S2_L2: CVA Flashcards
This results in a sudden, specific neurological deficit and occurs when a brain blood vessel is either occluded by a clot or bursts
Stroke / Cerebrovascular Accident
During the acute phase of stroke rehabilitation, what is the primary goal?
A) Maximize functional independence
B) Prepare for discharge home
C) Begin long-term rehabilitation planning
D) Evaluate the need for surgical intervention
B) Prepare for discharge home
Which of the following is NOT a common goal of stroke rehabilitation?
A) To improve mobility and range of motion
B) To reduce the risk of future strokes
C) To promote cognitive and emotional well-being
D) To treat the underlying cause of the stroke
D) To treat the underlying cause of the stroke
What is the primary objective of constraint-induced movement therapy (CIMT) in stroke rehabilitation?
A) To limit the use of the affected limb
B) To promote the use of the affected limb
C) To immobilize both limbs
D) To prevent muscle atrophy in the affected limb
B) To promote the use of the affected limb
What is the term for a communication disorder that can occur after a stroke, making it difficult for individuals to produce or understand speech?
A) Dysphagia
B) Aphasia
C) Apraxia
D) Hemiparesis
B) Aphasia
What is the main purpose of rehabilitation in the chronic phase of stroke recovery?
A) To achieve maximal recovery within the first few days
B) To address long-term disability and improve quality of life
C) To provide surgical interventions
D) To focus on prevention of future strokes
B) To address long-term disability and improve quality of life
During the acute phase of stroke rehabilitation, which type of therapy is most commonly emphasized?
A) Constraint-induced movement therapy (CIMT)
B) Hydrotherapy
C) Passive range of motion exercises
D) Bed rest
A) Constraint-induced movement therapy (CIMT)
Which therapy modality involves using electrical currents to stimulate muscles and facilitate muscle strengthening in stroke patients?
Neuromuscular electrical stimulation (NMES)
Which phase of stroke rehabilitation primarily focuses on optimizing long-term function and quality of life?
A) Acute phase
B) Subacute phase
C) Chronic phase
D) Maintenance phase
C) Chronic phase
Enumerate the 3 stages of the evolution of the recovery process from onset to the return to community life
- Acute
- Active Rehabilitation
- Adaptation to Personal Environment
Determine the stage in the evolution of the recovery process.
- improves compensatory strategies
- reduces disability
A. Acute
B. Active Rehabilitation
C. Adaptation to Personal Environment
- B
- B
The inpatient length of stay for acute stroke is currently _____ days
2 to 4
TRUE OR FALSE: The greatest deficit in persons with hemiplegia who have recovered basic motor skills and who have returned home is in the psychosocial and environmental areas
True
Which of the following impairments is typically associated with apraxia in stroke survivors?
A) Muscle weakness
B) Sensory deficits
C) Coordination problems
D) Loss of consciousness
C) Coordination problems
In stroke rehabilitation, what does the term “spasticity” refer to?
A) Inability to initiate movement
B) Rapid, involuntary muscle contractions
C) Difficulty with speech articulation
D) Impaired coordination of fine motor tasks
B) Rapid, involuntary muscle contractions
When conducting a motor assessment in stroke rehabilitation, which scale is commonly used to assess upper extremity motor function?
A) Functional Independence Measure (FIM)
B) Berg Balance Scale
C) Modified Ashworth Scale
D) Chedoke-McMaster Stroke Assessment
D) Chedoke-McMaster Stroke Assessment
Which approach to gait training in stroke rehabilitation focuses on repetitive practice of functional walking tasks, incorporating real-life scenarios?
A) Body-weight-supported treadmill training
B) Overground walking training
C) Robotic-assisted gait training
D) Neurodevelopmental treatment (NDT)
B) Overground walking training
Which specialized assessment tool is used to evaluate the quality of upper limb movements and motor recovery following stroke?
A) Fugl-Meyer Assessment (FMA)
B) National Institutes of Health Stroke Scale (NIHSS)
C) Barthel Index
D) Chedoke-McMaster Stroke Assessment
A) Fugl-Meyer Assessment (FMA)
Enumerate the 4 pathways a client does after the acute stage of recovery process.
- Returns home with or without home care services
- Goes to a rehabilitation hospital for a 2 to 4 week stay
- Goes to a subacute facility to become strong enough for the rehabilitation regimen
- Goes to a long-term care facility for rehabilitation or maintenance care
Historically, the recovery of motor function is to be completed _____ months after onset
3 to 6
CNS response to injury: initial loss of (1)_____ function, increase in (2)_____ after 48 hours and the emergence of (3)_____ of movement
- voluntary
- deep tendon reflexes
- synergistic patterns
TRUE OR FALSE: The dependence of synergistic movement decreases as voluntary function increases
True
Therapy interventions should emphasize (1)_____ on the affected side to maximize return and help the client achieve the (2)______
- movement patterns
- highest level of function
Enumerate the Predictors of Recovery.
