Stroke/Cerebral Vascular Accident (CVA) & Trauma

Question 1

Complete Cord Lesion:
UMN lesion

Answer 1

1. Complete BIL loss of sensory
2. BIL loss of motor function w/ spastic paralysis below level of lesion
3. Loss of B&B functions with spastic B&B

Question 2

Central Cord Lesion:
UMN lesion

Answer 2

1. Cavitation of central cord in cervical section
2. Loss of spinothalamic tracts w/ BIL loss of pain and temp.
3. Loss of ventral horn with BIL loss of motor function (primarily UE)
4. Preservation of proprioception and discriminatory sensation

Cuased by hyperextension injuries

Question 3

Brown-Sequard Syndrome:
UMN lesion

Answer 3

1. Hemisection of spinal cord
2. Ipsilateral loss of dorsal columns with loss of tactile discrimination, pressure, vibration, and proprioception
3. Ipsilateral loss of corticospinal tracts with loss of motor function and spastic paralysis below level of lesion
4. Contralateral loss of spinothalamic tract with loss of pain and temp below level of lesion; at lesion level, BIL of pain and temp

Caused by trauma

Question 4

Anterior Cord Syndrome:
UMN lesion

Answer 4

1. Loss of anterior cord
2. Loss of lateral corticospinal tracts w/ BIL loss of motor function and spastic paralysis below level of lesion
3. Loss of spinothalamic tracts with BIL of pain and temperature
4. Presevation of dorsal columns: proprioception, kinesthesia, and vibratory sense

caused by flexion injuries

Question 5

Posterior Cord Syndrome:
UMN lesion

Answer 5

1. Loss of dorsal columns bilaterally
2. BIL loss of proprioception, wibration, pressure, and epicritic sensations (stereognosis, two-point discrm.)
3. Presevation of motor function, pain, and light touch

least freq. caused by posterior injuries

Question 6

Cauda Equina Injury:
LMN lesion

Answer 6

1. Loss of long n. root at or below L1
2. Variable n. root damage (motor/sensory); incomplete (common)
3. Flaccid paraylsis (with no spinal reflex activity & B&B)
4. Potential for nerve regen of incomplete lesion; slow and stops after about 1 yr.

injury at the L1 level and below

L2-S3: Leg movement and sensation.
S2-S4: Genitalia sensation, bladder function, external anal sphincter.
S4-S5: Sensation overlying the coccyx

Question 7

CVA/stroke

Answer 7

a neurological dysfunction caused by a lesion in the brain; clinical syndromes that accompany ischemic or hemorrhagic lesions

Question 8

Transient Ischemic Attack (TIA)

Answer 8

1. a transitory stroke that occurs suddenly and usually lasts only a few minutes; disappear within an hour, can persist for up to 24 hrs.
2. Causes cerebral insufficiency d/t blood supply to the brain is briefly interrupted

AKA “ministroke”

Question 9

Symptoms of TIA

Answer 9

Symptoms:

1. numbness/weakness in the face, arm, or leg, especially on one side of the body
2. confusion/difficulty speaking/understanding speech
3. trouble seeing
4. difficult with walking, dizziness
5. loss of balance and coordination

Question 10

Cerebral infarction

Answer 10

TIA caused by either an embolism or thrombosis of the intra- or extracranial arteries

Question 11

cerebral hemorrhage

Answer 11

TIA caused when arteries rupture causing bleeding into the interstitial space (leading to hypertension/aneurysm)

Question 12

cerebral arteriovenous malformation (AVM)

Answer 12

TIA caused by abnormal, tangled collections of dilated blood vessels that results from congenitally malformed vascular structures

Question 13

Symptoms of CVA

Answer 13

1. abrupt onset of usually unilateral neurological signs (weakness, vision loss, sensory changes)
2. symptoms progress over several hours to two days

Question 14

Middle cerebral artery (MCA) stroke+
Internal carotid artery (ICA) stroke

Answer 14

Stroke resulted in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia (usually left) and/or apraxia (left), unilateral neglect (right), spatial dysfunction (right)

Question 15

Anterior cerebral artery (ACA) stroke

Answer 15

stroke that results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and/or mutism

