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OTA 233 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

Cerebrovascular Accident

A

sudden loss of blood supply resulting in loss of oxygen supply to the brain
damages kills brain cells
neurological deficits related to areas affected
affects opposite side of the body to the hemisphere of the brain affected

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2
Q

Ischemic stroke

A

87%

caused by thrombus- blood clot or embolus traveling blood clot

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3
Q

Hemorrhagic stroke- 10%

A

caused by rupture of blood vessel with bleeding into the brain
blood is leaked into adjacent brain tissue
often more severe than ischemic strokes
anurism is a type
usually die of complications if live after stroke

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4
Q

Risk Factors for CVA

A 
Risk Factors:
controllable:
hypertension
cigarette smoking
excessive alcohol intake
high cholesterol intake
obesity
uncontrollable:
increasing age
male sex
black race
history of DM
previous CVA or TIA
family history
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5
Q

Effects

A 
mental functions
sensory functions
neuromuscular
movement-related functions
voice speech functions
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6
Q

Dysfunction:

A 
flaccid paralysis or hypotonicity
absent or reduced reflexes
impaired posture
sensory deficits
visual impairments
perceptual dysfunction
cognitive dysfunction
behavioral and personality changes
impaired speech and language skills
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7
Q

Early Treatment:-Warning Signs

A

warning signs:
early treatment can reduce progression and residual effects if within 4 hours of start treatment
use of clot buster drugs
FAST- face, arm, speech, time

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8
Q

Medical management:

A

emergency treatment: open airway, establish fluid balance, and treat medical problems
give medicine
surgery may be indicated

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9
Q

*Hemispheric Lateralization:

A

Left cerebral hemisphere- Right hemipharesis
responsible for language, time concept, and analytic thinking
often have aphasia- partial or total loss of language communication and apraxia- motor planning problems

Right cerebral hemisphere- left hemipharesis
controls visual-perceptual function and perception of the whole
neglect/inattention more common
may retain good verbal but poor functional performance- dysarthria

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10
Q

Cerebellum Stroke:

A

abnormal reflexes of the head and torso
coordination and balance problems
ataxia
dizziness
problems with swallowing and articulation
cranial nerve deficits- vertigo, nausea, vomitting, headaches, nystagmus, slurred speech

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11
Q

Brainstem Stroke

A

controls primary functions- breathing, heart rate, blood pressure and arousal
dizziness
problems with swallowing and articulation
cranial nerve deficits
paralysis
likely to be critically ill- to need mechanical ventilation

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12
Q

MCA- Middle Cerebral Artery

A

most common
largest vessel branching off the internal carotid artery
most common cerebral occlusion site
feeds- femoral, temporal, parietal lobes of brain and basal ganglia and internal capsule

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13
Q

MCA- Effects

A

Effects of complete MCA CVA
facial asymmetry, arm weakness, and speech deficits
hemiplegia or hemiparesis of contralateral side
affecting lower part of face arm and hand
sensory loss in same areas
homonymous hemianopsia- visual field deficits affecting the same half of the visual field in both eyes

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14
Q

ACA- Anterior Cerebral Artery

A 
least common- frontal and parietal lobes
classic signs:
contralateral leg weakness and sensory loss
behavioral abnormalities
incontinence may occur
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15
Q

PCA- Posterior Cerebral Artery

A

feeds the medial occipital lobe and inferior and medial temporal lobes
vision- contralateral homonymous hemianopsia
larger strokes- aphasia and neglect

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16
Q

Cognitive Dysfunction:

A 
Inatention and memory deficits
attention and concentration deficits
disorientation
insight deficits
judgement and safety awareness deficits
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17
Q

Transient Ischemic Attack: TIA’s

A

incomplete stroke with symptoms lasting from a few minutes to 24 hours

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18
Q

Role of OT: Tx of CVA

A

improve motor function
integrate sensory-perceptual and cognitive functions
facilitate maximum level of functional independence
encourage resumption of life roles
promote health management and maintanence behaviors to prevent recurrent stroke

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19
Q

Grading of treatment:

A

increase length and complexity of activity
consider time for completetiong, extend of steps, number of steps, amount of physical assistance, verbal cues used and adaptive equipment

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20
Q

Remedial vs Compensatory Treatment:

A

remediation- restoring function
compensation- adaptation of task or environment
usually use a combination of both

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21
Q

Abnormal Reflexes/ Postural Mechanism post CVA

A

delayed righting, equilibrium, and protective response

address balance and trunk control of head and trunk-normal postural mechanisms

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22
Q

Positioning Techniques:

A 
reduce abnormal tone
promote alignment
prevent contracture & skin breakdown
Bed--
alternative positions
AE use as needed
prevent decupitus ulcers
affected arm is supported
resting hand splint in functional position
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23
Q

