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Neuromuscular System Evaluation and Management > Lecture CVA impairments > Flashcards

Lecture CVA impairments Flashcards

1
Q

brunnstom stages or recovery (7)*** (whether spasticity is increasing, decreasing, synergy patterns)

A
  • Stage 1: Flaccidity, no movement
  • Stage 2: Minimal voluntary movement, associated reactions; spasticity begins to develop
  • Stage 3: Voluntary control of movement synergies; spasticity peaks in severity!
  • Stage 4: Mastery of some movement combo outside of the synergies; spasticity begins to decline
  • Stage 5: Difficult movement combo are learned; synergies lose their dominance
  • Stage 6: Spasticity disappears, isolated joint movement & coordination achieved
  • Stage 7: Normal movement
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2
Q

Flexion Synergy (UE)

I remember it as flexing my biceps
Strongest component in *

A 
Scapular retraction/elevation
Shoulder abduction/ER
Elbow flexion*
Forearm supination
Wrist/finger flexion
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3
Q

Flexion Synergy (LE)

I remember it as about to stomp on a bug 45 degrees from me
Strongest component in *

A

Hip Flexion*/abd/ER
Knee flexion
Ankle DF/IV
Toe DF

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4
Q

Extension Synergy (UE)

Strongest component in *

A 
Scapular protraction
Shoulder adduction*/IR
Elbow extension
Forearm pronation*
Wrist/finger flexion
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5
Q

Extension synergy (LE)

I remember it as doing a ballet backward kick
Strongest component in *

A

Hip extension, adduction, IR
Knee extension
Ankle PF*/IV
Toe PF

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6
Q

Typical “Hemi Arm Posture”***

A 
Combination of flexion and extension patterns
• Shoulder ADD (Extension)
• Elbow flexion (Flexion)
• Forearm pronation (Extension)
• Wrist flexion (Flexion)
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7
Q

Typical “Hemi Leg Posture”***

A

Combination of flexion and extension patterns
• Hip flexion and adduction
• Knee extension
• Ankle plantarflexion

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8
Q

Typical Right Sided CVA deficits based on hemisphere

A 
less aware of deficits
left sided neglect
agnosia
visual spatial disorders
poor judgement 
fluctuations in performance
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9
Q

Typical Left Sided CVA deficits based on hemisphere

A 
Aphasia
no neglect
difficulty with verbal commands
slow and cautious 
aware of impairments
disorganised problem solving
apraxia
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10
Q

Spasticity

Lack of inhibition from higher levels causes:

A
  • An increase in stretch reflexes (especially in the antigravity muscles)
  • Exaggerated flexor muscle response following noxious stimuli
  • Flexor vs. Extensor spasticity
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11
Q

Spasticity

Symptoms

A

Hyperreflexia
Clonus
Spasms
Pain

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12
Q

Contractures: What is it

A

Shortening of Muscles, Tendons, Ligaments, Joint Capsule

Leads to restriction in ROM

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13
Q

Contractures: Secondary to:

A

Lack of muscle opposition

Hypertonicity

Lack of normal positioning

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14
Q

Bowel and Bladder Incontinence: What is more common than incontinence

A

Constipation and impaction more common than incontinence

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15
Q

Bowel and Bladder Incontinence

Assessment:

A
  • Assess for dysuria
  • Consider Foley catheter
  • AVOID BACKWASHING
  • Do not lift bag above level of bladder
  • Bowel and bladder management and training
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16
Q

72% of individuals with stroke experience…. and it leads to….

A

shoulder pain

Leads to:

  • Adhesive capsulitis
  • Traction/compression neuropathy
  • CRPS -complex regional pain syndrome
  • Bursitis/tendonitis
  • Rotator cuff tear
  • HO
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17
Q

Aerobic Capacity

A
  • Twice the O2 consumption/uptake seen in walking
  • CAD comorbidity may by biggest factor in debility and reduced activity
    tolerance
  • Inverse association between aerobic fitness and stroke mortality regardless of
    other factors
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18
Q

Borg RPE
Very light
Hard
Very Hard

A

Exertion Scale
9
15
17

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19
Q

Cognition and arousal to determine

A

pt.’s present capabilities, ability to
contribute to POC, consents etc.
- Memory Deficits
- Attention Deficits

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20
Q

Dysarthria

Impairment of _____* secondary to ______

A

Impairment of speech production 2° damage to the CNS or PNS,

causing oral motor weakness, paralysis, or incoordination of the motor-speech system.

