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Neuromuscular 1 > Stroke > Flashcards

Stroke Flashcards

1
Q

Modifiable risk factors

A

HTN
High cholesterol
Diabetes
Physical inactivity*
Obesity*
Alcohol consumption
Drug/tobacco use
A-fib

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2
Q

Unmodifiable risk factors

A

Age over 55
History of stroke/TIA
Family history of stroke
Male

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3
Q

Ataxia

A

poor muscle control that causes clumsy voluntary movements

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4
Q

Apraxia

A

inability to execute movement despite having the physical ability to perform them

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5
Q

Dysarthria

A

Difficulty speaking due to weakness of muscles used for speech

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6
Q

Aerobic activity guidelines for aging adults

A

Vigorous: 20 min 3x/week

Moderate: 30 min 5x/week

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7
Q

Muscle strengthening guidelines for aging adults

A

8-10 exercises; 10-15 reps

2x/week non-consecutive days

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8
Q

Flexibility training guidelines for aging adults

A

8-10 exercises; 15-30 sec holds

At least 2x/week but recommended 5-7

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9
Q

Balance activity guidelines for aging adults

A

Challenging but successful

Daily

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10
Q

Hemorrhagic stroke types

A

HTN
AVM
Aneurysm
Trauma

Epidural, subdural, subarachnoid, intracerebral

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11
Q

Ischemic stroke types

A

Large vessel:
- thrombotic (local obstruction)
- embolism (traveling clot or debris)

Small vessel: lacunar
- basal ganglia, pons, internal capsule
- HTN, diabetes, high cholesterol, smoking, age

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12
Q

Anterior brain circulation

A

Internal carotid artery
- middle cerebral artery
- anterior cerebral artery

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13
Q

Clinical findings of MCA stroke

A

CL hemiplegia UE > LE
CL hemianesthesia

R hemisphere
- L homonymous hemianopia
- spatial neglect

L hemisphere
- R homonymous hemianopia
- aphasia

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14
Q

Clinical findings of ACA stroke

A

CL hemiplegia LE > UE
CL hemianesthesia
Delay in verbal and motor response (abulia)
Apathy
Incontinence
Impaired judgement
Apraxia

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15
Q

Posterior brain circulation

A

Vertebral arteries > basilar artery > posterior cerebral arteries

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16
Q

Clinical findings of basilar stroke

A

crossed symptoms on the ipsilateral face/contralateral body, locked-in syndrome

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17
Q

Clinical findings of PCA stroke

A

CL homonymous hemianopia
Hemisensory loss
Cortical blindness
Thalamic syndrome (abnormal sensation of pain, temperature, proprioception, touch)
Exaggerated sensation (light pressure may be painful)

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18
Q

Clinical findings of cerebellar stroke

A

Gait unsteadiness
Ataxia
Vertigo
Nausea/vomiting

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19
Q

Clinical findings of superior cerebellar stroke

A

Ipsilateral ataxia
Nausea/vomiting
Dysarthria
CL loss of pain and temperature
Ipsilateral UE dysmetria

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20
Q

Clinical findings of AICA stroke

A

Ataxia
ipsilateral deafness
facial weakness
vertigo
nausea/vomiting
nystagmus
CL loss of pain and temperature

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21
Q

Clinical findings of lacunar stroke

A

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

22
Q

Clinical findings of PICA stroke

A

wallenburg syndrome
ipsilateral ataxia
Ptosis (eyelid drooping)
Sensory impairment ipsilateral face, CL body

23
Q

Homonymous hemianopia

A

field loss deficit in the same halves of the visual field of each eye

24
Q

Dysmetria

A

inability to control distance, speed, ROM necessary to perform smoothly coordinated movements

25
Q

Dosing for PT

A

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

26
Q

Subacute stroke PT intervention

A

CIMT
E-stim (NMES and FES)
BWSTT
Cardiovascular exercise

27
Q

Gait speed and function classification

A

Limited household ambulation: .4 m/s
Limited community ambulation: .4-.8 m/s
Full but slow community ambulation: .8 m/s

28
Q

Chronic stroke PT intervention

A

Cardiorespiratory training
Promote long-term activity
E-stim (NMES and FES)

29
Q

Which is the best window of timing for use of tissue Plasminogen Activator (tPA) for ischemic stroke?

A

</= 4.5 hours from last known well (LKW)

30
Q

Which is a possible window of timing for thrombectomy for an ischemic stroke of the posterior, anterior, vertebral or basilar arteries?

A

6-8 hours from last known well (LKW)

31
Q

Ischemic stroke vs. TIA

A

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

32
Q

Intervention for pusher syndrome

A
  • 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
33
Q

Brunnstrom stage 1

A

no voluntary movement, areflexia, flaccidity

34
Q

Brunnstrom stage 2

A

minimal voluntary movement in primitive synergies
DTRs begin to appear
spasticity begins

35
Q

Brunnstrom stage 3

A

most or full movement in primitive synergies
hyper-reflexia
spasticity peaks

36
Q

Brunnstrom stage 4

A

partial fractionated movement
DTRs decrease toward normal
spasticity decreasing

37
Q

Brunnstrom stage 6

A

full fractionated movement is possible
may still have some decreased coordination

38
Q

BSF test: strength/force/power

A

MMT, dynamometer
30 sec STS
Stair-climb

39
Q

BSF: motor control and fractionated movement

A

Selective motor control
- STREAM

Fine motor control
- cross body reach

40
Q

BSF: coordination

A

Lack of coordination w/ cerebellar stroke
- TNF
- HTS
- RAM

41
Q

BSF: sensation/pain

A

Light touch, extinction
Sharp/dull
Vibration
Pain

42
Q

BSF: endurance/fatigue

A

6 min walk test

43
Q

BSF: ROM, joint mobility, soft tissue flexibility

A

ROM measurements

Spasticity
- ashworth
- tardieu

Tone

44
Q

BSF: cognition, perception, communication

A

Wernicke’s and/or Broca’s aphasia
Spatial neglect or decreased spatial awareness
Impaired judgement
Locked-in syndrome (severe basilar)

45
Q

Acute/subacute remediation

A
  • regain as much lost function as possible
  • increase strength and motor control
    (CIMT, NMES)
  • bed mobility, transfers, gait, balance, WC mobility, BWSTT
  • aerobic conditioning
46
Q

Acute/subacute compensation

A
  • caregiver training
  • short-term orthotics or other bracing
  • FES
  • gait aids
  • wheelchair
47
Q

Acute/subacute prevention

A
  • second stroke
  • pneumonia
  • skin integrity
  • injury
  • falls
48
Q

Prefabricated orthotics

A

carbon fiber
plastic
external AFO
ACE wrap

49
Q

custom orthotics

A

solid AFO
articulated AFO
ground reaction AFO
KAFOs

50
Q

shoe inserts

A

UCBL orthosis
foot orthotics

51
Q

Medications for physical sequelae

A

Thrombolytics
Skeletal muscle relaxants (spatiscity)
Pain killers

Neuromuscular 1 (3 decks)

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