Balance Impairments:

A

poor automatic & postural adjustments against gravity

decreased weight bearing on affected side

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24
Q

Positioning Treatment

A 
NDT- handling techniques- plevis, shoulders, chest & head)
use wedges for anterior pelvic tilt
encourage crossing midline
co-treat with PT for balance 
sit on PB to improve righting reactions
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25
Q

Sensoriomotor Interventions-

Occupation-based Treatment Ideas

A

Weight shifting —- prepare for wheelchair transfer by weight shifting to front of seat
Weight bearing prone, side lying, then progress to sitting— watch a movie or read a book on a wedge in prone or side lying, in sitting rest arm on lap tray
Practice sit<>stand transfers - toilet transfers
segmental rolling/trunk rotation- in side lying, reach for clock
pelvic tilt- in sitting reach for snacks forward and overhead and place in bowl at elbow height

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26
Q

Abnormal Muscle Tone:

A

Flaccid paralysis: often replaced by spastic paralysis
more affective

synergies- want to break out to prevent contractors choose activities move away from synergies

Spasticity is described as minimal, moderate, or severe
can fluctuate through out the day

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27
Q

Motor Control Deficits:

A 
Voluntary muscle control absent immediately after stroke
function returns in stages and may stop at any stage
return proximal to distal
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28
Q

Common motor problems:

A

movement dominated by synergy patterns
impairment of coordination, including ataxia
fine motor- last to recover

29
Q

Motor Control Treatment:

A

PROM/AROM: full mobility of scapula, clavicle, and humerus is required for pain-free ROM
2 x a day ROM
AROM: used with minimal active movement

30
Q

Treatment of shoulder subluxation and pain:

A

avoid overhead pulley and pain
pain prevented by positioning PROM
proper handling
sling use- givmohr

31
Q

Motor Retraining

A

sensorimotor, task-oriented, or functionally based approaches
CIMT-usedful with learned disuse
robotic-assisted therapy may be used for retaining movement

32
Q

Influence muscle tone:

A

hypotonic muscles are stimulated through sensation

hypertonic muscles are inhibited through positioning and handling

33
Q

bilateral integration

A

important to start early, progression of the affected arm with motor return

34
Q

strength and endurance

A

used with caution is spasticity is presents
strengthening of unaffected side only if spasticity is no increased on affected side
endurance training graded to each clients needs

35
Q

Elevation and retrograde massage:

A

severe edema may be early sign of complex pain syndrome- RSD

treatment includes elevation, AROM, retrograde massage, compression wraps, and pneumatic compression devices

36
Q

Compensatory techniques

A

possible hard dominance retraining

teaching one handed techniques

37
Q

Hypotonicity:

Sensorimotor intervention————Occupation Based treatment-

A

quick stretch- patient performs a stretch with unaffected arm before ADL
resistance- squeezing shampoo bottle
traction- grasp tub grab bar and lean back to prepare for transfer
light touch- tactile cues during ADL
vestibular stimulation- take elevator to treatment room and then perform transfers
rhythmic initiation- therapist assists reach into closet for shirt, then pt reaches for pants

38
Q

Hypertonicity:

Sensorimotor intervention————Occupation Based treatment-

A

prolonged stretch - hold book open with affected hand
compression- lean on affected extremity to sit up in bed before reaching for face cloth
firm pressure- encourage use of affected arm for reach with firm touch vs light tactile cues
rocking rhythmically- sit in rocking chair
relaxation- contract relax, hold relax- squeeze face cloth then release

39
Q

Contracture:

Sensorimotor intervention————Occupation Based treatment

A

prolonged stretch- weight bearing through hand during ADL
splinting - use arm while in splint- don/dof splint
positioning- place hand to hold cup while pouring with unaffected hand

40
Q

Ataxia:

Sensorimotor intervention————Occupation Based treatment-

A

weight bearing- lean on affected arm while performing hygiene tasks
quadruped- spot clean carpet
D1/D2- putting away groceries

41
Q

visual deficits

A

may affect distance vision, peripheral awareness, or accommodations or may cause diplopia

42
Q

auditory deficits

A

usually from normal aging

should not be misinterpreted as confusion

43
Q

Tactile deficits:

A

changes in touch, pain, pressure, temperature, vibration and proprioception

44
Q

Olfactory and gustatory deficits:

A

may have a dulled sense of smell and taste

45
Q

Visual Perceptual Dysfunction:

A

remediation of visual- perceptual deficits
focuses on the restoration of skills
compensatory strategies for visual-
perceptual and perceptual motor impairment
intact skills compensate for deficits
repetitive practice may be needed to learn a strategy- Safety

46
Q

Visual Perceptual Treatments

A 
Treatment Ideas:
pen/paper tasks, visual scanning
cancellation tasks
reading, using anchor line
alphabet/number board on wall with post its, reaching and crossing midline to locate sequential characters to promote visual scanning
scavenger hunt in room/hallway
47
Q