Question 16

Posterior cerebral artery (PCA) stroke

Answer 16

stroke that results in homonymous hemianopsia, thalamic pain, hemisensory loss, and/or alexia (inability to read)

Question 17

Vertebrobasilar system

Answer 17

results in pseudobulbar signs:
1. dysarthria
2. dysphagia
3. emotional instability
4. tetraplegia

Question 18

Cause of ischemia

Answer 18

may result from a brain embolism from cardiac or arterial sources

Question 19

Cause of cerebral anoxia and aneursym

Answer 19

may result from hemorrhage and have similar treatment strategies

Question 20

T/F:

1. motor dysfunction occurs on the side of the body that’s opposite of the lesion
2. communication impairments that mildly to severely limits speech, reception of speech, or both. impairment is most often caused by damage to the right hemisphere of the brain

Answer 20

1. T
2. F - communication impairments are caused by damage to the LEFT hemisphere of the brain.

Question 21

aphasia

Answer 21

neurological language disorder

Question 22

global aphasia

Answer 22

loss of all language ability

Question 23

broca’s aphasia

Answer 23

broken speech; slow, labored speech with frequent mispronunciations

Question 24

wernicke’s aphasia

Answer 24

receptive aphasia; impaired auditory reception; speech may be fluent but is often meaningless or nonsensical

Question 25

anomic aphasia

Answer 25

difficulty finding words

Question 26

dysarthria

Answer 26

articulation disorder resulting from paralysis of the organs of speech

Question 27

Traumatic brain injury (TBI)

Answer 27

damage to the brain from an external mechanical or blunt force accompanied by a loss of consciousness, posttraumatic amnesia, skull fracture, or other unfavorable neurological findings attributed to the event; leading cause falls, motor vehicle accidents, striking/being stuck by an object, and self harm

Question 28

focal brain injury

Answer 28

direct blow to the head resulting from collision with an external object, a fall, or a penetrating injury

Question 29

multifocal and diffuse brain injury

Answer 29

sudden deceleration of the body and head, possibly from a motor vehicle, bicycle, or skateboard accident or a fall from a high surface

Question 30

decorticate rigidity

Answer 30

Upper extremities are in spastic flexed position with internal rotation and adduction. Lower extremities are in spastic extended position, internally rotated, and adducted.

Question 31

decerebrate rigidity

Answer 31

Upper and lower extremities are in spastic extension, adduction, and internal rotation. Wrist and fingers flex, plantar portions of the feet flex and invert, the trunk extends, and the head retracts.

Question 32

ataxia

Answer 32

abnormal movement resulting from cerebellum damage

Question 33

kinesthesia

Answer 33

awareness of the position and movement of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints.

Question 34

Glasgow Coma Scale

Answer 34

A neurological scale which provides an objective method to record the conscious state of a person; used for initual evaluation and continusing assessment to determine a person’s level of consciousness after head injry.

3 test:
1. eye
2. verbal
3. motor responses

score:
3-15
GCS<8: severe
GCS 9-12: moderate
GCS >13: minor

Question 35

Symptoms of postconcussion syndrome

Answer 35

Symptoms may continue for weeks, months, or a year or more after

1. headache
2. fatigue
3. cognitive impairment
4. dizziness
5. depression
6. impaired balance
7. irritability
8. apathy

Question 36

spinal cord injury (SCI)

Answer 36

1. trauma to the spinal cord as a result of compression, shearing force, contusion secondary to motor vehicle, accident, diving, accident, penetration wound, sports injury, or fall.
2. non-trauma results from tumor or progressive degenerative disease

Question 37

What are some complications of SCI?

