Stroke Flashcards
stroke
cerebrovascular accident
blood supply to the brain is interrupted, no O2, tissue dies
ischemic stroke
87%
blocked blood vessel (clog in the drain)
*can use tPA (clot busting drug) within ~3 hours of symptom onset
thrombotic stroke
type of ischemic stroke
blood clot
at the site of the clot
embolic stroke
type of ischemic stroke
moving particle (often from the heart) that breaks off and gets lodged somewhere else
hemorrhagic stroke
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)
TIA
transient ischemic attack
“mini stroke”
- temporary obstruction of blood flow from blockage
- no lasting damage, but warning sign for future strokes
risk factors
- older age, women, black, fam history, prior strokes, HTN (leading cause), diabetes, heart disorders, smoking, obesity
FAST
Facial drooping
Arm weakness
Speech difficulties
Time to call 911
motor impairment
contralateral to the lesion
paresis = weakness
plegia = paralysis
loss of trunk and postural control and sitting balance
impaired reactions and strategies
requires automatic adjustments to prevent falls
1. ankle - slow sway at ankles
2. hip - big hip sway
3. stepping - to widen BOS
UE impairments
subluxation: partial dislocation of shoulder joint from weak mx, gravitational pull, spastic mx
structural changes to soft tissue structures - shortened mx, contractures, over stretched
communication impairments
- global aphasia: loss of all language abilities
- broca’s aphasia: broken speech, expressive, words are appropriate but pauses/omits, typically aware of deficit (be patient, may get frustrated)
- wernicke’s: receptive, fluid, non sensical, lack of comprehension
- anomic aphasia: trouble finding words
- dysarthria: disorder of articulation (motor movements involved)
perceptual impairments
- spatial relations - where objects are in space
- spacial neglect (inattention, not responding to stimuli, not visual field deficit)
- body neglect - shaving only half of face, not using affected side
- form constancy - ID object despite variations
- figure ground - fore/background
- visual closure - ID partially covered object
perceptual impairments - agnosias
- 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
cognitive impairments
initiation, attention, organization, sequencing, problem solving
apraxia
praxis = 2 step process resulting in purposeful movement (1. idea and 2. production)
difficulty completing planned movements
ideational apraxia
no idea/concept of what to do
ideomotor apraxia
knows what to do, but has a loss of kinetic memory to actually produce the movement
visual impairments
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
task oriented approach
- top down, client centered, occupation based
- person, environment, occupational performance, functional tasks help organize behavior
5 steps of evaluation
- Role identification (role checklist, occupational performance history review)
- Assessment of occupational performance task (observation of ADL)
- Task selection and analysis
- Perform specific assessments (strength, sensory, pain, ROM, etc)
- Evaluation of the environment
formal stroke assessments
Barthel index
Stroke impact scale
Assessment of Motor & Process skills
COPM
Eval while seated
can they assume a static sitting position?
how is the alignment? symmetric?
can the patient perceive midline?
intervention while seated
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
task oriented treatment principle
minimize inefficient movement patterns
align treatment to the pt’s level
mimic reality - include common challenges of everyday life
eval while standing
- standing balance
- postural alignments, symmetry
- base of support
- postural reactions and stability during dynamic movement
formal balance assessments
berg balance scale
timed up and go
functional reach test
intervention while standing
- proper alignment with good BOS
- weight bearing and weight shifting activities
- functional and dynamic reaching activities
- automatic postural reactions
eval of upper extremity
observation through functional task performance
ROM, muscle tone, sensory function, motor control, strength and endurance, pain
assessments for UE function
wolf motor function test
arm motor ability
functional test for the hemiplegic UE
intervention for UE
- 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)
motor learning principles
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
generalization
applying the skills you learned for a specific task and transferring that same skill to another task
Constraint Induced Movement Therapy (CIMT)
- reverses effects of learned disuse of effected side
- constrain unaffected side and intensely training weaker side
other UE intervention
orthotic devices
NMES - electrical stim, can help with subluxation
virtual reality
mirror therapy
mental practice and imagery
important consideration for UE
- 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
addressing shoulder pain movement
shoulder flexion within 90
external rotation
scapular protraction
velocity test
determine if they have spasticity
MCA and ICA strokes
contralateral hemiplegia, homonymous hemianopsia, aphasia, neglect, spatial dysfunction
ACA stroke
contralateral hemiplegia, grasp reflex, incontinence, confusion, mutism
PCA stroke
homonymous hemianopsia, thalamic pain, semi sensory loss, alexia
vertebrobasilar system
results in pseudo bulbar signs - dysarthria, dysphagia, emotional instability
tetraplegia
general L/R CVA deficits
if it’s in L hemisphere - usually communication deficits and apraxia
R hemisphere - neglect/inability to attend to the left side and spatial dysfunction
