Final - Stroke, Post Stroke Gait Flashcards by Alyssa H

Anterior cerebral artery CVA characteristics

-LE
-memory and behavioral impairments
-frontal lobe involvement
-probs w/ imitation, bimanual tasks, urinary incont, apraxia

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Mid cerebral artery CVA characteristics

-UE and face
-contralateral homonymous hemianopsia
-dominant side (aphasia)
-R side (perceptual probs; unilateral neglect, depth perception, agnosia, apraxia)

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What is homonymous hemianopsia

Visual field lost on B sides
R occipital lobe lesion

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Wernicke’s aphasia

-fluent, sensory, receptive aphasia
-lesion in temporal lobe
-auditory comprehension impaired

Can’t understand but can speak

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Broca’s aphasia

-expressive aphasia
-premotor area of L frontal lobe
-comprehension good
-speech is labored or lost

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Define apraxia

Inability to carry out learned sequential movements on command

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Define agnosia

Inability to recognize an object by sight, touch, or hearing

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What are 4 main characteristics of vertebrobasilar artery stroke

-catastrophic
-comatose
-quadriplegic
-poor prognosis

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What CN does the vertebrobasilar artery affect

CN V-XII

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Locked in syndrome characteristics

-rapid progression from hemiparesis to tetraplegia
-progression from dysarthria to anarthria
-pt can’t move or speak, but is AO

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Cause of lacunar syndrome

small vessel deep in cerebral WHITE matter

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What structures are involved in lacunar syndrome for pure motor

Post limb of internal capsule, pons and pyramids

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What structures are involved in pure sensory lacunar syndrome

Ventrolateral thalamus or thalamocortical projections

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What are the results of a cerebellar stroke

DECREASED
-coordination of voluntary movements
-gross and fine motor coordination
-postural control
-balance and equilibrium
-coordination of eye movements

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What are the results of a brain stem stroke

DECREASED
-alertness*
-ANS control
-arousal and sleep regulation
-swallowing
-balance and movements

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Symptoms of right CVA

L AFFECTED
-weakness/paralysis
-neglect, spatial perceptual probs
-poor judgment, impulsive
-short attention span, short term memory loss
-weak facial mus
-cognitive probs

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Symptoms of L CVA

R AFFECTED
-weakness/paralysis
-aphasia (wernike’s or broca’s)
-personality changes (cautious, compulsive, disorganized)
-difficulty with new info (decreased memory)

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How is spasticity assessed and graded

-resistance to passive jt
-Ashworth or Modified Ashworth

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What 4 outcome measures can be used to assess arm, hand, and/or finger fxn

-action research arm test
-box and block test
-nine hole peg
-wolf motor fxn test

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Describe UE flexion synergy

-scap retract, elevation, or hyper extension
-sh ABD, ER
-elbow flexion
-forearm sup
-wrist and finger flex

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Describe UE ext synergy

-scap protraction
-sh ADD, IR
-elbow ext
-forearm pro
-wrist and finger flexion

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Describe LE flexor synergy

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-hip flex, ABD, ER
-knee flex
-DF
-toe flex

Describe LE extension synergy

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-hip ext, ADD, IR
-knee ext
-PF, INV
-toe ext

What is stage 1 of Brunnstrom’s stages of recovery

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Flaccidity; no active limb movement

What is stage 2 of Brunnstrom’s stages of recovery

Beginning of minimal voluntary movement; increased tone

What is stage 3 of Brunnstrom’s stages of recovery*

-Voluntary control of movement synergy *spasticity at peak

What is stage 4 of Brunnstrom’s stages of recovery

*movement outside of synergy -decreased tone

What is stage 5 of Brunnstrom’s stages of recovery

-increased complex movement -greater limb independence

What is stage 6 of Brunnstrom’s stages of recovery

Individual jt movement, coordinated movement

What is stage 7 of Brunnstrom’s stages of recovery

Normal function

How to reduce common malalignments in supine

-affected UE: scap protracted, pillow under arm to keep every neutral -affected LE: hip fwd (pelvis protracted), pillow under knee to prevent hyperext

Reduce common malalignments SLying on more affected side

-affected UE: scap protracted, arm neutral in front -affected LE: hip extension and knee flexed, supported by pillows

Reduce common malalignments SLying on less affected side

-trunk: small pillow/towel placed under rib cage to elongate hemi side -UE: scap protracted, arm supported on pillow in front

Reduce common malalignments sitting

-UE: sh protracted and fwd, arm supported on pillow -LE: hips 90

What is another name for pusher syndrome

Contraversive pushing

Pusher syndrome characteristics

strong side PUSH towards the weaker side

Interventions for pusher syndrome

-PT sits on pt’s less involved side and instructs pt to lean towards them -pt’s less involved side next to a wall and instructed to lean towards the wall

2 clinical signs of a pusher

-spontaneous body tilting toward more affected side -ABD and ext of less affected extremities

What are 7 PT approaches for post stroke mgt

-tasks specific -CIMT -motor imagery and mental practice -mirror -TMS -strength and aerobic -treadmill/gait

Typical gait deviations - initial stance

-limit DF -lack knee flex (soleus contract, limited quad)

Typical gait deviations - mid stance

-decreased knee ext (decreased calf act) -knee hyperext (soleus contract) -lat pelvic shift -limit hip extension and DF

Typical gait deviations - preswing

Decreased knee flex and PF (weak calf)

Typical gait deviations - early and mid swing

-limit knee flex (stiff rec fem and decreased HS act)

Typical gait deviations - late swing

Limit knee ext and DF (stiff calf, decreased DF act)

What does treadmill training improve? What is the baseline speed for backward walking?

-gait speed, endurance, distance -less than or equal to 0.4m/s

What does fxnal e-stim do for gait?

-increase PF/DF mus recruitment -improve gait biomechanics and walking fxn

Advantages of biofeedback for gait

-increase quality and quantity of skilled reps -valuable for telehealth and home based step ex

What are the parameters for BWSTT?

-not exceed 30-40% BWS -at least 2 mph

Advantages of BWSTT

-decreased energy expenditure -task specific practice -decreased anxiety/fear of falling -walk faster -active problem solving

Disadvantages of BWSTT

-harness discomfort -false proximal stability -treadmill limitations -labor intensive for PT

Which artery is the most common for ischemic stroke?

Middle cerebral

What is ideomotor apraxia

Inability to execute gestures d/t deficits in action execution -difficulty executing motor command despite knowing what to do Ex. Unable to wave goodbye when asked, but can do it spontaneously

What is ideational apraxia

Difficulty planning and sequencing complex motor actions -difficult to understand concept of task Ex. Using toothbrush to comb hair instead of brushing teeth

Internal carotid artery stroke characteristics

-supplies MCS and ACA -if ACA also affected, LOC d/t massive lesion -warning signs: hx of transient ischemic attack, temporary fading of vision in ipsilateral eye

Final - Stroke, Post Stroke Gait Flashcards

(54 cards)