Stroke/CVA Flashcards
TIA: transient ischemic attack
Only last a few minutes
Occurs suddenly, most symptoms of TIA disappear within an hour
Warning sign of more strokes to come
Cerebral infarction (tissue death)
Due to embolism (obstruction of blood vessel) or thrombosis (blood clot) of intra and extra cranial arteries
Cerebral hemorrhage
Bleed secondary to hypertension or aneurysm
Cerebral arteriovenous malformation (AVM)
Abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures
Middle Cerebral artery (MCA) stroke
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
Internal Carotid artery (ICA) stroke
Similar to MCA
Anterior Cerebral artery (ACA) stroke
impaired judgment and insight, sensation, incontinence
Results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and mutism
Posterior cerebral artery (PCA) stroke
VISION
prominent multiple cranial nerve deficits, visual deficits, memory impairments
Homonymous hemianopsia, thalamic pain, hemi-sensory loss, and alexia
Vertebrobasilar system
Pseudobulbar signs (dysarthria, dysphagia, emotional instability), tetraplegia
Effects of stroke in left hemisphere
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
Effects of stroke in right hemisphere
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
CVA Modifiable risk factors
Hypertension Cardiac disease Atrial fibrillation Diabetes mellitus Smoking Alcohol abuse Hyperlipidemia
Nonmidifiable risk factors
Age: increase with age
Gender: males at higher risk
Race: African American and Latinos are at greater risk
Heredity
Cerebellar stroke
ataxia, dysphagia (difficulty swallowing), dyarthria (muscle issue, mouth can’t produce sounds), sensation abnormalities
balance & coordination
OT Assessment of CVA
Occupational Profile Interview/observation: Self care: Barthel Index, FIM (acute care) IADL: KELS, AMPS (outpatient) Leisure/social: ACS (outpatient) All areas: COPM (community)
Performance skills areas to address
motor/sensory
visual/perceptual
cognition
psychosocial/communication (personality change)
OT Intervention for CVA
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)
UE function
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
Typical 3 biggest goals after CVA
- Speech (speak again)
- Walk again
- Use arm again
UE Function
Brunnstrom’s synergies
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
UE Function Assessments
Voluntary Movement: Fugl-Meyer Tone: Ashworth scale Subluxation: cm ROM: goni Strength: MMT (consider validity with tone abnormalities) Edema: circumference, volumeter Sensation
UE Contracture
shortening of soft tissue due to prolonged immobilization
may result in discomfort and functional limitations
UE Edema
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)
Postural Adaptation
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
Postural adaptation assessment
observation of task
Berg Balance Scale
assess sitting/standing: static/dynamic
Postural Adaptation Intervention
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
Apraxia
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
Ideomotor
accuracy erros (spatial/temporal)
i.e. hammering behing them or really small movements
Ideational
content erros (knowledge/sequence) don't know what to do with object
i.e. eating spaghetti with a toothbrush
difficult to identify/rehabilitate
Cognitive deficits
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