- Motor Recovery
- Arm Recovery
TRUE OR FALSE: Initial return of arm movement in the first 4 days is one indicator of the possibility of full arm recovery.
False
first 2 weeks*
TRUE OR FALSE: Failure to recover grip strength before 24 days will result in no recovery of arm function at 3 months
True
The following are common impairments in stroke, EXCEPT:
A. Pain
B. Edema
C. Hypotonicity
D. Shoulder subluxation
E. None
E. None
TRUE OR FALSE: Stroke may result to depression
True
How does weakness from stroke differ from generalized weakness or orthopedic weakness?
it involves one entire side of the body and includes the trunk and extremities
Trunk control allows the body to? (1-4)
- Reman upright
- Adjust to weight shift
- Control movements against the constant pull of gravity
- Change and control body position for balance and function
This refers to the overall state of tension in the body musculature
Postural tone
Postural tone is influenced by the input from the? (1-4)
- Corticospinal tracts
- Vestibular system
- Alpha and gamma systems
- Peripheral-tactile and proprioceptive receptors
Enumerate the steps in MRP.
- Analysis of Task
- Practice of Missing Components
- Practice of Task
- Transference of Learning
- Explanation-identification of goal
- Re-evaluation
A. Analysis of Task
B. Practice of Missing Components
C. Practice of Task
D. Transference of Learning
- B/ C
- C
- Observation
- Involvement of relative and staff
A. Analysis of Task
B. Practice of Missing Components
C. Practice of Task
D. Transference of Learning
- A
- D
- Instruction
- Opportunity to practice in context
A. Analysis of Task
B. Practice of Missing Components
C. Practice of Task
D. Transference of Learning
- B/ C
- D
- Practice + verbal and visual feedback + manual guidance
- Consistency of practice
A. Analysis of Task
B. Practice of Missing Components
C. Practice of Task
D. Transference of Learning
- B/ C
- D
- Analysis
- Organization of self-monitored practice
A. Analysis of Task
B. Practice of Missing Components
C. Practice of Task
D. Transference of Learning
- A
- D
- Comparison
2.Structured learning environment
A. Analysis of Task
B. Practice of Missing Components
C. Practice of Task
D. Transference of Learning
- A
- D
Describe the 1st level of trunk control
Ability to perform basic movement components
Describe the 2nd level of trunk control
manifests with trunk and extremity patterns coordination, may be best explained through anticipatory postural control
Describe the 3rd level of trunk control
allows strength and stability for power production from arm and leg
Enumerate motor control deficits seen in stroke patients.
- Improper Initiation
- Inappropriate Muscle Selection
- Inappropriate Sequencing
- Excessive Force Production
Determine which motor control deficit is being described.
When force is excessive, the movement pattern is slow and the extremity feels stiff.
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
D. Excessive Force Production
Determine which motor control deficit is being described.
Occurs when the client attempts to move the arm or leg in space and substitutes the stronger proximal muscles for weaker distal muscles
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
A. Improper Initiation
Determine which motor control deficit is being described.
Will include improper initiation and excessive co-contraction.
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
C. Inappropriate Sequencing
Determine which motor control deficit is being described.
Muscles easily fatigue and the extremity slowly falls back to the starting position.
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
D. Excessive Force Production
Determine which motor control deficit is being described.
Occurs when the client substitutes a strong muscle group for a paralyzed muscle although it is inappropriate for the function
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
B. Inappropriate Muscle Selection
Determine which motor control deficit is being described.
Therapists often label this movement a “spastic” pattern and intervene with inhibition techniques.
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
D. Excessive Force Production
Determine which motor control deficit is being described.
Happens when the patient activates muscles with inappropriate effort during
voluntary movement.
A. Improper Initiation
B. Inappropriate Muscle Selection
C. Inappropriate Sequencing
D. Excessive Force Production
D. Excessive Force Production
TRUE OR FALSE: Excessive co-contraction occurs when the client activates too many muscles either at the same time or out of sequence for the task
True
A clinically associated with paralysis and weakness
A. Hypotonicity
B. Spasticity
A. Hypotonicity
A clasp-knife phenomenon
A. Hypotonicity
B. Spasticity
B. Spasticity
Hyperactive tendon responses
A. Hypotonicity
B. Spasticity
B. Spasticity
extremities display no resistance to passive movement and feel heavy
A. Hypotonicity
B. Spasticity
A. Hypotonicity
Resistance to stretch
A. Hypotonicity
B. Spasticity
B. Spasticity
Increased velocity-dependent
A. Hypotonicity
B. Spasticity
B. Spasticity
Clinical Hypertonicity can be separated from spasticity partly because clinical hypertonicity responds to ______
movement interventions
Situations in which hypertonicity occurs:
- Increase tone as a result of ______
- Increased tension on a two-joint muscle caused by _____ and the resultant _____ of muscles
- Increased tone that is voluntarily produced during attempts at _____ movement
- proximal instability
- poor joint alignment & shortening
- active
Why does arm pain present in CVA patients?
