Mod 3: CVA Flashcards
2 main causes of stroke/CVA
ischemic (embolus or thrombus causes lack of oxygen)
hemorrhagic (artery bursts in brain)
3 areas of hemorrhagic stroke
intracerebral
subdural (venous)
subarachnoid (arterial & more severe)
atherosclerosis causes blood clot to form in cerebral arteries
cerebral thrombus
“mini stroke” & small clot with signs/symptoms that resolve quickly w/ no permanent residual neuro deficits
transient ischemic attack (TIA)
completed stroke vs. stroke in evolution
total neuro deficits at onset
vs
gradually progressing thrombus & neuro deficits delayed 1-2 days after onset
“gold standard” for Dx/imaging (2)
CT scan
MRI
F.A.S.T.
face (unilateral droop; numb/weak, HA)
arm (lagging movement; numb/weak)
speech (slurred, dysphagia)
Time (quick to ER)
purpose & timeline for tPA
-for which type stroke?
(tissue plaminogen activator)
clot-dissolving enzyme med
must be given within 3 hrs from onset
-for ischemic (not hemorrhagic*) stroke
anterior arterial blood supply to brain:
_____ branches into _____ & ______
internal carotid arteries
middle cerebral & anterior cerebral arteries (MCA & ACA)
posterior arterial blood supply to brain:
_____ becomes ______ & ______
vertebral arteries
basilar & posterior cerebral arteries (PCA)
arterial supply for collateral circulation that connects ACA & PCA
Circle of Willis
damage to ACA on ____ tract that causes _____ hemiplegia with sensory loss of ____ extremities more than _____ extremities
corticospinal tract
contralateral
LE > UE
damage to MCA causes ___ hemiplegia with sensory loss of ____ & ____ extremities more than ____ extremities
contralateral
face & UE more than LE
damage to ____ Artery causes contralateral hemiplegia, pain (thalamic sensory), Pushers syndrome (perception), involuntary movement & vision loss
Posterior Cerebral Artery (PCA)
damage to ___ Artery (combo of ___ & ____) results in death or mix of deficits of incomplete occlusion
Internal Carotid Artery (ICA)
anterior & middle
damage to ___ & ___ arteries causes mix of ipsilat/contralat signs, CN s/s of brainstem, paralysis of face, throat, trunk & limbs
vertebral & basilar arteries
(cerebellar involvement = ipsilat signs)
____ CVA lesion: quick/impulsive behavior, indifferent/denial mood, difficulty processing info visually, visual/spatial & body image problems; should encourage slowing down & safety
Right lesion
____ CVA lesion: slow/disorganized/frustrated behavior, anxious/aggressive/sad behavior, difficulty processing verbal info, idomotor & ideational apraxia; needs positive feedback
Left lesion
visual field cut- partial vision b/c part of retina not working
d/t MCA & PCA strokes
hemianopsia
type of pain syndrome d/t PCA lesion
-chronic w/ constant burning, intermittent sharp pain
-indirect cause of musculoskeletal pain ___
-contraindication: ____
thalamic sensory syndrome
shoulder subluxation
no traction*
mm tone initially is ____ then _____
-nature of reflexes when spasticity & synergies emerge: ____
weakness greater ____
flaccid then spastic
hyperreflexic
distal than proximal
UE flexion synergy of scapula: (2)
elevation & retraction
UE extensor synergy of scapula: (2)
depression & protraction
involuntary movement of a body part d/t intentional active/resistive movement of another body part
associated reaction
(Brunnstrom)
flexion of involved UE facilitates flexion of involved LE
homolateral synkinesis
Stage which spasticity is at it’s peak & voluntary movement possible in synergistic patterns
Stage 3
Stages which spasticity emerges ___ & spasticity declines ____
Stage 2
Stage 4
difficulty planning/initiating movements: __ CVA
Difficulty sustaining movements: ___ CVA
Left CVA
Right CVA
deficit in motor planning & completing a task though ROM, MMT & coordination may be intact
apraxia
Ideational vs. ideomotor apraxia
ideational: “No idea how to perform;” no proprio input available to formulate motor plan & sequence tasks
ideomotor: movement plan but can’t perform it
Types of Gait possible (5)
Trendelenburg (hip drop)
scissoring (spastic adductor)
Equinus (foot drop)
Ataxic
Circumducted (extension synergy)
receptive vs. expressive aphasia
-vs. global aphasia
can’t understand language (but speaks well)
can’t speak/express language (but understands well)
global: impairment of speech production & comprehension
when pt ignores stimuli on one side of body
-combo w/ anosognosia (dec. insight/awareness of one’s impairments)
unilateral neglect
neurogenic bladder
spastic vs. flaccid
spastic: mm spasm, incomplete emptying, holds less urine
flaccid: distended bladder mm, overfills and then accident
how to position on unaffected side
affected arm on pillow w/ protraction
affected leg forward w/ pillow support
*outside of synergies
how to position supine
pillow under affected butt/thigh to bring side forward (hip ext)
pillow under affected scap for protraction & elbow extension
how to position on affected side
head flexed, trunk rotated
shoulder protracted w/ arm 90* flexion & supination
sound leg flexed on pillow
*important position for elongation & inc. tactile awareness of that side
interventions for spastic tone reduction
cryotherapy (no heat*)
stretch/positon/splint
PNF techniques for mobility
WB & joint approx for stability
activate antagonist mm
**dec. UE flex synergy pattern (starting point)
interventions for mm facilitation (5)
quick stretch
resistance
joint traction for flexor pattern
joint approx for extensor pattern
tapping
UE interventions for shoulder subluxation & management
WB positions (POE, mod plantigrade)
Postural stabilization
reaching w/ uninvolved side
external rotation
stroke & push for joint approx w/ PROM
tapping to facilitate tricep (elbow ext)
PNF scap patterns in sidelying
2 main focuses of interventions for CVA pts
functional tasks (w/ symmetry & equal WB)
transitional movements (ex: side-sitting) w/ elbow/hand prop)
Principles for ambulation training
tactile feedback/cues
first- weight shifting focus w/ diagonal forward movement
facilitate arm swing for trunk rotation
assist/strengthen hip extension to prevent knee hyperext
add dual-tasking
weight shifts to weaker side d/t perceptual deficits from PCA CVA
-extends body & resists flexion
-avoids WB on strong side
ipsilateral pushing/ Pusher syndrome
principles for pusher syndrome interventions
encourage active movements to strong side
visual feedback- mirror
strong hand in pt’s lap to dec pushing
verbal & tactile feedback
reorient to midline
lean strong side to therapist or wall
intervention for ___ CVA:
use communication plan
assess level of understanding
give frequent feedback
don’t underestimate ability*
Left
intervention for ___ CVA:
use verbal cues (not demonstrated)
frequent feedback
focus on slow, controlled movement
prioritize safety
don’t overestimate ability*
Right
