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PT9122 - Rehab > Lecture 4 - Stroke Aphasia (common problems with stroke) > Flashcards

Lecture 4 - Stroke Aphasia (common problems with stroke) Flashcards

1
Q

What domains of cognitive function is most likely to be impaired post-stroke

A
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2
Q

Where can I find information about a patient’s cognitive status?

A
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3
Q

Describe a vascular cognitive impairment (VCI)

A

Its a condition where damage to blood vessels in the brain leads to injury of brain tissue resulting in changes of thinking and memory (could result in mild to full blown vascular dementia). VCI can be caused by stroked, tiny clots that block small blood vessels in brain, bleeding from small blood vessels in brain, or blood vessel wall disease resulting in lack of oxygen and damage to brain cells. Risk factors for VCI are heart failure, diabetes, and HTN.

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4
Q

Describe cerebrovascular injury

A

Can be varied presentation, with varied lesions (cortical or subcortical, small-vessel disease with white mater lesion, lacunar infarcts or brain hemorrhage), varied causes (stroke, heart failure, HTN, atrial fb, cardiac arrest, diabetes, renal failure) and can occur in isolation or unmask/accelerate neurodegenerative processes

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5
Q

What does diagnosis and assessment look like for VCI

A
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6
Q

What is the relationship between cognitive impairment and rehab outcomes

A

Higher cognitive status on admission to rehab = better functional outcomes at discharge, but that doesnt mean people with lower status still shouldnt try and get rehab to have better outcomes

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7
Q

Is depression and decreased energy common after a stroke

A

Yes (25-60%)

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8
Q

What are 3 explanations for depression following a stroke

A
  1. Its a normal response to change in health status and disability (dysphagia (inability/difficulty to swallow increases risk of depression)
  2. Location of the lesion (eg. left frontal hemisphere)
  3. Psychological contributions post-stroke (eg. living alone, dependence in activity > 3 months, few social contacts > 1 year post-stroke)
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9
Q

Describe pseudobulbar affect

A

Emotional outbursts of uncontrolled or exaggerated laughing, crying, or anger that are inconsistent with mood or the situation and can quickly change from one extreme to the other that is caused by potential lesions in frontal lobe and cortico-ponto-cerebellar circuitry. It is associated with Alzheimer’s, stroke, ALS, MS< ABI and treatment includes antidepressants or dextromethorphan hydrobromide

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10
Q

Pseudobulbar affect vs depression

A
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11
Q

Right hemisphere vs left hemisphere in terms of emotional & behavioral effects

A
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12
Q

What are some assessment tools for mood

A
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13
Q

Primary Somatosensory Cortex

A

Receives info from tactile and proprioceptive receptors via DCML and also receives pain and temperature info. Has contralateral representation and has a homunculus (amount of cortex devoted to body part is not proportional to absolute size of that body surface)

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14
Q

Primary Auditory Cortex

A

Receives info from cochlea to both ears through thalamus and provides conscious awareness of the intensity of sounds

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15
Q

Primary Vestibular Cortex

A

Receives info about head movements and head position relative to gravity

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16
Q

Primary Visual cortex

A

Vision

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17
Q

Secondary sensory areas

A

Analyze sensory input from both thalamus and primary sensory cortex

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18
Q

What are the 3 secondary sensory areas

A
19
Q

Name the 2 ascending long tracts and what sensations they perceive

A
20
Q

Spinothalamic Tract Pathway

A
21
Q

DCML Pathway

A
22
Q

What are 3 methods to test the integrity of DCML following a lesion

A

NOTE ON ROMBERG: Stand feet close together and ask to close eyes, if loss of balance = positive

23
Q

Describe perception deficits after stroke

A

Ability to correctly interpret sensations from the body or stimuli from the environment. Patients with impaired sensation wont always have cognitive/perceptual problems.

NOTE: Difference between cortical lesions and thalamus impact on perception deficits (in image)

24
Q

Name some examples of sensory and visual perception deficits

A
25
Q

Cognitive and perceptual deficits need to be distinguished from:

A
26
Q

Describe unilateral spatial neglect

A

A failure to report, respond or orient to sensory stimuli presented on contralateral side of stroke lesion that is not due to a lack of sensation (primarily right hemisphere/right-sided strokes -> left sided neglect). That could be trimodal (auditory, visual and tactile) that could be caused by inability to integrate all sensory info and inability to direct attention/orient to stimulus.

27
Q

Why is left sided neglect more common

A
28
Q

How to perform mirror therapy for unilateral spatial neglect

A
29
Q

Apraxia

A

Disorder of motor planning (inability to execute previously learned purposeful movements)

30
Q

What are 2 types of limb apraxia

A
31
Q

Anosognosia

A

No knowledge of their illness/disease (form of neglect) and is associated with severe hemiplegia (usually right-sided stroke in parietal lobes) so they dont realize that anything is wrong or that they need help

32
Q

Agnosia

A
33
Q

Describe central post-stroke pain

A

Associated with thalamic lesions where the site and size of pain varies (usually burning) and the onset of pain can be anywhere from immediatley to 3 years after stroke. Treatment includes antidepressants, anti-epileptics, TENS, joint contracture prevention, psychological support

34
Q

Dysphagia

A

Difficulty swallowing and is very common and could result in malnutrition, or aspiration. Signs include choking on food, coughing during meals, drooling/loss of food from mouth, pocketing of food in cheeks, slow effortful eating, difficulty swallowing pills

35
Q

What are consequences of aspiration

A
36
Q

Wernicke’s Area

A

Comprehension of language

37
Q

Broca’s Area

A

Language output

38
Q

Pathway of communication

A
39
Q

What do contralateral areas corresponding to Wernicke’s and Broca’s area in the right hemisphere do (left side)

A
40
Q

Aphasias

A

Acquired communication disorders caused brain damage. Left hemisphere is dominant for language ).

41
Q

What stroke is most common with language disorders

A

Left hemispheric middle cerebral artery strokes

42
Q

Fluent aphasia (Wernicke’s/sensory/receptive aphasia)

A

Lesion is in auditory association cortex in left lateral temporal lobe where speech flows smoothly (motor function ok) but auditory comprehension of speech is impaired (difficulty understanding spoken language, following commands and reading written words)

43
Q

Non-fluent aphasia (Broca’s/expressive aphasia)

A

Lesion in left premotor cortex where flow of speech is slow and hesitant (vocab limited) and speech production is labored or lost completely but comprehension is retained

PT9122 - Rehab (16 decks)

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