stroke pt 2

Question 1

what kind of scan is the most common if a stroke is suspected?

Answer 1

CT

Question 2

do MRIs or CT scans have greater sensitivity for acute stroke

Answer 2

MRI

Question 3

what kind of imaging is used to examine the vertebrobasilar system

Answer 3

doppler ultrasound

Question 4

this imaging technique is an x-ray of the carotid artery but is invasive and has a small risk of causing a stroke

Answer 4

arteriography and digital subtraction angiography

Question 5

the acute phase of rehab for stroke usually begins within ______ hours

Answer 5

72

Question 6

your patient is in the acute phase of stroke rehab. what should that consist of?

Answer 6

• early mobilization and use of hemiparetic side
• positioning, ADLs, functional mobility
• patient caregiver information

Question 7

the subacute phase of stroke rehab often takes place where? how many hours of therapy per day?

Answer 7

inpatient rehab
3 hours

Question 8

patients in the chronic phase of stroke rehab are greater than __ months post-stroke

Answer 8

6

Question 9

pts in the chronic phase of stroke rehab typically get therapy where? what is the focus?

Answer 9

outpatient or home
focus on continuing to improve functional performance and resuming participation in community

Question 10

cranial nerve for facial sensation?

Answer 10

5

Question 11

cranial nerves for facial movement

Answer 11

5, 7

Question 12

cranial nerve for auditory function

Answer 12

8

Question 13

cranial nerve for visual fields, acuity, and pupillary reflex

Answer 13

2

Question 14

cranial nerves for swallowing

Answer 14

9, 10, 12

Question 15

cranial nerves for extra-occular movements

Answer 15

3, 4, 6

Question 16

central post-stroke pain

Answer 16

pain arising as a direct consequence of a lesion or disease affecting the central somatosensory system * occurs in about 10% of strokes

Question 17

stage 1 of motor recovery

Answer 17

flaccid paralysis *system is in shock

Question 18

stage 2 of motor recover

Answer 18

• min voluntary movement
• basic synergies appear
• spasticity develops

Question 19

stage 3 of motor recovery

Answer 19

• voluntary control of movement synergies
• further increase in spasticity

Question 20

stage 4 of motor recovery

Answer 20

• synergies decline
• spasticity starts to decrease

Question 21

stage 5 of motor recovery

Answer 21

• more difficult movement combos learned
• limb synergies lose dominance

Question 22

stage 6 of motor recovery

Answer 22

• spasticity disappears
• individual joint movements possible
• coordination approaches normal

Question 23

what side does spasticity occur on?

Answer 23

contralateral

Question 24

T or F: initially, patients post stroke are hyperreflexic

Answer 24

F: they are initially hyporeflexic and flaccid due to shock to the system

Question 25

associated reaction

Answer 25

involuntary and automatic movement of a body part as a result of an intentional active or resistive movement in another body part ex. when yawning the UE flexes or LE extends

Question 26

homolateral synkinesis

Answer 26

flexion pattern of involved UE facilitates flexion pattern of lower extremity

Question 27

raimiste's phenomenon

Answer 27

- abduction or adduction of the uninvolved extremity when resistance applied to involved extremity in the same direction

Question 28

souque's phenomenon

Answer 28

raising involved extremity above 100 degrees with elbow extension will produce extension and abduction of the fingers

Question 29

UE flexor synergy - describe it

Answer 29

scap retraction shoulder abduction and ER elbow flexion supination finger flexion

Question 30

LE extensor synergy - describe it

Answer 30

hip extension, adduction, IR knee extension plantar flexion inversion toe flexion

Question 31

T or F: for the LE, it doesn't matter if it is a flexion or extensor synergy, there is always ankle inversion

Answer 31

T

Question 32

patient presents with ataxia and motor weakness. which part of the brain is most likely involved

Answer 32

cerebellum

Question 33

pt presents with slowed and involuntary movements. which part of the brain is most likely involved

Answer 33

basal ganglia

Question 34

ideational apraxia

Answer 34

inability to produce movement either on command or automatically

Question 35

ideomotor apraxia

Answer 35

unable to initiate motion on command but can move automatically

Question 36

in stroke, do proximal or distal muscles typically exhibit greater strength deficits

Answer 36

distal

Question 37

T or F: stroke patients typically fall in the direction of weakness

Answer 37

T

Question 38

pusher syndrome

Answer 38

- tendency to fall towards hemiparetic side - altered perception of body orientation in relation to gravity

Question 39

Fugl-meyer assessment of physical performance (FMA)

Answer 39

used to determine motor function after stroke ** higher score is better

Question 40

stroke rehabilitation assessment of movement (STREAM)

Answer 40

measure of voluntary movement and basic mobility

Question 41

stroke impact scale

Answer 41

self-report measure, assess function and quality of life after stroke

Question 42

chedoke-mcmaster stroke assessment

Answer 42

physical impairment and activity/disability

Question 43

national institute of health stroke scale (NIHSS)

Answer 43

screening tool focused on initial impairments ** lower score is better

Question 44

what are the 11 parts of NIHSS scale?

Answer 44

1 - level of consciousness 2 - horizontal gaze 3 - visual fields 4 - facial palsy 5 - motor arm 6 - motor leg 7 - limb ataxia (finger-nose, heel-shin) 8 - sensory (pin prick) 9 - lanugage (aphasia) 10 - dysarthria 11 - extinction/inattention

Question 45

NIHSS score ranges

Answer 45

>25 = very severe impairment 15-24 = severe 5-14 = mod severe <5 = mild

Question 46

NIHSS score of <5= discharge to?

Answer 46

home

Question 47

NIHSS score of 6-13 = discharge to

Answer 47

rehab

Question 48

NIHSS score of >13 = discharge to ?

Answer 48

SNF

Question 49

what is fugl-meyer based on

Answer 49

brunnstrom motor recovery stages

Question 50

in fugl-meyer each item is scored from _____ to ___ with a total possible score of ____-

Answer 50

0-2 226

Question 51

fugl-meyer parts (5) and highest possible score for each part

Answer 51

motor function (100) sensation (24) balance (14) joint ROM (44) joint pain (44)