Stroke/Cerebral Vascular Accident (CVA) & Trauma Flashcards
Complete Cord Lesion:
UMN lesion
- Complete BIL loss of sensory
- BIL loss of motor function w/ spastic paralysis below level of lesion
- Loss of B&B functions with spastic B&B
Central Cord Lesion:
UMN lesion
- Cavitation of central cord in cervical section
- Loss of spinothalamic tracts w/ BIL loss of pain and temp.
- Loss of ventral horn with BIL loss of motor function (primarily UE)
- Preservation of proprioception and discriminatory sensation
Cuased by hyperextension injuries
Brown-Sequard Syndrome:
UMN lesion
- Hemisection of spinal cord
- Ipsilateral loss of dorsal columns with loss of tactile discrimination, pressure, vibration, and proprioception
- Ipsilateral loss of corticospinal tracts with loss of motor function and spastic paralysis below level of lesion
- 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
Anterior Cord Syndrome:
UMN lesion
- Loss of anterior cord
- Loss of lateral corticospinal tracts w/ BIL loss of motor function and spastic paralysis below level of lesion
- Loss of spinothalamic tracts with BIL of pain and temperature
- Presevation of dorsal columns: proprioception, kinesthesia, and vibratory sense
caused by flexion injuries
Posterior Cord Syndrome:
UMN lesion
- Loss of dorsal columns bilaterally
- BIL loss of proprioception, wibration, pressure, and epicritic sensations (stereognosis, two-point discrm.)
- Presevation of motor function, pain, and light touch
least freq. caused by posterior injuries
Cauda Equina Injury:
LMN lesion
- Loss of long n. root at or below L1
- Variable n. root damage (motor/sensory); incomplete (common)
- Flaccid paraylsis (with no spinal reflex activity & B&B)
- 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
CVA/stroke
a neurological dysfunction caused by a lesion in the brain; clinical syndromes that accompany ischemic or hemorrhagic lesions
Transient Ischemic Attack (TIA)
- a transitory stroke that occurs suddenly and usually lasts only a few minutes; disappear within an hour, can persist for up to 24 hrs.
- Causes cerebral insufficiency d/t blood supply to the brain is briefly interrupted
AKA “ministroke”
Symptoms of TIA
Symptoms:
- numbness/weakness in the face, arm, or leg, especially on one side of the body
- confusion/difficulty speaking/understanding speech
- trouble seeing
- difficult with walking, dizziness
- loss of balance and coordination
Cerebral infarction
TIA caused by either an embolism or thrombosis of the intra- or extracranial arteries
cerebral hemorrhage
TIA caused when arteries rupture causing bleeding into the interstitial space (leading to hypertension/aneurysm)
cerebral arteriovenous malformation (AVM)
TIA caused by abnormal, tangled collections of dilated blood vessels that results from congenitally malformed vascular structures
Symptoms of CVA
- abrupt onset of usually unilateral neurological signs (weakness, vision loss, sensory changes)
- symptoms progress over several hours to two days
Middle cerebral artery (MCA) stroke+
Internal carotid artery (ICA) stroke
Stroke resulted in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia (usually left) and/or apraxia (left), unilateral neglect (right), spatial dysfunction (right)
Anterior cerebral artery (ACA) stroke
stroke that results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and/or mutism
Posterior cerebral artery (PCA) stroke
stroke that results in homonymous hemianopsia, thalamic pain, hemisensory loss, and/or alexia (inability to read)
Vertebrobasilar system
results in pseudobulbar signs:
1. dysarthria
2. dysphagia
3. emotional instability
4. tetraplegia
Cause of ischemia
may result from a brain embolism from cardiac or arterial sources
Cause of cerebral anoxia and aneursym
may result from hemorrhage and have similar treatment strategies
T/F:
- motor dysfunction occurs on the side of the body that’s opposite of the lesion
- 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
- T
- F - communication impairments are caused by damage to the LEFT hemisphere of the brain.
aphasia
neurological language disorder
global aphasia
loss of all language ability
broca’s aphasia
broken speech; slow, labored speech with frequent mispronunciations
wernicke’s aphasia
receptive aphasia; impaired auditory reception; speech may be fluent but is often meaningless or nonsensical
anomic aphasia
difficulty finding words
dysarthria
articulation disorder resulting from paralysis of the organs of speech
Traumatic brain injury (TBI)
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
focal brain injury
direct blow to the head resulting from collision with an external object, a fall, or a penetrating injury
multifocal and diffuse brain injury
sudden deceleration of the body and head, possibly from a motor vehicle, bicycle, or skateboard accident or a fall from a high surface
decorticate rigidity
Upper extremities are in spastic flexed position with internal rotation and adduction. Lower extremities are in spastic extended position, internally rotated, and adducted.
decerebrate rigidity
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.
ataxia
abnormal movement resulting from cerebellum damage
kinesthesia
awareness of the position and movement of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints.
Glasgow Coma Scale
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
Symptoms of postconcussion syndrome
Symptoms may continue for weeks, months, or a year or more after
- headache
- fatigue
- cognitive impairment
- dizziness
- depression
- impaired balance
- irritability
- apathy
spinal cord injury (SCI)
- 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.
- non-trauma results from tumor or progressive degenerative disease
What are some complications of SCI?
- respiratory (dec. vital capacity)
- decubitus ulcar formation
- orthostatic HTN
- DVT (can turn into embolism which require immediate medical attention)
- autonomic dysreflexia (meidcal emergency if not reversed by removing the irritating stimulatus quickly
- spasticity
- heterotopic ossification
- B&B issues
- Temperature regulation
- fatigue
- Sexual dysfunction
autonomic dysreflexia
an abnormal response to a noxiouss stimulus that results in an extreme rise in BP, pounding headache, and profuse sweating
management of autonomic dysreflexia
- identify offending stimulus and relieve the underlying issue immediately; meds if this does not work
- 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
- UTI
- heterotopic ossification (formation fo bone in abnormal location)
Cerebral Palsy (CP)
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
spastic CP
a lesion of the motor cortex will result in spasticity with flexor and extensor imbalance.
- hyertonia (inc. tone)
- hyperreflexia (inc. intensity of reflex responses)
dyskinetic CP
a lesion in the basal ganglia results in fluctuations in muscle tone
- dystonia (excessive/inadequate m. tone)
- athetosis (writhering involuntary movements which are more distal than proximal
- chorea (spastic involuntary movement which are more proximal than distal and lack of co-contractions.)
ataxic CP
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
ataxia
describes a lack of coordination while performing voluntary movements; appearance of clumsiness, inaccuracy, or instability; not smooth movements/disjointed/jerky
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
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.
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.”
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.
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
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.