Spatial Relations Deficits:

A

clients may have difficulty with shape recognition, depth perception, figure-ground distinction, and vertical or horizontal orientation
Functional Manifestation
Dressing difficulties: unable to orient clothing, locate armholes, leg holes or bottom of shirt
May put glasses on upside down
attempts to put dentures in upside down
difficulty orienting body to get out of bed

48
Q

OT Treatment Spatial Relations:

A 
use repetition and practice
monitor amount & type of cueing required
set up environment/task the same way every time
use pictures/written instructions
use mirror for visual feedback
49
Q

Unilateral Body Neglect:

A

inability to interpret perceptual messages from the hemiplegic side of the body
functional manifestations
pt does not use involved extremity for ADL or position it correctly for transfers

50
Q

Unilateral Spatial Neglect:

functional manifestation:

A

does not attend to person speaking on affected side
keeps head rotated towards affected side
does not use items on affected sides

51
Q

Treatment: for Spatial Neglect

A

constant cueing- visual, verbal, and tactile
set up activities the same way; repetitions
set up environment to ensure safety
provide stimulation from involved side
promote head turning toward involved side

52
Q

Ideomotor Apraxia

A 
impaired motor planning
functional manifestations:
pt may appear clumsy, unable to adjust self to task
pt may have problems sequencing task
difficulty moving bolus
poor coordination with utensils
difficulty fasteners
53
Q

Ideational Apraxia

A

inability to plan motor acts
functional manifestations:
pt does not know what to di in order to perform an activity
does the pt attempt to use items incorrectly
may perform task incorrectly

54
Q

Treatment for Apraxia:

A 
verbal and tactile cues
positioning garmet in same position each time
bottom up to top
pull over clothes
hand over hand assistance
perform same way each time
55
Q

Cognitive Dysfunction:

A

initiation and motivation deficits

  • difficulty starting and finishing a task
  • decrease in intrinsic motivation

Attention and concentration deficits

  • deficits in ability to attend and maintain focus
  • tx: adjust environment, remove distractions
56
Q

Disorientation and confusing

A
  • awareness of person, place, time and situation
  • retain personal information the longest
  • forget situational information first
    * Tx: provide visual cues for place, date, situation: reinforce orientation but be careful about making pt frustrated or belligerent
57
Q

Memory deficits

A
  • CVA affects reception, integration, and retrieval of information
  • Tx: use external memory aides, repetition, and visual cues
58
Q

Sequencing and organization

A
  • affects understanding of time and space
  • may stop activity after each step of an activity
  • use familiar environment
59
Q

Insight deficits

A
  • unable to recognize deficits
  • Tx: frequency re-education into current status/stimulation occasionally may allow pt to fail at certain tasks to promote awareness of deficits
60
Q

Judgement and safety

A
  • impaired ability to understand the consequences of behavior
  • may be resistive to feedback
  • Tx: discuss consequences of actions, allow pt to fail at task and review why and what could have been done differently.
61
Q

Generalization and learning deficits:

A

client should perform task in various context

62
Q

Cognitive fatigue

A

build rest periods into treatment sessions

63
Q

Behavior Manifestations: Impulsivity

A
  • decreased insight can lead to impulsivity
  • functional manifestations: shovels food in mouth and swallows without chewing
  • does not test water temperature before showering
  • does not completely stand before transfer
  • does not lock w/c breaks
    * Treatment:
    * use clear instructions to ensure safety
    * setup environment to ensure pt safety
64
Q

Behavior Manifestation: Perseveration

A
  • Perseveration:
    * meaningless, non-purposeful repetition of an action
    * Functional manifestations:
    * pt repeats activity or part of activity over and over
  • Treatment:
    * use verbal cues to break up repetition
65
Q

Dysarthria:

A
  • oral-motor dysfunction resulting in difficulty in pronouncing sounds or combinations of sounds
    * Tx: oral motor exercises
66
Q

Aphasia:

A
  • acquired language disorder- range of deficits
  • broca- aphasia: expressive aphasia
  • wernicks aphasia: receptive aphasia
  • global aphasia: loss of expressive and receptive skills
  • anomia- word finding difficulty
67
Q

Dysphagia:

A
  • difficulty swallowing because of weakness
  • clinical signs- drooling, pocketing of food, coughing, or gurgling
  • high risk for aspiration
  • Treatment:
  • involves feeding program and modified diet- levels of food
68
Q

Treatment of Unilateral Neglect:

A

reinforce attention to involved side with visual and tactile cues
use of mirror during ADL’s tasks
encourage use of involved side in all task as mush as possible
reinforce safety and setup with functional transfers

OTA 233 (3 decks)

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