Mod 3: CVA

Question 1

2 main causes of stroke/CVA

Answer 1

ischemic (embolus or thrombus causes lack of oxygen)
hemorrhagic (artery bursts in brain)

Question 2

3 areas of hemorrhagic stroke

Answer 2

intracerebral
subdural (venous)
subarachnoid (arterial & more severe)

Question 3

atherosclerosis causes blood clot to form in cerebral arteries

Answer 3

cerebral thrombus

Question 4

“mini stroke” & small clot with signs/symptoms that resolve quickly w/ no permanent residual neuro deficits

Answer 4

transient ischemic attack (TIA)

Question 5

completed stroke vs. stroke in evolution

Answer 5

total neuro deficits at onset
vs
gradually progressing thrombus & neuro deficits delayed 1-2 days after onset

Question 6

“gold standard” for Dx/imaging (2)

Answer 6

CT scan
MRI

Question 7

F.A.S.T.

Answer 7

face (unilateral droop; numb/weak, HA)
arm (lagging movement; numb/weak)
speech (slurred, dysphagia)
Time (quick to ER)

Question 8

purpose & timeline for tPA
-for which type stroke?

Answer 8

(tissue plaminogen activator)
clot-dissolving enzyme med
must be given within 3 hrs from onset
-for ischemic (not hemorrhagic*) stroke

Question 9

anterior arterial blood supply to brain:
_____ branches into _____ & ______

Answer 9

internal carotid arteries
middle cerebral & anterior cerebral arteries (MCA & ACA)

Question 10

posterior arterial blood supply to brain:
_____ becomes ______ & ______

Answer 10

vertebral arteries
basilar & posterior cerebral arteries (PCA)

Question 11

arterial supply for collateral circulation that connects ACA & PCA

Answer 11

Circle of Willis

Question 12

damage to ACA on ____ tract that causes _____ hemiplegia with sensory loss of ____ extremities more than _____ extremities

Answer 12

corticospinal tract
contralateral
LE > UE

Question 13

damage to MCA causes ___ hemiplegia with sensory loss of ____ & ____ extremities more than ____ extremities

Answer 13

contralateral
face & UE more than LE

Question 14

damage to ____ Artery causes contralateral hemiplegia, pain (thalamic sensory), Pushers syndrome (perception), involuntary movement & vision loss

Answer 14

Posterior Cerebral Artery (PCA)

Question 15

damage to ___ Artery (combo of ___ & ____) results in death or mix of deficits of incomplete occlusion

Answer 15

Internal Carotid Artery (ICA)
anterior & middle

Question 16

damage to ___ & ___ arteries causes mix of ipsilat/contralat signs, CN s/s of brainstem, paralysis of face, throat, trunk & limbs

Answer 16

vertebral & basilar arteries
(cerebellar involvement = ipsilat signs)

Question 17

____ CVA lesion: quick/impulsive behavior, indifferent/denial mood, difficulty processing info visually, visual/spatial & body image problems; should encourage slowing down & safety

Answer 17

Right lesion

Question 18

____ CVA lesion: slow/disorganized/frustrated behavior, anxious/aggressive/sad behavior, difficulty processing verbal info, idomotor & ideational apraxia; needs positive feedback

Answer 18

Left lesion

Question 19

visual field cut- partial vision b/c part of retina not working
d/t MCA & PCA strokes

Answer 19

hemianopsia

Question 20

type of pain syndrome d/t PCA lesion
-chronic w/ constant burning, intermittent sharp pain
-indirect cause of musculoskeletal pain ___
-contraindication: ____

Answer 20

thalamic sensory syndrome
shoulder subluxation
no traction*

Question 21

mm tone initially is ____ then _____
-nature of reflexes when spasticity & synergies emerge: ____
weakness greater ____

Answer 21

flaccid then spastic
hyperreflexic
distal than proximal

Question 22

UE flexion synergy of scapula: (2)

Answer 22

elevation & retraction

Question 23

UE extensor synergy of scapula: (2)

Answer 23

depression & protraction

Question 24

involuntary movement of a body part d/t intentional active/resistive movement of another body part

Answer 24

associated reaction
(Brunnstrom)

Question 25

flexion of involved UE facilitates flexion of involved LE

Answer 25

homolateral synkinesis

Question 26

Stage which spasticity is at it's peak & voluntary movement possible in synergistic patterns

Answer 26

Stage 3

Question 27

Stages which spasticity emerges ___ & spasticity declines ____

Answer 27

Stage 2 Stage 4

Question 28

difficulty planning/initiating movements: __ CVA Difficulty sustaining movements: ___ CVA

Answer 28

Left CVA Right CVA

Question 29

deficit in motor planning & completing a task though ROM, MMT & coordination may be intact

Answer 29

apraxia

Question 30

Ideational vs. ideomotor apraxia

Answer 30

ideational: "No idea how to perform;" no proprio input available to formulate motor plan & sequence tasks ideomotor: movement plan but can't perform it

Question 31

Types of Gait possible (5)

Answer 31

Trendelenburg (hip drop) scissoring (spastic adductor) Equinus (foot drop) Ataxic Circumducted (extension synergy)

Question 32

receptive vs. expressive aphasia -vs. global aphasia

Answer 32

can't understand language (but speaks well) can't speak/express language (but understands well) global: impairment of speech production & comprehension

Question 33

when pt ignores stimuli on one side of body -combo w/ anosognosia (dec. insight/awareness of one's impairments)

Answer 33

unilateral neglect

Question 34

neurogenic bladder spastic vs. flaccid

Answer 34

spastic: mm spasm, incomplete emptying, holds less urine flaccid: distended bladder mm, overfills and then accident

Question 35

how to position on unaffected side

Answer 35

affected arm on pillow w/ protraction affected leg forward w/ pillow support *outside of synergies

Question 36

how to position supine

Answer 36

pillow under affected butt/thigh to bring side forward (hip ext) pillow under affected scap for protraction & elbow extension

Question 37

how to position on affected side

Answer 37

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

Question 38

interventions for spastic tone reduction

Answer 38

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)

Question 39

interventions for mm facilitation (5)

Answer 39

quick stretch resistance joint traction for flexor pattern joint approx for extensor pattern tapping

Question 40

UE interventions for shoulder subluxation & management

Answer 40

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

Question 41

2 main focuses of interventions for CVA pts

Answer 41

functional tasks (w/ symmetry & equal WB) transitional movements (ex: side-sitting) w/ elbow/hand prop)

Question 42

Principles for ambulation training

Answer 42

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

Question 43

weight shifts to weaker side d/t perceptual deficits from PCA CVA -extends body & resists flexion -avoids WB on strong side

Answer 43

ipsilateral pushing/ Pusher syndrome

Question 44

principles for pusher syndrome interventions

Answer 44

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

Question 45

intervention for ___ CVA: use communication plan assess level of understanding give frequent feedback don't underestimate ability*

Answer 45

Left

Question 46

intervention for ___ CVA: use verbal cues (not demonstrated) frequent feedback focus on slow, controlled movement prioritize safety don't overestimate ability*

Answer 46

Right