Stroke/CVA Flashcards
Cerebral thrombosis-
blood clot within cerebral arteries or branches
Cerebral infarction
Tissue death resulting from ischemia or occlusion of blood supply
Cerebral Emboli
composed of bits of matter formed elsewhere that travel through the blood stream where it lodges in a vessel causing occlusion and infarction
Intercerebellar hemorrhage
caused by a rupture of a cerebral vessel with subsequent bleeding into the brain
Primary cerebellar hemorrhage
non-traumatic spontaneous hemorrhage, often occurs in small blood vessels weakened by atherosclerosis which causes an aneurysm
Subarachnoid hemorrhage
occurs from bleeding into the subarachnoid space typically from a saccular or berry aneurysm affecting primarily large blood vessels
Arterial venous malformation
a congenital defect that can result in a stroke, characterized by a tangle or arteries and veins with agenesis of interposing capillaries
Anterior Cerebral Artery Syndrome
- Contralateral HEMIPARESIS and HEMI SENS LOSS involving LE more than UE-because somatotopic organization of medial aspect of cortex includes functional area for LE
- Urinary Incontinence
- Difficulty with imitation and bimanual tasks, apraxia
- Abulla (akinetic mutism), slowness, lack of spontaneity, motor inaction, limited initiation (delayed-need to direct them)
Middle Cerebral Artery Syndrome
- Contrateral hemiparesis involving UE, LE less effected and more spared
- Contralateral hemisensory loss involving face and UE, LE less effected and more spared
- Motor speech impairement: Broca’s or non-fluent aphasia with limited vocabulary, slow hesitant speech
- Receptive speech impairement: Wernicke’s or fluent aphasia with impaired auditory comprehension
- Perceptual deficits: unilat neglect, depth perception, spatial relations, agnosia
- Limb-kinetic apraxia
- Contralateral homonymous hemianopsia (visual field defect-lose both sides of one eye)
- Loss of CONJUGATE gaze to opposite side
- Most common site of stroke.
Posterior Cerebral Artery Syndrome (peripheral territory)
- Contralateral or bilat homonymous hemianopsia (macular sparing if bilat-lose outside vision/central still functional).
- Visual agnosia (can’t recognize visual objects)
- Prosopagnosia (can’t recognize faces)
- Dyslexia (diffic reading) without agraphia (can’t write), color naming (anomia), and discrimination problems
- Memory defect
- Topographic disorientation
Posterior Cerebral Artery Syndrome (Central Territory)
- Thalamic pain (cent-post stroke), spontaneous pain and dysesthesias (tingle/burning), sens impairements
- Involuntary movements, choreoathetosis (rapid, jerky, very irreg)
- CONTRALAT hemiplegia
- Weber’s syndrome (oculomotor nerve paralysis. Ipsilateral but parotic contralateral)
- Paresis of vertical eye movements, slight miosis (excessive constriction of pupil of eye) and ptosis (droopy eye lid), sluggish pupillary light response
Vertebral Artery Strokes
- Supply the cerebellum, pons, and medulla
- Sy/Sx- ipsilateral and contralateral presentation, vertigo, nausea, vomiting, dizziness, ataxia (loss of control of body movements, nystagmus (involuntary eye movement), visual changes, upper and lower limb paralysis
Basilar Artery Stroke
- “Locked-in Syndrome”
- Bilateral CVA of the Pons
- Commonly from High BP or aneurysms
- Sy/Sx- Paresis rapidly progressing to tetraplegia (nothing moves), lower bulbar paralysis (CN V-XII), Anarthria (can’t speak or control facial muscles), preserved consciousness and sensation, blinking preserved, 59% of those with locked in syndrome die
Synergies
mass movement patterns associated with neurological deficit; primitive automatic, reflexive, stereotyped. When stimulated at one joint the limb responds at multiple joints or all joints. Outside of conscious control. Difficult to manage.
