Stroke Flashcards
Ischemic vs Hemorrhagic stroke
Ischemic: blood flow obstructed d/t clot.
Hemorrhagic: blood vessel ruptures & blood leaks into brain.
ACA symptoms
-Hemiparesis (contra LE)
-Sensory loss (contra LE)
-Urinary incontinence
-Apraxia
-Difficulty w/ imitation
-Difficulty w/ bimanual tasks
-Motor slowness or delay
-Grasp reflex (contra)
-Sucking reflex (contra)
MCA symptoms
-Hemiparesis (contra UE, face)
-Sensory loss (contra UE, face)
-Language & speech impairments
-Perception disorders, unilateral neglect
-Homonymous hemianopsia (contra)
Aphasia typically occurs with lesions on which side of the brain?
Left
Broca Aphasia: lesion location, definition, & treatment considerations
AKA Expressive or Non-fluent aphasia.
-Frontal lobe lesions.
-Slow, hesitant, broken speech.
-Use yes/no questions.
Wernicke Aphasia: lesion location, definition, & treatment considerations
AKA Repetitive or Fluent aphasia.
-Temporal lobe lesions.
-No comprehension.
-Word salad.
-Use gestures & demonstrations.
Unilateral Neglect: lesion location, definition, & treatment considerations
-Right MCA
-Lack of awareness of weak side.
-Encourage use of hemiparetic extremities, use environment to encourage awareness.
Homonymous Hemianopsia: lesion location & definition
-Vision loss of same half of both eyes.
-R MCA = L HH = left side of both eyes lose vision.
-L MCA = R HH = right side of both eyes lose vision.
PCA symptoms (peripheral)
-Homonymous Hemianopsia (contra)
-Prosopagnosia (inability to recognize familiar faces)
-Dyslexia (WITHOUT agraphia)
-Color discrimination
-Memory deficits
-Topographical disorientation
PCA symptoms (central)
-Central branch of PCA affects Thalamus.
-Post-Stroke Thalamic Pain Syndrome: everything is painful, even clothing.
-Cannot be treated but usually resolves on its own.
Right vs. Left hemisphere lesions: behavioral impairments
Right: quick, impulsive.
Left: slow, cautious.
Right vs. Left hemisphere lesions: intellectual impairments
Right: rigidity of thought.
Left: highly distractable.
Right vs. Left hemisphere lesions: emotional impairments
Right: difficulty with negative emotions.
Left: difficulty with positive emotions.
Difference between spasticity & synergy
Spasticity: increased tone, velocity-dependent. Assessed with PROM (fast movements).
Synergy: combined motions. Assessed with AROM.
Brunnstrom Stage 1
Flaccid.
No active limb movement.
Brunnstrom Stage 2
Beginning of minimal voluntary movement.
In synergy.
Increased tone.
Brunnstrom Stage 3
Voluntary control of movement.
In synergy.
Peak spasticity.
Brunnstrom Stage 4
Movement out of synergy.
Spasticity starting to decrease.
Brunnstrom Stage 5
Increased complex movements.
Greater independence from synergies.
Brunnstrom Stage 6
Coordinated movement.
Individual joint movements.
Brunnstrom Stage7
Normal function, fully recovered.
Spasticity pattern: scapula
Retraction
Down rotation
Spasticity pattern: shoulder
Adduction
IR
Depression
Spasticity pattern: elbow
Flexion
Spasticity pattern: forearm
Pronation
Spasticity pattern: wrist
Flexion
Adduction
Spasticity pattern: hand
Finger flexion
Thumb adducted in palm
Clenched fist
Spasticity pattern: pelvis
Retraction (hip hiking)
Spasticity pattern: hip
Adduction
IR
Extension
Spasticity pattern: knee
Extension
Spasticity pattern: foot & ankle
PF
Inversion
Equinovarus
Toes claw (TMT ext + MTP flex) or toes curl (TMT flex + MTP flex)
Positioning strategies with spasticity: supine
-Scap protracted.
-Shoulder slightly abducted.
-Elbow extended.
-Arm supported with pillow.
-Wrist neutral.
-Fingers extended.
-Thumb abducted.
-Hip protracted.
-Pillow under knee.
-Splint to maintain neutral foot & ankle if needed.
Positioning strategies with spasticity: side-lying on less affected side
-Pillow under ribcage to elongate.
-Scap protracted.
-Shoulder slightly abducted.
-Elbow extended.
-Arm supported with pillow.
-Wrist neutral.
-Fingers extended.
-Thumb abducted.
-Hip flexed.
-Knee flexed.
Positioning strategies with spasticity: side-lying on more affected side
-Scap protracted.
-Shoulder slightly abducted & ER.
-Elbow extended.
-Arm supported with pillow.
-Forearm supinated.
-Wrist neutral.
-Fingers extended.
-Thumb abducted.
-Hip extended.
-Knee flexed.
Positioning strategies with spasticity: sitting
-Spine extended.
-Scap protracted.
-Arm supported on arm trough or lapboard.
-Wrist neutral.
-Fingers extended.
-Thumb abducted.
-Hips flexed to 90.
Flexion Synergy Pattern for UE
-Scapula retraction & elevation.
-Shoulder abduction & ER.
-Elbow flexion.
-Wrist & finger flexion.
Flexion Synergy Pattern for LE
-Hip flexion, abduction, & ER.
-Knee flexion.
-Ankle DF & inversion.
-Toe DF.
Extension Synergy Pattern for UE
-Scapula protraction.
-Shoulder adduction & IR.
-Elbow extension.
-Wrist & finger flexion.
Extension Synergy Pattern for LE
-Hip extension, adduction, & IR.
-Knee extension.
-Ankle PF & inversion.
-Toe PF.
Which muscles are typically NOT involved in synergy patterns?
Lats
Teres major
Serratus anterior
Finger extensors
Ankle evertors
