Stroke Flashcards
Modifiable risk factors
HTN
High cholesterol
Diabetes
Physical inactivity*
Obesity*
Alcohol consumption
Drug/tobacco use
A-fib
Unmodifiable risk factors
Age over 55
History of stroke/TIA
Family history of stroke
Male
Ataxia
poor muscle control that causes clumsy voluntary movements
Apraxia
inability to execute movement despite having the physical ability to perform them
Dysarthria
Difficulty speaking due to weakness of muscles used for speech
Aerobic activity guidelines for aging adults
Vigorous: 20 min 3x/week
Moderate: 30 min 5x/week
Muscle strengthening guidelines for aging adults
8-10 exercises; 10-15 reps
2x/week non-consecutive days
Flexibility training guidelines for aging adults
8-10 exercises; 15-30 sec holds
At least 2x/week but recommended 5-7
Balance activity guidelines for aging adults
Challenging but successful
Daily
Hemorrhagic stroke types
HTN
AVM
Aneurysm
Trauma
Epidural, subdural, subarachnoid, intracerebral
Ischemic stroke types
Large vessel:
- thrombotic (local obstruction)
- embolism (traveling clot or debris)
Small vessel: lacunar
- basal ganglia, pons, internal capsule
- HTN, diabetes, high cholesterol, smoking, age
Anterior brain circulation
Internal carotid artery
- middle cerebral artery
- anterior cerebral artery
Clinical findings of MCA stroke
CL hemiplegia UE > LE
CL hemianesthesia
R hemisphere
- L homonymous hemianopia
- spatial neglect
L hemisphere
- R homonymous hemianopia
- aphasia
Clinical findings of ACA stroke
CL hemiplegia LE > UE
CL hemianesthesia
Delay in verbal and motor response (abulia)
Apathy
Incontinence
Impaired judgement
Apraxia
Posterior brain circulation
Vertebral arteries > basilar artery > posterior cerebral arteries
Clinical findings of basilar stroke
crossed symptoms on the ipsilateral face/contralateral body, locked-in syndrome
Clinical findings of PCA stroke
CL homonymous hemianopia
Hemisensory loss
Cortical blindness
Thalamic syndrome (abnormal sensation of pain, temperature, proprioception, touch)
Exaggerated sensation (light pressure may be painful)
Clinical findings of cerebellar stroke
Gait unsteadiness
Ataxia
Vertigo
Nausea/vomiting
Clinical findings of superior cerebellar stroke
Ipsilateral ataxia
Nausea/vomiting
Dysarthria
CL loss of pain and temperature
Ipsilateral UE dysmetria
Clinical findings of AICA stroke
Ataxia
ipsilateral deafness
facial weakness
vertigo
nausea/vomiting
nystagmus
CL loss of pain and temperature
Clinical findings of lacunar stroke
Depends on location
Posterior limb of internal capsule: motor deficit
Anterior limb of internal capsule: weakness of face and dysarthria
Posterolateral thalamus: pure sensory loss
Pons: ataxia, clumsiness, weakness
Clinical findings of PICA stroke
wallenburg syndrome
ipsilateral ataxia
Ptosis (eyelid drooping)
Sensory impairment ipsilateral face, CL body
Homonymous hemianopia
field loss deficit in the same halves of the visual field of each eye
Dysmetria
inability to control distance, speed, ROM necessary to perform smoothly coordinated movements
Dosing for PT
Frequency:
2-5x/week acute care (subacute)
1-2x/week outpatient (chronic - stop w/ functional plateau; monthly/yearly follow ups)
Intensity:
amount person can be successful
cardiovascular training effect
Time:
20-60 min
Type:
neuromotor/skill acquisition
cardiovascular/pulmonary
strength
flexibility
Subacute stroke PT intervention
CIMT
E-stim (NMES and FES)
BWSTT
Cardiovascular exercise
Gait speed and function classification
Limited household ambulation: .4 m/s
Limited community ambulation: .4-.8 m/s
Full but slow community ambulation: .8 m/s
Chronic stroke PT intervention
Cardiorespiratory training
Promote long-term activity
E-stim (NMES and FES)
Which is the best window of timing for use of tissue Plasminogen Activator (tPA) for ischemic stroke?
</= 4.5 hours from last known well (LKW)
Which is a possible window of timing for thrombectomy for an ischemic stroke of the posterior, anterior, vertebral or basilar arteries?
6-8 hours from last known well (LKW)
Ischemic stroke vs. TIA
Ischemic: disruption of blood supply leading to cell death; seen with CT or MRI; 4% risk of recurrence
TIA: temporary disruption of blood supply w/o evidence of cell death; not visible on imaging; 3-20% risk of recurrence
Work up for both is the same
Intervention for pusher syndrome
- get pt. to realize disturbed perception
- use visual aids to understanding body’s relation
- learn movements to get vertical
- maintain vertical while performing other activities
Brunnstrom stage 1
no voluntary movement, areflexia, flaccidity
Brunnstrom stage 2
minimal voluntary movement in primitive synergies
DTRs begin to appear
spasticity begins
Brunnstrom stage 3
most or full movement in primitive synergies
hyper-reflexia
spasticity peaks
Brunnstrom stage 4
partial fractionated movement
DTRs decrease toward normal
spasticity decreasing
Brunnstrom stage 6
full fractionated movement is possible
may still have some decreased coordination
BSF test: strength/force/power
MMT, dynamometer
30 sec STS
Stair-climb
BSF: motor control and fractionated movement
Selective motor control
- STREAM
Fine motor control
- cross body reach
BSF: coordination
Lack of coordination w/ cerebellar stroke
- TNF
- HTS
- RAM
BSF: sensation/pain
Light touch, extinction
Sharp/dull
Vibration
Pain
BSF: endurance/fatigue
6 min walk test
BSF: ROM, joint mobility, soft tissue flexibility
ROM measurements
Spasticity
- ashworth
- tardieu
Tone
BSF: cognition, perception, communication
Wernicke’s and/or Broca’s aphasia
Spatial neglect or decreased spatial awareness
Impaired judgement
Locked-in syndrome (severe basilar)
Acute/subacute remediation
- regain as much lost function as possible
- increase strength and motor control
(CIMT, NMES) - bed mobility, transfers, gait, balance, WC mobility, BWSTT
- aerobic conditioning
Acute/subacute compensation
- caregiver training
- short-term orthotics or other bracing
- FES
- gait aids
- wheelchair
Acute/subacute prevention
- second stroke
- pneumonia
- skin integrity
- injury
- falls
Prefabricated orthotics
carbon fiber
plastic
external AFO
ACE wrap
custom orthotics
solid AFO
articulated AFO
ground reaction AFO
KAFOs
shoe inserts
UCBL orthosis
foot orthotics
Medications for physical sequelae
Thrombolytics
Skeletal muscle relaxants (spatiscity)
Pain killers