Flexor Synergies: UE FLX SYN
- Scapular retraction/elevation
- Shoulder ABD, ER
- Elbow flexion-strongest component
- Wrist flexion
- Finger flexion
Flexor Synergies:
LE FLX SYN
- Hip flexion-strong component, ABD, ER
- Knee flexion
- Ankle dorsiflexion, inversion
- Toe extension
Extensor Synergies-
UE EXT SYN-
- Scapular protraction
- Shoulder ADD, INT ROT-strong component
- Elbow EXT
- Forearm pronation-strong component
- Wrist Flexion
- Finger Flexion
Extensor Synergies-
LE EXT SYN-
- Hip ext, ADD-strong component, INT ROT
- Knee EXT
- Ankle dorsiflexion-strong component, Inversion
- Toe Flexion
Spasticity
a. Hypertonicity
b. Present ~ 90% of stroke patients
c. Occur in antigravity muscles (stand or sit upright)
d. Velocity dependent
e. Spasticity does not equal tone
Apraxia
the inability to plan and execute coordinated movement. Speaking in L hemisphere. (more common in L hemisphere strokes than R)
Ideational apraxia
inability to produce movement either on command or automatically, a total breakdown of the ability to conceptualize a task. (hand tooth brush and paste-wont now what to do w/o command)
Ideal motor apraxia
inability to produce a movement on command but can produce the movement automatically. (tell to brush teeth-don’t know, but give paste and brush teeth)
FUGYL-MEYER ASSESSMENT OF PHYSICAL PERFORMANCE
a. Impairment based test organized by recovery
b. Scoring 0-2 (0 can’t do the task, 2 independent performance)
c. Test includes separate sections: LE, UE, balance, sensation, ROM, pain
FUGYL-MEYER MOTOR SCALE
a. Shortened version
b. Only the UE and LE sections of the form
c. Still takes 20 min to give
d. Still consistent with other tests
STROKE REHABILITATION ASSESSMENT OF MOVEMENT
a. STREAM
b. Clinical measure of voluntary movements
c. 30 item test (UE, LE, Mobility)
d. Can predict discharge destination
e. Can document change over time
CHEDOKE_MCMASTER STROKE ASSESSMENT
a. Impairment and disability measure
b. Two parts- impairment inventory and activity inventory
c. 14 score items/All has sub scales
d. Not free and pay per use
e. 45-60 mins
STROKE IMPACT SCALE
a. SIS
b. Self-report measure
c. Meant to assess quality of life post stroke
d. 8 subgroups (last question-how much do you feel you have recovered from your stroke)
e. 30 mins to complete
f. They perform test themselves
g. Questions with yes/no or draw on scale (has many drawbacks for post stroke patients)
FUNCTIONAL INDEPENDENCE MEASURE
a. FIM
b. Measure of burden of care
c. 15 items
d. Score 7-1
e. Can score a 0 if the task was not completed
f. Medicare requirement
g. Difficult to progress
History and Examination
aka patient eval
Hx- PMH, PLOF, DME, assistance at home?
Sensation- sharp & 2 pt discrimination
Tone/reflexes- variable based on presentation
MMT- UE/LE
Supine to sit
Sitting balance
Stand pivot or side board to chair
W/C?- cranial nerve integrity, vision, w/c mobility
Stand in // bars- stand balance, steping, wt shift
Litegait- symmetry, step length, stance time, distance, assistance of LE mngmt
Stairs- if cant stand no stairs
Tests and Outcome measures- stream (short), Fugyl-meyer (long), FIM (required)
Evaluation
evaluate results, identify impairments, identify functional limitations, establish PT Dx, establish prognosis
Solid ankle AFO
keeps neutral covering malleolus. Doesn’t allow tibia to advance on foot
Dorsal spring leaf-
allows tibial advance. Spring pops you into DF/some PF
DF assist AFO-
In DF when in neutral. Not much PF.
DF stop AFO-
Prevents knee hyper extension
Pusher syndrome causes
ipsilateral pushing or contraversive pushing
CVA causing injury to the thalamus. Postero-lateral thalamus most likely damaged. ushers always have these effected but could be and not have pushers.
Pusher syndrome systems
Neglect, apraxia, and aphasia occurs inconsistently with presentation of pusher
visual system and input to vestib system intact
Graviceptive (proprioception to vertical) system appear most affected- postural vertical is disturbed.
Pusher syndrome observation
individual using uninvolved side actively pushing toward the involved
Actively seek any stabe surface with their uninvolved side to push to involved side
avg of 20 deg tilt present
Pusher syndrome tx
find a vertical
Perching-raise up to LE in EXT. Can’t push with bad then
Reaching tasks
