Stroke Flashcards
What are the primary types of CVA?
Hemorrhagic
- 15-20%
- Aneurysm
- Trauma
Ischemic
- Majority of strokes
- Oxygen loss caused by clot
- Atherosclerosis
* Thrombosis
TIA (Transient ischemic attack)
- temporary
MCA/branch occlusion (most common)
MCA supplies lateral cerebellar cortex: lat frontal lobe, lat parietal lobe, sup temporal lobe
Contralateral lower facial hemiplegia
Contralateral hemiplegia (arm and leg)
Contralateral sensory loss (face, arm, leg)
Contralateral homonymous hemianopsia
Dysphasia (dominant hemisphere)
Contralateral neglect (non-dominant hemisphere)
ACA occlusion
Anterior cerebral artery supplies medial cortex: med frontal lobe, sup-med parietal lobe
Contralateral hemiplegia (leg>arm)
Contralateral sensory loss (leg>arm)
Apraxia
Vertebrobasilar system occlusion
Supplied brainstem, cerebellum, PCA
Many syndromes depending on location of occlusion e.g. lateral medullary syndrome of vertebral artery/PICA
- ipsilateral cerebellar signs
- ipsilateral Horner’s syndrome
- anaesthesia to pain and temp on ipsilateral face and contralateral body
- ipsilateral bulbar muscle weakness
PCA occlusion
Supplies post cerebral cortex: occipital lobe, thalamus, inf. temporal lobe
Contralateral homonymous hemianopsia
Sensory impairment
Involuntary movements
Right brain stroke
Weakness on the left side of the body
Vision problems
Quick, impulsive behavior
Left side neglect or inattention
Memory loss
Spatial-perceptual deficits
Tends to deny or minimize problems
Rapid performance, short attention span
Major fall risk
Impaired judgement
Impaired time concepts
Left brain stroke
Weakness on right side of body
Difficulty speaking (dysphagia)
Slow, cautious behavior
Memory loss more common with this side
Impaired right/left discrimination
Aware of deficits: depression, anxiety
Impaired comprehension
Who’s on the stroke team?
SLP
Neuro
PT/PTA
OT/COTA
Activity therapist
Nurse
Family
GP
Core role of OT in stroke according to ICF dimension with body structures and functions
Vision
- hemianopsyia
- crossing midline
- difficulty tracking
- opening and closing eye
- accommodating
* wait 6 months before getting glasses changed
Visual perception
- figure ground
- form constancy
- depth perception
- visual memory
- visual discrimination
Memory
- ST
- LT
- immediate
Cognition
- mental status
- acquiring knowledge and understanding
Executive function
- ability to recognize something’s wrong
- plan
- equivalent to clinical reasoning
Sensorimotor changes
- change in tone
- tingling, numbness
- loss of proprioceptive sense
Psychosocial adjustment
- depression
- changes in occupations
Core role of OT in stroke according to ICF dimension with activity
UE function
Personal self care tasks
Domestic or IADLs
Leisure activities
Driving
Core role of OT in stroke according to ICF dimension with participation
Occupational roles
Community integration
Core role of OT in stroke according to ICF dimension with environment
Physical
Social
Cultural
What are common impairments seen with stroke patients?
Shoulder subluxation
Increased tone (spasticity)
Aphasia
Hemianopsyia
Hemiplegia
Postural changes
Balance issues
Ability issues
Common Assessments
Activity Card Sort
COPM
Barthel Index
Beck Depression Inventory
Berg Balance
Fugle-Myer
FMI
Functional Reach
GDS
GCS
KELS
MMSE
3 stroke appropriate top-down assessments
Barthel
KATZ
KELS
FIM
3 stroke appropriate bottom-up assessments
Berg
ROM
MMT - unless they have abnormal tone, then use modified ashworth
Functional reach
Types of aphasia
Global
Broca’s
Wernicke’s
Anomic
- Word finding
Dysarthria
What is global aphasia?
Profound impairment of all modalities of receptive and expressive language.
Marked impairments of comprehension of single words, sentences, and conversations, as well as severely limited spoken output
What is Broca’s aphasia?
Language production
A form of expressive aphasia
No issue understanding speech
Struggle to form complete sentences
Have awareness
What is Wernicke’s aphasia?
Language comprehension
A form of receptive aphasia
Difficulty understanding speech
Can’t use communication board
What is anomic aphasia?
Mild form of aphasia in which the individual has difficulty with word-finding, or naming items
Speech is typically fluent
What is dysarthria?
where you have difficulty speaking because the muscles you use for speech are weak
