Neuro - Rehab Flashcards
What does the research show about acute therapy rehabilitation compared to no therapy following a stroke?
Patients that end up at therapy rehab care tend to have better outcomes when compared to sub-acute rehab or no therapy
- ) More independence in ADLs
- ) Less mortality
- ) Less re-hospitalizations
- ) Gains persist after one year
What is a CVA?
Cerebral vascular accident
rapid onset of focal or global cerebral function disturbance lasting >24 hours, with no apparent cause other than vascular origin. “brain attack”
What is TIA?
Transient ischemic attack
“mini stroke” <24 hours
What are the epidemiology of stroke?
3rd leading cause of death 780,000 strokes annually (75% new) 6 million stroke survivors most common reason for rehabilitation Leading cause of disability in US
How did the occurrence of stroke change in the 1950-1975 and from 1975-1985?
For the first 25 years there was a 50% decrease in CVA secondary to decrease in CAD, HTN and cigarettes
Then in 1975-1985 there was a 20% increase in stroke secondary to increase in the use of CT which correctly diagnosed stroke
What is the prognosis after a stroke?
1st month care CVA 90% deaths secondary to direct effect of brain lesion or complications of immobility
In the 1st 6 months heart disease
What is the goal of stroke rehabilitation?
To return maximum recovery of physical,
cognitive and psychological function, thereby, optimizing independence, quality of life, and dignity of the patient
Multidimensional nature of stroke and its
consequences makes an interdisciplinary approach to
patient care the most appropriate strategy
What is the role of the Physiatrist in the interdisciplinary rehabilitation team?
Physiatrist- Provides primary medical care, while coordinating interdisciplinary team and medical specialists
What are the natural recovery signs from impairments?
Immediately there is Decreased voluntary movement and MSRs
In 48 hrs the are increased MSRs
In one to 38 days there will be Spasticity and Clonus
In 6 - 33 days recovcery of increase voluntary movement and decreased spasticity. MSR’s are still increased
In addition, it was noted that motor control returned proximally (shoulder)
before distally, and LE fnx recovered earlier than UEs.
What are the predictors of motor recovery?
Complete paralysis of arm at onset correlates with poor prognosis in
useful hand function (only 9% gain good recovery)
Some movement of hand by 4 weeks correlates with good chance (70%)
of making full recovery
Poor prognosis also associated with severe proximal spasticity
What are types of CVA?
Inscemic is thrombotic, embolci and lacunar
Hemorrhagic is intracerebral and subarachnoid
What are the locations of thrombotic CVAs?
Larger arteries: ICA, ACA, MCA, PCA VBA
Where do embolisms usually come from?
Cardiac source from afib, cardiac catheders, endocarditis (2/2 infection, RA)
Where do lacunar CVAs occur?
small vessels usually in the putamen, internal capsule, pons, thalamus, caudate.
Caused from uncontrolled HTN and usually present as pure motor or sensory.
What is a global aphasia?
ACA/MCA/PCA infarcts caused my massive hemorrhage
Pt. are not fluent, cannot comprehend, and cannot repeat