arm pain may be d/t imbalance of muscles, improper movement patterns, joint dysfunction, improper weight-bearing patterns, muscle shortening, or diminished sensation and sensory interpretation
Enumerate the sources of pain.
- Joint Pain
- Muscle and Tendon Pain
- Shoulder-Hand Syndrome/ Complex Regional Pain syndrome
What is the reason for joint pain in CVA pts?
loss of scapular and humeral rhythm and insufficient humeral external rotation
What is the reason for muscle or tendon pain in CVA pts?
When a shortened or posturing muscle is stretched too quickly or beyond available length
What is the s/sx for Shoulder-Hand Syndrome in CVA pts?
- tenderness and swelling of the hand
- altered sensitivity in the shoulder and entire arm
- loss of shoulder and hand range of motion, severe edema, and loss of skin elasticity
- demineralizaiton of bone, severe soft tissue deformity, and joint contracture
Mx for SHS: Five Steps for intervention for severe and chronic arm pain
- Eliminate ____
- ______ the arm and hand to touch
- Eliminate _____
- Introduce pain-free arm movements by reestablishing _____
- Beginning with ______ gradually increase the variety and complexity of arm movements
- pain
- desensitize
- hand edema
- scapular mobility
- guided arm movements below 60°
Hand and foot edema is another common secondary impairment that develops as a consequence of (1)_____ and (2)_____ factors
- loss of movement control
- hospitalization
TRUE OR FALSE: Foot edema is more common than hand edema
False
It is as common as hand edema
Foot edema limits ankle joint ______ range
dorsiflexion
Edema begins on the (1)_____ surface of the hand and foot, progresses (2)____, and then continues (3)_____ across the wrist or ankle
- volar
- dorsally
- proximally
TRUE OR FALSE: Edema must be eliminated before active reeducation begins
True
Describe edema in stage I.
tissue feels soft and fluid
Describe edema in stage II.
tissue is gelatinous and pitting, the edematous fluid cannot be physically expressed
Describe edema in stage III.
characterized by hard, lumpy tissue that does not “pit” in response to manual pressure
Match the description to its edematous stage
Requires gentle bilateral compression to break up the hard, solid areas into regions of softness
A. Stage I
B. Stage II
C. Stage III
C. Stage III
Match the description to its edematous stage
must be softened and liquified through trans-tissue massage
A. Stage I
B. Stage II
C. Stage III
B. Stage II
Match the description to its edematous stage
elevation, elastic gloves, bandaging, and retrograde massage are ineffective
A. Stage I
B. Stage II
C. Stage III
D. A and B
E. B and C
E. B and C
Match the description to its edematous stage
responds to retrograde massage and elevation
A. Stage I
B. Stage II
C. Stage III
A. Stage I
TRUE OR FALSE: When edematous tissue is soft and fluid, active and active assistive extremity movement patterns produce muscular contractions that assist venous and lymphatic return of the fluid.
True
______ occurs when any of the biomechanical factors contributing to the glenohumeral joint stability are interrupted
Shoulder Subluxation
In persons with hemiplegia, subluxation is related to a change in what?
angle of the glenoid fossa d/t muscle weakness
In the frontal plane, the scapula is normally held at an angle of ____
40°
Determine the kind of SH subluxation
- elbow flexes and the forearm supinates as tension increases in biceps
- present in the acute stage
- humerus subluxate inferiorly with internal rotation
A. Inferior
B. Anterior
C. Superior
- B
- A
- A
Determine the kind of SH subluxation
- d/t coracohumeral ligament rupture
- unlocking mechanism of the capsule is lost
- occurs when the humeral head lodges under the coracoid process in a position of internal rotation and slight abduction
A. Inferior
B. Anterior
C. Superior
- A
- A
- C
Coracohumeral ligament rupture occurs from a
forced abnormal passive motion
Determine the kind of SH subluxation
- found in clients with atypical patterns of return and trunk rotational asymmetries
- occurs with inappropriate muscle firing and co-contraction
- humeral head is “locked” in this position so that every movement of the humerus is accompanied by scapular movement
A. Inferior
B. Anterior
C. Superior
- B
- C
- C
Determine the kind of SH subluxation
- scapula elevates and tilts forward on the rib cage and the humerus hyperextends with internal rotation
- not painful
- result in downward rotation of the scapula
A. Inferior
B. Anterior
C. Superior
- B
- C
- A
Mobility skills are selected in three functional positions. What are they?
