Final - Stroke, Post Stroke Gait Flashcards
Anterior cerebral artery CVA characteristics
-LE
-memory and behavioral impairments
-frontal lobe involvement
-probs w/ imitation, bimanual tasks, urinary incont, apraxia
Mid cerebral artery CVA characteristics
-UE and face
-contralateral homonymous hemianopsia
-dominant side (aphasia)
-R side (perceptual probs; unilateral neglect, depth perception, agnosia, apraxia)
What is homonymous hemianopsia
Visual field lost on B sides
R occipital lobe lesion
Wernicke’s aphasia
-fluent, sensory, receptive aphasia
-lesion in temporal lobe
-auditory comprehension impaired
Can’t understand but can speak
Broca’s aphasia
-expressive aphasia
-premotor area of L frontal lobe
-comprehension good
-speech is labored or lost
Define apraxia
Inability to carry out learned sequential movements on command
Define agnosia
Inability to recognize an object by sight, touch, or hearing
What are 4 main characteristics of vertebrobasilar artery stroke
-catastrophic
-comatose
-quadriplegic
-poor prognosis
What CN does the vertebrobasilar artery affect
CN V-XII
Locked in syndrome characteristics
-rapid progression from hemiparesis to tetraplegia
-progression from dysarthria to anarthria
-pt can’t move or speak, but is AO
Cause of lacunar syndrome
small vessel deep in cerebral WHITE matter
What structures are involved in lacunar syndrome for pure motor
Post limb of internal capsule, pons and pyramids
What structures are involved in pure sensory lacunar syndrome
Ventrolateral thalamus or thalamocortical projections
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
What are the results of a brain stem stroke
DECREASED
-alertness*
-ANS control
-arousal and sleep regulation
-swallowing
-balance and movements
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
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)
How is spasticity assessed and graded
-resistance to passive jt
-Ashworth or Modified Ashworth
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
Describe UE flexion synergy
-scap retract, elevation, or hyper extension
-sh ABD, ER
-elbow flexion
-forearm sup
-wrist and finger flex
Describe UE ext synergy
-scap protraction
-sh ADD, IR
-elbow ext
-forearm pro
-wrist and finger flexion
Describe LE flexor synergy
-hip flex, ABD, ER
-knee flex
-DF
-toe flex
Describe LE extension synergy
-hip ext, ADD, IR
-knee ext
-PF, INV
-toe ext
What is stage 1 of Brunnstrom’s stages of recovery
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