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21
Q

Dysarthria
Deficits in….
Lesions affecting CN… (2)
Caused by…

A
  • Deficits in swallowing
  • Lesions affecting CN IX (Glossopharyngeal N.) & CN X (Vagus N.)
  • Causes:
    Delayed triggering of swallow reflex
    Decreased pharyngeal peristalsis
    Decreased lingual control
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22
Q

Incoordination

Result of:

A
  • Cerebellar or BG involvement
  • Proprioceptive losses
  • Motor weakness
  • Ataxia, esp. with cerebellar disorders
  • Impaired stretch reflex response that normally allows automatic adaptation of
    mm. to postural/movement changes
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23
Q

Emotional lability:*

A

unstable or changeable emotional state,

characterized by a pathological rapid change from laughing to weeping with only slight provocation.

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24
Q

(R) CVA:
Difficulty with…
Described as…
Major Issue…

A
  • Difficulty grasping the whole idea or the overall organization
    of a pattern or activity
  • Described as: indifferent, quick, impulsive, euphoric, pt. overestimates their
    ability while minimizing their problems.
  • Major Issue: SAFETY!!
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25
Q

(L) CVA:
Difficulty with…
Described as…

A
  • difficulty with processing info in sequential/linear manner
  • Described as: slower, negative, cautious, uncertain, depressed, anxious
26
Q

Somatagnosia:
What is it?
Difficulty performing …
Lesion located at…

A

Somatagnosia: lack of awareness of the body structure & the relationship of body parts in oneself or in others.

Difficulty performing transfers; following directions re: arm position

Lesion: Dominant parietal lobe, or posterior temporal lobe

27
Q 
Unilateral Neglect (spatial neglect):
What is it?
Types: (2)
Typically affects where in the body?
Lesion located at...
A

Unilateral Neglect (spatial neglect): inability to register and to integrate stimuli & perceptions from one side of the body & the environment.

Types: Personal, peri-personal, & extrapersonal

Typically affects the left side of the body; sensory loss compounds the problem.

Lesion: non-dominant parieto-occipital area

28
Q

Right-left discrimination:
What is it?
Lesion located at…

A

inability to identify the R or L side of one’s
own body or the examiner.
Lesion: parietal lobe of either hemisphere

29
Q

Finger Agnosia:
What is it?
Lesion located at…

A

inability to identify the fingers of one’s own hand;
correlates highly with poor dexterity
Lesion: parietal lobe of either hemisphere

30
Q

Anosognosia:
What is it?
Lesion located at…

A

severe condition including denial, neglect and lack of awareness of the presence or severity of one’ s paralysis.
Lesion: non-dominant parietal lobe

31
Q

Figure -ground discrimination:
What is it?
Lesion located at…

A

inability to visually distinguish a figure
from the background in which it is embedded.
Lesion: non-dominant parietal lobe

32
Q

Form Consistency:
What is it?
Lesion located at…

A

inability to perceive or to attend to subtle
differences in form and shape.
Lesion: non-dominant parieto-temporo-occipital region

33
Q

Spatial Relations Deficit:
What is it?
Lesion located at…

A

inability to perceive the relationship of one
object in space to another object, or to oneself. Difficulty crossing midline. i.e. drawing a clock, setting a table
Lesion: non-dominant parietal lobe

34
Q

Position in space:
What is it?
Lesion located at…

A

inability to perceive and to interpret spatial
concepts such as up, down, under, over, in, out, etc.
Lesion: non-dominant parietal lobe

35
Q

Spatial Memory Deficit:
What is it?
Lesion located at

A

impaired memory of location of
objects/places (ie. Furniture in home)
Lesion: non-dominant parietal lobe

36
Q

Topographical Disorientation:
What is it?
Lesion located at…

A

difficulty in understanding &
remembering the relationship of one location to another, unable to trace path/route
Lesion: non-dominant occipito-parietal lobe

37
Q

Depth and Distance Perception:
What is it?
Lesion located at…

A

inaccurate judgment of direction,
distance and depth.
Lesion: non-dominant occipital lobe

38
Q

Vertical Disorientation:
What is it?
Lesion located at…

A

distorted perception of what is vertical; causes
imbalance & distorted midline orientation
Lesion: non-dominant parietal lobe

39
Q

Agnosia: What is it?

A

Agnosia
Inability to recognize familiar objects using one or more of the sensory
modalities, while often retaining the ability to recognize the same
object using other sensory modalities.

