and get upset with constructive criticism
9. ~Have problem with time;
10. trouble with spatial awareness
31
Stroke on the Left- symptoms (7)
1. ~Right motor issues
2. ~Speak issues (know problems with W and B; Express and receptive)
3. ~Local aphasia
4. ~Disorganized
5. ~Slow and cautious;
6. overly aware of their impairments
* ~They think they are doing horrible/ afraid/ etc;
* have to talk them into doing something
7. ~Have some processing delays
32
bilateral hemipshere stroke symptoms (5 major)
1. ~Visual- homonymous hemianopsia
2. ~Lability- unstable personality (person can be crying and they don’t have a reason to)
3. Affective:
* ~Apathy,
* irritable,
* anxiety,
* depression
4. Cognitive
* ~Confusion,
* short attention span,
* loss of memory
5. ~Inability to preform executive functions
33
When people are recovering from a stroke, they will often ask...
When am I going to get better?
34
Recovering from a stroke: what are some things that are going on that are helping (4)
1. Blood flow
* ~Angiogenesis,
* collateral blood flow helps with recovery
* ~Thinning the blood,
2. keeping the inflammatory response down
3. ~Pts are going to sleep a lot!
4. ~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
35
Recovering from a stroke: what is something that will help if they are flaccid?
why?
what should you be careful of?
1. ~go into weight bearing to cause compression in jts
2. ~will get them to have muscle firing
3. ~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
36
Roods techniques- types (10)
when performed they can be ______ or \_\_\_\_\_\_\_\_.
\*\*\*Can be facilitative or inhibitory
1. ~Stretch
2. ~Jt manipulation
3. ~Cutaneous touch
4. ~Ice
5. ~Heat
6. ~Vestibular
7. ~Auditory
8. ~Visual
9. ~Gustatory
10. ~Olfactory
37
Roods techniques- Facilitative
* ~To increase the threshold- excitatory inputs
* ~produces contraction
38
Roods techniques- Inhibitory
~To decrease the threshold ~relaxation
39
Roods techniques- 3 type of Stretch techniques
1. ~quick
2. ~repetitive
* ~CMP (continuous passive motion)
3. ~Prolonged
40
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
41
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
42
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)
43
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
44
Roods techniques- three Jt manipulation types
1. ~traction
2. ~low grade manipulations
3. ~approxiations
45
Roods techniques- Jt manipulation Traction
what is it/how does it work?
facillitaive or inhibitory?
creates space and relaxes muscles
inhibitory
46
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
47
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
48
Roods techniques- Cutaneous touch types (2)
1. ~Quick touch
2. ~Maintain touch
49
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
50
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
51
Roods techniques- 2 Ice types
~quick strokes
~prolonged
52
Roods techniques- Ice quick
what is it/how does it work?
facilitative or inhibitory?
quick cutanious strokes causes contraction
facilitative
53
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
54
Roods techniques- Heat
what is it/how does it work?
facilitative or inhibitory?
heat Relaxes them
inhibitory (never used to provoke muscles)
55
Roods techniques- 3 Vestibular types
1. ~rocking
2. ~spinning
3. ~bouncing on the ball
56
Roods techniques- Vestibular: rocking
facilitative or inhibitory?
inhibitory (relaxes us)
57
Roods techniques- Vestibular: spinning
facilitative or inhibitory?
causes contractions
facilitative
58
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
59
Roods techniques- 2 Auditory types
~loud
~soft
60
Roods techniques- Auditory loud
facilitative or inhibitory?
facilitative / contractions
61
Roods techniques - auditory: soft
facilitative or inhibitory?
relaxes (inhibitory)
62
Roods techniques- 2 Visual types
~bright
~soft
63
Roods techniques- Visual: bright
facilitative or inhibitory?
Bright loud colors- awake/ contraction
facillitative
64
Roods techniques- Visual: soft
facilitative or inhibitory?
asleep/ relaxation
inhibitory
65
Roods techniques- 2 examples of Gustatory types
~sour
~sweet
66
Roods techniques- Gustatory sour
facilitative or inhibitory?
Sour, etc- wake up/ contraction
facillitative
67
Roods techniques- Gustatory sweet
facilitative or inhibitory?
Chocolate, etc- relaxation
inhibitory
68
Roods techniques- two examples of Olfactory types
~bleach
~nice smells
69
Roods techniques - olfactory types: bleach
facilitative or inhibitory?
Bleach, etc- wake up/ contraction
facillitative
70
Roods techniques- Olfactory: nice
facilitative or inhibitory?
Relaxing smells (coffee :) )
inhibitory