Answer 37

1. respiratory (dec. vital capacity)
2. decubitus ulcar formation
3. orthostatic HTN
4. DVT (can turn into embolism which require immediate medical attention)
5. autonomic dysreflexia (meidcal emergency if not reversed by removing the irritating stimulatus quickly
6. spasticity
7. heterotopic ossification
8. B&B issues
9. Temperature regulation
10. fatigue
11. Sexual dysfunction

Question 38

autonomic dysreflexia

Answer 38

an abnormal response to a noxiouss stimulus that results in an extreme rise in BP, pounding headache, and profuse sweating

Question 39

management of autonomic dysreflexia

Answer 39

1. identify offending stimulus and relieve the underlying issue immediately; meds if this does not work
2. prevention of autonomic dysreflexia : educate on pressure ulcers, compliance with catherization and medication, balanced diet, educate on condition/risk/recognizing S&S (sweating, headache), first aid procedures
3. UTI
4. heterotopic ossification (formation fo bone in abnormal location)

Question 40

Cerebral Palsy (CP)

Answer 40

caused by an injury and/or disease prior to, during, or shortly after birth resulting in brain damage and secondary neurological and muscular deficits; common causes include lack of oxygen, intracranial hemorrhage, meningitis, chronic alcohol abuse, toxicosis, infections, genetic factors, endocrine, and metabolic disorders;nonprogressive and usually detected by 12 months of age

Question 41

spastic CP

Answer 41

a lesion of the motor cortex will result in spasticity with flexor and extensor imbalance.

1. hyertonia (inc. tone)
2. hyperreflexia (inc. intensity of reflex responses)

Question 42

dyskinetic CP

Answer 42

a lesion in the basal ganglia results in fluctuations in muscle tone

1. dystonia (excessive/inadequate m. tone)
2. athetosis (writhering involuntary movements which are more distal than proximal
3. chorea (spastic involuntary movement which are more proximal than distal and lack of co-contractions.)

Question 43

ataxic CP

Answer 43

a lesion in the cerebellum results in hypotonia and ataxic movements characterized by a lack of stability so coactivation is difficult, resulting in more primitive patterns of movement.

classified as mild, moderate, and severe

Question 44

ataxia

Answer 44

describes a lack of coordination while performing voluntary movements; appearance of clumsiness, inaccuracy, or instability; not smooth movements/disjointed/jerky

Question 45

An OTR® is performing upper-extremity activities with a client experiencing left hemiparesis. The OTR® notes a decrease in ROM in the left upper extremity. What factors BEST describe this decrease in ROM?

Edema, joint contracture, and weakness
Edema, muscle tone, and sensation
Sensation, muscle tone, and proprioception
Sensation, ataxia, and proprioception

Answer 45

Solution: The correct answer is A.

The client is most likely experiencing weakness, edema, and contracture of the left upper extremity as a result of the left hemiparesis.

B, C, D: Although the client is likely experiencing edema, “muscle tone” is not sufficient to describe hypertonicity or hypotonicity. Sensation may affect the client’s awareness of the upper extremity and contribute to decreased ROM, but it does not best describe the decrease. Proprioception simply describes a measure of the arm in space as determined by the client. Ataxia is primarily related to the inability to perform small adjustments for coordinated movement, not gross ROM.

Question 46

An OTR® in an acute care setting is working on a dressing program with a client with spinal cord injury. What statement by the OTR is appropriate to facilitate positive coping for the client?

“I have selected these clothes for you today.”
“Would you like to wear the blue or the red shirt?”
“What clothes do you want to wear today?”
“You should wear these clothes today.”

Answer 46

Solution: The correct answer is C.

To promote positive psychosocial adaptation, clients with spinal cord injury should be allowed opportunities to participate in decision making and to guide care tasks that require assistance.

A, D: Selecting clothes for the client does not allow the client a choice in the dressing process and therefore does not support the client’s psychosocial adaptation or positive coping.

B: Clients with spinal cord injury do not typically have cognitive deficits; therefore, limiting the choice the client needs to make is unnecessary.

Question 47

An OTR® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance?

Homemaking assistance for a few hours a day
Attendant care for 24 hours a day
Attendant care for 12 hours a day

Answer 47

Solution: The correct answer is A.

A client with low-level (T1) SCI should be independent in personal care and only require a few hours of homemaking assistance each day upon discharge.

B: Attendant care for 24 hours a day may be indicated for clients with higher level SCI injury (C1–C4).

C: Attendant care for 12 hours a day may be indicated for clients with C5–C6 SCI injury.