Module 8 - Stroke Flashcards
1
Q
What is stroke?
A
Stroke, or CVA, is an acute onset of neurological dysfunction due to an abnormality in cerebral circulation with resultant signs and symptoms that correspond to involvement of focal areas of the brain.
2
Q
Name 2 stroke associations.
A
1) National Stroke Association
2) American Stroke Association
3
Q
What is the #1 stroke epidemiology?
A
disability
4
Q
What is the #4 stroke epidemiology?
A
death
5
Q
Are males or females at more risk for stroke?
A
slightly females
6
Q
What is the number of stroke prevalence?
A
7,000,000
7
Q
What is the number of stroke incidence?
A
750,000
8
Q
What is the mortality rate of stroke?
A
140,000
9
Q
What are some modifiable risk factors for stroke?
A
TIA HTN obesity alcohol smoking heart disease diabetes mellitus
10
Q
What are some UNmodifiable risk factors for stroke?
A
age race gender prior stroke family history of stroke
11
Q
What are some diagnostic procedures for stroke?
A
blood panel diagnostic imaging (ECG/EKG, echocardiogram, CT/MRI, US transcranial doppler)
12
Q
What are the two classifications & percentages for stroke?
A
1) Ischemic - 87%
2) Hemorrhagic - 13%
13
Q
What is ischemic?
A
cerebral thrombosis or embolis
14
Q
What is hemorrhagic?
A
intracerebral subarchnoid arteriovenous malformation (AVM)
15
Q
Which artery is most common for a stroke to occur?
A
middle cerebral artery (MCA)
16
Q
What happens when stroke occurs in the PCA?
A
this is the occipital lobe, blindness will occur
17
Q
What happens what stroke occurs in the common carotid artery?
A
disrupts the major blood flow into the brain
18
Q
What drug breaks up a clot?
A
TBA
19
Q
When an intracerebral hemorrhage occurs what color is on the CT?
A
white
20
Q
Right hemisphere stroke will have effects of…
A
left hemiparesis
left hemi-sensory loss
visual-perceptual deficits
impulsive/poor judgement
21
Q
Left hemisphere stroke will have effects of…
A
right hemiparesis
right hemi-sensory loss
slow and cautious behavior
speech/language deficits
22
Q
Which arteries is a branch of the internal carotid artery?
A
anterior (ACA)
middle (MCA)
23
Q
The ACA supply what areas?
A
MCA (frontal and parietal lobes) and subcortical structure
24
Q
What does the ACA effects?
A
contralateral hemiparesis
sensory loss LE > UE
25
Which area effect facial involvement?
MCA
26
The MCA supply what areas?
lateral cerebral hemispheres (frontal, temporal, and parietal) and subcortical structures
27
What does the MCA effects?
contralateral spastic hemiparesis
sensory loss
UE & face > LE
28
What makes the ICA area the most dangerous stroke (supplies area)?
it will block both the ACA & MCA
29
What happens when there is a complete occlusion in the ICA?
death
30
What happens when there is an incomplete occlusion in the ICA?
combo of ACA and MCA characteristics
31
Where does the PCA supply?
occipital, medial, inferior temporal lobes
upper brainstem
midbrain
posterior diencephalon
32
What does the PCA effects?
contralateral hemiplegia
sensory loss
visual impairments
thalamic pain syndrome
33
What is Lacunar Syndromes?
caused by deep small vessel disease and are consistent with specific anatomical sites
34
Where does the Vertebrobasilar Artery supply?
cerebrum
medulla
pons
internal ear
35
What happens when there is a complete occlusion of the Vertebrobasilar Artery?
death
36
What happens when there is an incomplete occlusion of the Vertebrobasilar Artery?
```
ipsilaterally and contra-laterally
locked-in syndrome
bulbar palsy
Wallenberg's syndrome
vestibular deficits
cerebellar deficits
```
37
The Vertebrobasilar Artery effects what cranial nerves?
9-12
38
What drug is used for treating thrombus?
Coumadin
39
What drug is used for treating hypertension?
Procardia
40
What drug is used for treating seizures?
Dilantin
41
What drug is used for treating spasticity?
Baclofen
42
What drug is used for treating pain?
Vicodin
43
What drug is used for treating insomnia?
Ambien
44
What drug is used for treating depression?
Paxil
45
What is the rehab process?
medically stable
functional recovery potential
guide to PT practice
46
What is the guide to PT practice?
strength impairments
sensory and perceptual impairments
coordination impairments
balance impairments
47
Who is involved in the rehab process?
```
patient and family
physician
nurse
pt/ot/st/op
case manager
social worker
neuropsychologist
recreational therapists
```
48
What is the subjective examination?
medical chart review
nursing consultation
patient and/or family member interview
49
What is lethargy according to the standard descriptive terminology?
drowsy, able to respond briefly
50
What is obtudination according to the standard descriptive terminology?
difficult to arouse, confused
51
What is stupor according to the standard descriptive terminology?
unresponsive, awakened by intense stimuli
52
What is coma according to the standard descriptive terminology?
unresponsive
53
What does the Glascow Coma Scale measure?
eye opening
best motor response
verbal response
54
What is a mild score on the Glascow Coma Scale?
13-15
55
What is a moderate score on the Glascow Coma Scale?