40
Q

Three types of Agnosias and where the lesions are

A

Visual Agnosia: Lesion in occipito-temporo-parietal lobes of either
hemisphere
Auditory Agnosia: Lesion in dominant temporal lobe
Tactile Agnosia: Lesion in occipito-temporo-parietal lobes of either
hemisphere

41
Q

Visual agnosias:

Visual Object Agnosia

A

inability to recognize & name common objects

brush, key, comb

42
Q

Visual agnosias:

Simultanagnosia

A

inability to perceive the whole or the “big picture”,
only sees 1 element of an object at a time
decreased visual span - tubular vision

43
Q

Visual agnosias:

Prosopagnosia

A

facial agnosia, inability to recognize familiar faces

44
Q

Visual agnosias:

Color Agnosia

A

difficulty recognizing names of colors

45
Q 
Apraxia:
What is it?
Where it is seen in the brain?
Often accompanied by?
Lesion located at...
A

Disorder of voluntary learned movement; inability to perform purposeful movements.
Seen in L hemisphere lesions more than R; often accompanied by aphasia
Lesion: Premotor frontal cortex of either hemisphere, Left inferior
parietal lobe, corpus callosum

46
Q

Types of Apraxia:

Ideomotor

A

Breakdown between concept & performance; movement is clumsy/slow
i.e. Ask a pt to brush his/her hair
(Can’t do on command)

47
Q

Oral Apraxia

A

subtype of ideomotor apraxia in which buccofacial muscles cannot produce purposeful movement.

48
Q

Types of Apraxia:

Ideational

A

Failure in the conceptualization of the task; incorrect tool
use
ie. Present pt with a toothbrush & toothpaste 🡪 “mouthing”
toothpaste

49
Q

Apraxia

-Like syndromes (2)

A

Not true apraxias; more associated with R hemisphere lesions
Includes:
Constructional Apraxia
Dressing Apraxia

50
Q

Constructional Apraxia:

A

Difficulty in recognizing parts to a whole
secondary to faulty spatial analysis & conceptualization of the task.
ie. Assembling a sandwich

51
Q

Dressing Apraxia:

A

inability to dress oneself properly owing to a

disorder in body scheme or spatial relations.

52
Q

Secondary Impairments
Psychological Problems:
more severe w/
includes…

A

more severe w/ (L) CVA
Frustration, anxiety, depression or denial.
Cognitive deficits influence behavior; pt irritable, inflexible, hypercritical, impatient, impulsive

53
Q

Secondary Impairments

Decreased ROM/contractures/deformity

A

↓ flexibility, disuse atrophy, edema, pain

UE contractures: elbow, wrist, finger flexors & supinators/pronators

LE contractures: PF/IV; depends on dominant synergy

Alters alignment: ↑ energy expenditure & altered patterns of movement

54
Q

Secondary Impairments
DVT/PE:
diagnosed by
Treated with

A

diagnosed by ultrasound

Treated with anticoagulants and antiplatelet agents

55
Q

Secondary Impairments

Pain: Causes

A 
Mm. imbalances
Improper movement patterns
Musculoskeletal strain
Poor alignment
Thalamic Syndrome: initial sensory loss on contralateral side, changes to
severe burning pain.
56
Q

Secondary Impairments

Shoulder subluxation: due to

A 
paresis, loss of
muscular tone &
proprioception;
Ligaments and
capsule act as
supporting structure
57
Q

Secondary Impairments

CRPS:***

A

swelling and tenderness of the fingers, hand and shoulder
Sympathetic vasomotor changes: warm, red, glossy skin, trophic changes of fingernails
Later stages: contraction of hand in “intrinsic minus” position

58
Q

Secondary Impairments

Deconditioning:

A

stroke as a result of cardiac disease requires diligent monitoring
Poor activity tolerance 2° cardiorespiratory system & musculoskeletal system
↓ CO, cardiac compensation and serious rhythm disorders

59
Q

Sensory Assessment CVA Considerations
Superficial Sensation:
Deep Sensation:

A 
Superficial Sensation: Light Touch
Test intact before impaired
Body part rather than dermatome
Deep Sensation: Proprioception and Kinesthesia
Test intact side first
60
Q

Motor Assessment

A 
- Minimize position
changes.
Complete all
testing possible in
each position
- Initiate strength
tests at level 3/5
- May document
Motor Control
description vs.
MMT (or both)

Neuromuscular System Evaluation and Management (21 decks)

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