OT CVA

Question 1

Agnosia

Answer 1

inability to recognize people, objects, and/or shapes

Question 2

Apraxia

Answer 2

loss of ability to execute or carry out skilled movements and gestures, despite having the desire and ability to perform them

Question 3

Aphasia

Answer 3

-difficulty of understanding language-
- In expressing wants ideas and thoughts

Question 4

Anomia

Answer 4

problems recalling words, names, numbers- Type of aphasia

Question 5

CVA on LEFT (R-hemi)

Answer 5

1. Communication problems (aphasia) May include speaking, listening, reading, writing difficulty
2. Impaired logic, time awareness, sequencing abilities
3. Decreased analytical and mathematical ability (dyscalculia)
4. Depression more common
5. Cautious; slow performance, Anxious
   6.Are more likely to achieve self-care independence earlier

Question 6

CVA on RIGHT (L-hemi)

Answer 6

1. Visual/perceptual deficits
2. Difficulty with spatial analysis, shape recognition, face recognition
3. Decreased intuition, and music and art awareness
4. Neglect of left side
5. Distractible, Impulsive behavior, rapid performance of tasks
6. Sudden outbursts of emotion (pseudobulbar effects)
   7.Lack of insight into their impairments (Anosognosia)
   8.May retain good verbal skills
   9.Slower to become independent

Question 7

Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA)

Answer 7

5 domains, 155 items total
motor function
sensation
balance
joint ROM
joint pain

Question 8

Brunstromm stages of recovery

Answer 8

0-Flaccidity
1-6- Spasticity
3-spasticity peaks
7-Normal

Question 9

Ashworth stages of spasticity

Answer 9

0- no increase in tone
4- rigid in flexion/extension

Question 10

Brain Stem

Answer 10

• depending on the severity of the injury, it can affect both sides of the body.
• Can leave them in a “locked in” state
  -HR, breathing, BP affected

Question 11

Cerebellar stroke

Answer 11

Damage to the cerebellum can cause lack of balance and coordination (Ataxia), can also cause slurring of speech (Dysarthria)

Question 12

Learned non-use syndrome leads to:

Answer 12

V strength
V ROM
V fine motor skills
Can lead to pain, contractures
**Make sure affected hand is used in all stages
** constraint induced therapy

Question 13

General goals for CVA

Answer 13

1. Prevention of deformity and contracture
2. Prevention of injury
3. Encourage normal posture and movement
4. Maximize AROM, PROM, strength, coordination
5. Achieve maximal use of affected side
6. Remediate cognitive & perceptual deficits
7. Maximal independence in all areas of occupation
8. Maximize mobility skills
9. Achieve functional communication and social skills
10. Facilitate realistic adaptation to residual problems
11. Facilitate re-entry into social participation

Question 14

Typical pattern of stroke arm

Answer 14

Scapular retraction
Shoulder depression and internal rotation
Elbow flexion
Forearm pronation
Wrist flexion
Flexion and adduction of the fingers

Question 15

Hemiplegic shoulder can lead to?

Answer 15

If not handled properly this can lead to pain syndrome
-Avoid the development of shoulder pain

Question 16

Painful shoulder:

Answer 16

• Interferes with rehab
• Makes sleeping difficult
• Requires more medication
• Clients avoid using arm

Question 17

Shoulder pain: 2 possible causes:

Answer 17

Impingement
Immobility

Question 18

Impingement

Answer 18

-Trauma to the joint
- Improper handling/poor positioning
- It is common for clients to have higher tone causing internal rotation and adduction
-This mm imbalance contributes to misalignment and puts them at greater risk of impingement

Question 19

Immobility of the shoulder causes?

Answer 19

Caused by NOT doing anything
Soft tissue tightening, and loss of ROM
Pts who have prolonged periods of bedrest or who have developed increased tone can find it difficult to move and are susceptible to pain syndrome

Question 20

Shoulder hand syndrome or CRPS is?

Answer 20

• Pain in shoulder that progresses to the whole arm

Question 21

Signs of CRPS

Answer 21

• Limited shoulder ROM
• Swollen, shiny, hand with limited hand ROM
• Pain in even the slightest wrist extension

Question 22

HOW TO PROTECT HEMIPLEGIC SHOULDER:

Answer 22

• NEVER pull on the hemi shoulder
• Do not hold on to the hemiplegic arm to support during sitting, standing, or walking
• Avoid re-positioning in the w/c by putting your arms under their arms
• Do not force painful ROM
• Do not raise the arm in flexion or abduction past 90 degrees
• Do not raise the arm in flexion or abduction without external rotation of the humerus

Question 23

Prevent shoulder pain : bed positioning

Answer 23

Bed positioning:
Position on hemiplegic side- best position
Make sure scapula is in full protraction
On supine, have arm on side of body palm up

Question 24

Prevent shoulder pain: Reduce edema

Answer 24

-ice slush
-retrograde massage
-active ROM

Question 25

Prevent shoulder pain: How to encourage movement of involved shoulder

Answer 25

- make sure scapula is gliding BEFORE ROM to shoulder -ROM only to a point of discomfort

Question 26

Prevent shoulder pain: Wrist in slight extension

Answer 26

- position on a wheel chair lap trat - possible use of splint

Question 27

Precent shoulder pain: How to maintain ROM of MCP/PIP/DIP joints

Answer 27

-gentle PROM; AROM -facilitation of a gross grasp

Question 28

Principles of treatment

Answer 28

- Make sure client is comfortable - If seated- feet flat on the floor - Respect pain at all times-never take PROM or AROM into painful range - Work proximal to distal - Monitor fatigue and frustration - Client-centered focus is important - On-going education of client and family

Question 29

Spasticity is?

Answer 29

- 40% of people will develop spasticity- level will vary - Muscle stiffness - Upper extremity hypertonia - Loss of fine motor control - Soft tissue contracture - Muscle spasms and muscle fatigue - Changes in limb posture

Question 30

Constraint-induced movement therapy is used for?

Answer 30

For learned non-use - CI is best if the client has some motor recovery - Extend wrist, move arm, extend fingers, cognition Mirror box therapy

Question 31

FACILITATION (EXCITE)

Answer 31

Cold Light touch Tapping, stroking Fast movements Pain Fast stretch

Question 32

INHIBITION (RELAX)

Answer 32

Firm touch Pressure Slow movements No pain Prolonged stretch Warm

Question 33

3 Ways to incorporate a non-functional arm:

Answer 33

1. As a weight-bearing/stabilizer- arm on table 2. Guided movement- hand over hand- good for apraxic and aphasic clients. Attempt to move the client as normally as possible 3. Bilaterally- use both hands- using dynamic balance

Question 34

WC positioning:

Answer 34

Half lap tray to keep arm in sight Lower seat to allow foot propelling Plexiglass- allows them to see feet and floor

Question 35

Functional hand progress-stages

Answer 35

gross grasper- sweeping, holding a bowl gross manipulator- catching/throwing ball, fold laundry fine manipulator-tying knots, opening containers, typing