- supine
- sitting
- standing
Determine the following problems seen in which gait deviations.
- Lack of proper initiation pattern and direction
- Atypical leg muscle firing patterns
- Loss of ability to transfer weight through foot
- Inability to continue to move forward as a leg
- Poor trunk control
A. Forward Progression
B. Single & Double Limp Support
C. Swing (early and late)
- A
- C
- B
- C
- A
Determine the following problems seen in which gait deviations.
- Insufficient ankle joint dorsiflexion range
- Insufficient trunk control to maintain position over one leg
- Foot posturing
- Inappropriate foot contact
- Poor lower extremity control
A. Forward Progression
B. Single & Double Limp Support
C. Swing (early and late)
- A
- B
- C
- A
- B
Determine the causes seen in forward progression. You may choose 2 answers
- Muscle tightness
- Loss of control edema
- Excessive lateral shift
- Foot posturing
A. Poor trunk control
B. Lack of proper initiation pattern and direction
C. Insufficient ankle joint dorsiflexion range
D. Inappropriate foot contact
- C & D
- C
- B
- D
Determine the causes seen in forward progression.
- Loss of alignment of upper trunk over lower trunk
- Loss of control of upper trunk as leg initiates weight shift forward
- Excessive forward trunk flexion
- Weakness of foot and ankle muscles
A. Poor trunk control
B. Lack of proper initiation pattern and direction
C. Insufficient ankle joint dorsiflexion range
D. Inappropriate foot contact
- A
- A
- B
4.D
Determine the causes seen in single and double limb support.
- Muscle tightness
- Loss of ankle joint dorsiflexion range
- Asymmetries during unilateral stance
- Loss of knee control in unilateral stance
- Hip instability
A. Insufficient trunk control to maintain position over one leg
B. Poor lower extremity control
C. Loss of ability to transfer weight through foot
- C
- B
- A
- B
- B
Determine the causes seen in single and double limb support.
- Weakness or inappropriate activation of leg muscles
- Loss of control of upper trunk over lower trunk
- Toe clawing or curling
- Inability to maintain leg on floor or behind body
A. Insufficient trunk control to maintain position over one leg
B. Poor lower extremity control
C. Loss of ability to transfer weight through foot
- C
- A
- B
- C
Enumerate the problems in early and late swing
- Atypical leg muscle firing patterns
- Inability to continue to move forward as a leg
- Foot posturing
TRUE OR FALSE: Atypical leg muscle firing patterns are due to a loss of ankle and foot PF. It also presents a problem with initiation patterns
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
TRUE OR FALSE: Atypical leg muscle firing patterns is d/t a lack of proper initiation. It is also caused by the inability to control trunk and lower extremity
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
What is the spinal pattern and muscle activity in posterior weight shift of the lower body in sitting?
Spinal Pattern: Flexion
Muscle Activity: Concentric Flexor Acivity
What is the spinal pattern and muscle activity in anterior weight shift of the lower body in sitting?
Spinal Pattern: Extension
Muscle Activity: Concentric extension activity
What is the spinal pattern and muscle activity in lateral weight shift to the right of the lower body in sitting?
Spinal Pattern: lateral flexion (convexity to right)
Muscle Activity: Eccentric lateral activity on (R), Concentric lateral activity on (L)
What is the spinal pattern and muscle activity in posterior weight shift of the upper body in sitting?
NOTE: pt is sitting back up
Spinal Pattern: Extension
Muscle Activity: Concentric extension activity
What is the spinal pattern and muscle activity in anterior weight shift of the upper body in sitting?
Note: pt is reaching down the floor
Spinal Pattern: Flexion
Muscle Activity: Eccentric extension activity
What is the spinal pattern and muscle activity in lateral weight shift of the upper body in sitting?
Note: pt reaches sideways and down to right
Spinal Pattern: lateral flexion (convexity to right)
Muscle Activity: Eccentric lateral activity on (L)
What is the spinal pattern and muscle activity in lateral weight shift of the upper body in sitting?
Note: pt comes back up to middle
Spinal Pattern: Spine moves back to neutral
Muscle Activity: Concentric lateral activity on (L)
The following are common impairments in stroke, EXCEPT:
A. Loss of control
B. Spasticity
C. Hypertonicity
D. Psychosocial issues
E. None
C. Hypertonicity
