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the boards > Stroke > Flashcards

Stroke Flashcards

1
Q

stroke

A

cerebrovascular accident
blood supply to the brain is interrupted, no O2, tissue dies

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2
Q

ischemic stroke

A

87%
blocked blood vessel (clog in the drain)
*can use tPA (clot busting drug) within ~3 hours of symptom onset

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3
Q

thrombotic stroke

A

type of ischemic stroke
blood clot
at the site of the clot

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4
Q

embolic stroke

A

type of ischemic stroke
moving particle (often from the heart) that breaks off and gets lodged somewhere else

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5
Q

hemorrhagic stroke

A

13%
BLEEDING - ruptured blood vessel
can be AVM or aneurysm that burst
often c/o headache first
no tPA
intracerebral (bleeding into the brain tissue)
subarachnoid (into the subarachnoid space)

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6
Q

TIA

A

transient ischemic attack
“mini stroke”
- temporary obstruction of blood flow from blockage
- no lasting damage, but warning sign for future strokes

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7
Q

risk factors

A
  • older age, women, black, fam history, prior strokes, HTN (leading cause), diabetes, heart disorders, smoking, obesity
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8
Q

FAST

A

Facial drooping
Arm weakness
Speech difficulties
Time to call 911

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9
Q

motor impairment

A

contralateral to the lesion
paresis = weakness
plegia = paralysis
loss of trunk and postural control and sitting balance

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10
Q

impaired reactions and strategies

A

requires automatic adjustments to prevent falls
1. ankle - slow sway at ankles
2. hip - big hip sway
3. stepping - to widen BOS

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11
Q

UE impairments

A

subluxation: partial dislocation of shoulder joint from weak mx, gravitational pull, spastic mx
structural changes to soft tissue structures - shortened mx, contractures, over stretched

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12
Q

communication impairments

A
  1. global aphasia: loss of all language abilities
  2. broca’s aphasia: broken speech, expressive, words are appropriate but pauses/omits, typically aware of deficit (be patient, may get frustrated)
  3. wernicke’s: receptive, fluid, non sensical, lack of comprehension
  4. anomic aphasia: trouble finding words
  5. dysarthria: disorder of articulation (motor movements involved)
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13
Q

perceptual impairments

A
  1. spatial relations - where objects are in space
  2. spacial neglect (inattention, not responding to stimuli, not visual field deficit)
  3. body neglect - shaving only half of face, not using affected side
  4. form constancy - ID object despite variations
  5. figure ground - fore/background
  6. visual closure - ID partially covered object
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14
Q

perceptual impairments - agnosias

A
  • visual: unable to ID an object by looking at it
  • somatoagnosia: can’t recognize own body parts
  • phosphagnosia: unable to recognize faces
  • anosagnosia: lack of understanding of their deficits
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15
Q

cognitive impairments

A

initiation, attention, organization, sequencing, problem solving

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16
Q

apraxia

A

praxis = 2 step process resulting in purposeful movement (1. idea and 2. production)

difficulty completing planned movements

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17
Q

ideational apraxia

A

no idea/concept of what to do

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18
Q

ideomotor apraxia

A

knows what to do, but has a loss of kinetic memory to actually produce the movement

19
Q

visual impairments

A

homonymous hemianopsia: loss of visual field on same side in both sides (so you can just see R or L side)

saccades
pursuits
vergence
accommodation
fixation

20
Q

task oriented approach

A
  • top down, client centered, occupation based
  • person, environment, occupational performance, functional tasks help organize behavior
21
Q

5 steps of evaluation

A
  1. Role identification (role checklist, occupational performance history review)
  2. Assessment of occupational performance task (observation of ADL)
  3. Task selection and analysis
  4. Perform specific assessments (strength, sensory, pain, ROM, etc)
  5. Evaluation of the environment
22
Q

formal stroke assessments

A

Barthel index
Stroke impact scale
Assessment of Motor & Process skills
COPM

23
Q

Eval while seated

A

can they assume a static sitting position?
how is the alignment? symmetric?
can the patient perceive midline?

24
Q

intervention while seated

A

good upright posture
proper alignment (so they can use their arms, etc)
- feet flat on the floor, pelvis in neutral/slight anterior, equal WB, spine erect, shoulders symmetric, head over shoulders

supported sitting at EOB

reaching activities - keep it functional

dynamic weight shifting (promotes pelvic weight bearing)

maintain trunk in midline, trunk strengthening and ROM against gravity

compensatory strategies

25
Q

task oriented treatment principle

A

minimize inefficient movement patterns

align treatment to the pt’s level

mimic reality - include common challenges of everyday life

26
Q

eval while standing

A
  • standing balance
  • postural alignments, symmetry
  • base of support
  • postural reactions and stability during dynamic movement
27
Q

formal balance assessments

A

berg balance scale
timed up and go
functional reach test

28
Q

intervention while standing

A
  • proper alignment with good BOS
  • weight bearing and weight shifting activities
  • functional and dynamic reaching activities
  • automatic postural reactions
29
Q

eval of upper extremity

A

observation through functional task performance

ROM, muscle tone, sensory function, motor control, strength and endurance, pain

30
Q

assessments for UE function

A

wolf motor function test
arm motor ability
functional test for the hemiplegic UE

31
Q

intervention for UE

A
  • awareness and incorporation of the affected side (encourage use)
  • weight bearing (in sidling, on forearms - proximal stability, during transitions)
  • move objects across a surface (prepares for functional reach)
32
Q

motor learning principles

A

variable: practicing variations of the same tasks in different contexts
random: repetitive practice of several tasks in a varied sequence within a session

decrease physical guidance and feedback

teach task analysis and problem solving

33
Q

generalization

A

applying the skills you learned for a specific task and transferring that same skill to another task

34
Q

Constraint Induced Movement Therapy (CIMT)

A
  • reverses effects of learned disuse of effected side
  • constrain unaffected side and intensely training weaker side
35
Q

other UE intervention

A

orthotic devices
NMES - electrical stim, can help with subluxation
virtual reality
mirror therapy
mental practice and imagery

36
Q

important consideration for UE

A
  • teach safe handling
  • don’t pull on unstable joint
  • no overhead pulleys
  • don’t let arm dangle unsupported
  • maintain passive ROM
  • address pain

sling?? okay, but keeps it static/disuse
- give mohr

37
Q

addressing shoulder pain movement

A

shoulder flexion within 90
external rotation
scapular protraction

38
Q

velocity test

A

determine if they have spasticity

39
Q

MCA and ICA strokes

A

contralateral hemiplegia, homonymous hemianopsia, aphasia, neglect, spatial dysfunction

40
Q

ACA stroke

A

contralateral hemiplegia, grasp reflex, incontinence, confusion, mutism

41
Q

PCA stroke

A

homonymous hemianopsia, thalamic pain, semi sensory loss, alexia

42
Q

vertebrobasilar system

A

results in pseudo bulbar signs - dysarthria, dysphagia, emotional instability
tetraplegia

43
Q

general L/R CVA deficits

A

if it’s in L hemisphere - usually communication deficits and apraxia

R hemisphere - neglect/inability to attend to the left side and spatial dysfunction

the boards (31 decks)

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