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7: Neurological System Disorders > Stroke/CVA > Flashcards

Stroke/CVA Flashcards

1
Q

TIA: transient ischemic attack

A

Only last a few minutes
Occurs suddenly, most symptoms of TIA disappear within an hour
Warning sign of more strokes to come

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2
Q

Cerebral infarction (tissue death)

A

Due to embolism (obstruction of blood vessel) or thrombosis (blood clot) of intra and extra cranial arteries

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3
Q

Cerebral hemorrhage

A

Bleed secondary to hypertension or aneurysm

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4
Q

Cerebral arteriovenous malformation (AVM)

A

Abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures

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5
Q

Middle Cerebral artery (MCA) stroke

A

plegia (paralysis) of face/upper limb, sensory impairments

most common

Contralateral hemiplegia, hemianesthesia (loss of tactile sensibility on one side of body), homonymous hemianopsia (loss of visual field to L or R of vertical midline), aphasia (L), or apraxia (L), unilateral neglect, and spatial dysfunction

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6
Q

Internal Carotid artery (ICA) stroke

A

Similar to MCA

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7
Q

Anterior Cerebral artery (ACA) stroke

A

impaired judgment and insight, sensation, incontinence

Results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and mutism

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8
Q

Posterior cerebral artery (PCA) stroke

A

VISION
prominent multiple cranial nerve deficits, visual deficits, memory impairments

Homonymous hemianopsia, thalamic pain, hemi-sensory loss, and alexia

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9
Q

Vertebrobasilar system

A

Pseudobulbar signs (dysarthria, dysphagia, emotional instability), tetraplegia

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10
Q

Effects of stroke in left hemisphere

A 
Movement on R side of body (processing of sensory information from right side of body)
Visual reception from R field
Visual verbal processing
Bilateral motor praxis
Verbal memory
Bilateral auditory reception
Speech
Processing of verbal auditory information
CLASS:
right hemiplegia
aphasia
impaired attention
apraxia
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11
Q

Effects of stroke in right hemisphere

A 
Movement on L side of body (processing sensory information from L side of body)
Visual reception in L visual field
Visual spatial processing
Left motor praxis
Nonverbal memory
Attention to incoming stimuli
Emotion
Processing of nonverbal auditory information
Interpretation of abstract information
Interpretation of tonal inflections
CLASS: 
L hemiplegial
spatial/perceptual impairments
neglect
impulsivity
lack of awareness, insight
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12
Q

CVA Modifiable risk factors

A 
Hypertension
Cardiac disease
Atrial fibrillation
Diabetes mellitus
Smoking
Alcohol abuse
Hyperlipidemia
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13
Q

Nonmidifiable risk factors

A

Age: increase with age
Gender: males at higher risk
Race: African American and Latinos are at greater risk
Heredity

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14
Q

Cerebellar stroke

A

ataxia, dysphagia (difficulty swallowing), dyarthria (muscle issue, mouth can’t produce sounds), sensation abnormalities

balance & coordination

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15
Q

OT Assessment of CVA

A 
Occupational Profile
Interview/observation:
Self care: Barthel Index, FIM (acute care)
IADL: KELS, AMPS (outpatient)
Leisure/social: ACS (outpatient)
All areas: COPM (community)
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16
Q

Performance skills areas to address

A

motor/sensory
visual/perceptual
cognition
psychosocial/communication (personality change)

17
Q

OT Intervention for CVA

A

Team approach to recovery
Acute: early mobilization and return to self-care
Rehabilitation: improve occupational performance
Remedial: restoration of body structure/function (bottom up approach-address strength)
compensatory: adaptation with task specific devices/techniques (top-down, task specific)

<90 pts on FIM=skilled nursing/lost of help needed)

18
Q

UE function

A

primary focus often is the amount/quality of movement and coordination

Other factors: tone, synergies, ROM limitations, sensation, learned non-use, motor planning, pain, hand dominance

19
Q

Typical 3 biggest goals after CVA

A
  1. Speech (speak again)
  2. Walk again
  3. Use arm again
20
Q

UE Function

Brunnstrom’s synergies

A

synergy= linked muscles all come together to pick up a cup

Flexor synergy (UE): scapular retraction and/or elevation, shoulder abduction and external rotation, elbow flexion, and forearm supination

Extensor synergy (LE): opposite of all above

21
Q

UE Function Assessments

A 
Voluntary Movement: Fugl-Meyer
Tone: Ashworth scale
Subluxation: cm
ROM: goni
Strength: MMT (consider validity with tone abnormalities)
Edema: circumference, volumeter
Sensation
22
Q

UE Contracture

A

shortening of soft tissue due to prolonged immobilization

may result in discomfort and functional limitations

23
Q

UE Edema

A

retention of fluid that typically occurs in dorsum of hand after CVA due to lack of muscle activity and dependent positioning

provide compression garments, retrograde massage, and instruction/education on positioning (elevation)

24
Q

Postural Adaptation

A

impairment in postural control can result in:
diff. with limb control
increased fall risk
impaired ability to interact with the environment
increase aspiration risk
trunk weakness
inability to shift weight in LE equally in standing
loss of postural reactions/balance strategies

25
Q

Postural adaptation assessment

A

observation of task
Berg Balance Scale
assess sitting/standing: static/dynamic

26
Q

Postural Adaptation Intervention

A

equal weight bearing in hips, feet flat on floor, neutral pelvis (it typically anteriorly tilts)
“ready” position for function
maintain trunk ROM
differentiatie body parts from one another
stop and hold movements
increase/decrease postural tone
move both side of body symmetrically

27
Q

Apraxia

A

cognitive disorder but manifest in motor

a disorder or motor planning characterized by the inability to carry our skilled movements in the presence of intact sensation, movement, and coordination

28
Q

Ideomotor

A

accuracy erros (spatial/temporal)

i.e. hammering behing them or really small movements

29
Q

Ideational

A 
content erros (knowledge/sequence)
don't know what to do with object

i.e. eating spaghetti with a toothbrush

difficult to identify/rehabilitate

30
Q

Cognitive deficits

A

impaired attention, perception, memory, comprehension, reasoning, problem-solving, judgement, initiation, planning, and self-monitoring/awareness

STAY CLOSE!! Very problematic and dangerous

provide prompts/cues on performance with suggestions, simplify tasks, educate for safety

7: Neurological System Disorders (14 decks)

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