9-12
56
What is a severe score on the Glascow Coma Scale?
less or equal to 8
57
Neuromotor disorders consists of:
dysarthria (impaired speech and non-speech oral muscles)
verbal apraxia (impaired speech muscles/Broca's aphasia)
dysphagia (impaired swallowing)
58
Aphasia consists of:
global aphasia (designation of severity versus type)
Broca's aphasia (non-fluent or expressive aphasia)
Wernicke's aphasia (fluent or receptive aphasia)
59
Cognitive status:
Orientation (person, place, time, and circumstance)
Ability to follow 1-3 step commands
Mini-manual state examination
Preservation
60
Emotional and behavioral status:
Emotional lability (psuedobulbar affect)
Depression
Apathy
61
Vital signs:
```
temperature: 96.8-99.5 F
blood pressure: 95-119/60-79 mmHg
heart rate: 60-90 bpm
respiratory rate: 12-20 breaths/min
oxygen saturation rate: 95-100%
```
62
Bowel & bladder:
hyperreflexia
hyporeflexia
sphincter control
sensory loss
63
Integumentary system:
Color
Integrity
Pressure sores
64
Deep Vein Thrombosis:
Swelling and edema lower leg
| Pain/tenderness/ache/tightness in calf
65
Sensory integrity:
superficial, deep, and combined cortical
| pain (thalamic pain, hyperalgesia)
66
Vision:
visual neglect
| homonymous hemianopsia
67
CN I:
Olfactory
| ask patient to identify items with very specific odors (spa, coffee) placed under nose; each nostril tested separately
68
CN II:
Optic
ability to see is tested by asking patient to read an eye chart; peripheral vision is tested by asking patient to detect objects from corners of eyes
69
CN III:
Occulomotor
ability to move each eye up, down, and inward is tested by asking patient to follow a target moved by examiner
pupils' response to light is checked by shining a bright light into each pupil in a darkened room
upper eyelid is checked for drooping (ptosis)
70
CN IV:
Trochlear
| ability to move each eye down and inward is tested by asking patient to follow a target moved by examiner
71
CN V:
Trigeminal
facial sensation is tested using a pin and a wisp of cotton; blink reflex is tested by touching cornea of eye with a cotton wisp
strength and movement of muscles that control jaw are tested by asking patient to clench teeth and open jaw against resistance
72
CN VI:
Abducens
| ability to move each eye outward beyond midline is tested by asking patient to look to side
73
CN VII:
Facial
ability to move face is tested by asking patient to smile, open mouth, show teeth, and close eyes tightly
taste is tested using substances that are sweet, sour, and salty
74
CN VIII:
Vestibulocochlear
hearing is tested with a tuning fork
balance is tested by asking patient to walk a straight line or by performing head thrust test
75
CN IX:
Glossopharyngeal
76
CN X:
Vagus
77
Both CN IX and X are tested by:
ask patient to swallow, say "ah" to check movement of palate and uvula, back of throat is touched with a tongue blade to evoke gag reflex, patient asked to speak to determine whether voice sounds nasal
78
CN XI:
Accessory
| patient is aced to turn head and shrug shoulders against resistance
79
CN XII:
Hypoglossal
| patient asked to stick out tongue and is observed for deviations to one side or other
80
Joint Integrity and Mobility is tested by:
AROM and PROM
81
Perception:
Body scheme/image (unilateral neglect)
Spatial relations
Agnosia (telling what the objects are)
82
Brunnstrum Stages of Motor Recovery at initial to overtime:
1: Flaccid
2: Minimal voluntary synergistic movement, spasticity emerges
3: More voluntary synergistic movement, spasticity maximal
4: Some movements out of synergy, spasticity declines
5: Synergy patterns lose dominance
6: no spasticity, individual joint movements possible
83
Hemiplegia is:
complete
84
Hemiparesis is:
incomplete
85
Flaccidity is:
hypotonicity
86
Spasticity if:
hypertonicity
87
Modified Ashworth Scale (MAS) measures tone levels:
0: no increase in muscle tone
1: minimal increase in muscle tone at end of range
1+: minimal increase in muscle tone (less than half of PROM)
2: more marked increase in muscle tone (most PROM)
3: considerable increase in muscle tone (PROM difficult)
4: rigid
88
Abnormal (Obligatory) Synergy Patterns:
UE Flexion
UE Extension
LE Flexion
LE Extension
89
What are the 5 major UE internal rotators?
```
anterior deltoid
teres major
lats
subscapularis
pectoralis major
```
90
What is the UE Flexion pattern?
```
scapular retraction, elevation
shoulder abduction, external rotation
elbow flexion
forearm supination
wrist and finger flexion
```
91
What is the UE Extension pattern?
```
scapular protraction
shoulder adduction, internal rotation
elbow extension
forearm pronation
wrist and finger flexion
```
92
What is the LE Flexion pattern?
hip flexion, abduction, external rotation
knee flexion
ankle df and inversion
toe df
93
What is the LE Extension pattern?
hip extension, adduction, internal rotation
knee extension
ankle pf and inversion
toe pf
94
What are some abnormal reflexes?
hyporeflexia, flaccidity
hyperreflexia, clonus, clasp knife response, Babinski
associated reactions
95
What are some altered coordinations?
ataxia
bradykinesisa
choreoathetosis and hemiballismus
96
Ataxia have lesions in the:
cerebellar
97
Bradykinesia, choreoathetosis, and hemiballismus lesions are in the:
basal ganglia
98
Altered motor programming is either:
ideational or ideomotor apraxia
99
Ideational apraxis is:
inability automatically or on command
100
Ideomotor apraxia is:
automatically but not on command
101
Postural control and balance:
Asymmetrical stance
Reactive postural control
Anticipatory postural control
Ipsilateral Pushing (Pusher Syndrome)
102
Functional and mobility and ambulation:
Bed mobility
Transfers
Gait/Locomotion
103
A specific instrument to measure disability:
Fugl-Meyer Assessment of Physical Performance (FMA)
