Stroke Treatments Flashcards
1
Q
More than ____ stokes occur annually in the US.
A
795,000
2
Q
Stroke is the (1/2/3) leading cause of death.
A
3
3
Q
1 out of every ___ deaths is caused by stroke
A
1 out of 18
4
Q
Every ___ minutes, a person dies of stroke in the US.
A
4 minutes
5
Q
What is the leading cause of adult disability in the US?
A
stroke
6
Q
_____ of stroke survivors have moderate to severe disability.
A
2/3
7
Q
2/3 of all strokes occur in people > ___ y/o
A
65 y/o
8
Q
Strokes are more likely in (men/women)
A
men
9
Q
What is the most common cause of stroke?
A
cerebral infarction (thrombosis or embolism)
10
Q
What are the 3 most commonly recognized risk factors for cerebrovascular disease?
A
HTN
DM
heart disease
11
Q
What type of stroke is more prevalent? Ischemic or hemorrhagic?
A
ischemic (thrombotic or embolic)
Accounts for 70-80% of strokes
12
Q
Hemorrhagic strokes account for ___% of strokes.
A
20%
13
Q
Where do plaques causing thrombotic infarction commonly form?
A
In front of the first major branching of the cerebral arteries
14
Q
How long does it take for a Thrombotic infarction to occlude an artery?
A
several hours
15
Q
TIA is a type of ____ infarction.
A
thrombotic
16
Q
(true/false) TIA will incompletely occlude an artery.
A
FALSE
17
Q
Where can embolic infarctions come from?
A
heart
internal carotid aertery thrombosis
artherosclerotic plaque of carotid sinus
18
Q
Embolic infarction is usually a sign of ___ disease.
A
heart disease
19
Q
What artery is most commonly infarcted on with embolic infarctions?
A
Middle Cerebral artery (MCA)
20
Q
Most common intracranial hemorrhages causing stroke are from what?
A
HTN
ruptured saccular aneurysm
arteriovenous malformation (AVM)
21
Q
What is the most common symptom of hemorrhagic infarction?
A
severe HA
22
Q
What are s/s of stroke?
A
- SUDDEN numbness/weakness of face, arm, or leg
- SUDDEN confusion, trouble speaking, or understanding
- SUDDEN trouble seeing in one or both eyes
- SUDDEN trouble walking, dizziness, loss of balance and/or coordination
- SUDDEN severe HA w/ no known cause
23
Q
What medications/treatment can be used as acute management of ischemic CVA?
A
Antiplatelets (MOST COMMON)
thrombolics/ thrombolysis
Thrombectomy
rtPA (alteplase) –> dissolves blood clot
Desmoteplase
24
Q
definition: Intended for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusions
Similar to a vacuum
Can be used within 8 hours
A
penumbra system
25
If a patient survives a ruptured aneurysm, they will be on bed rest for ___-___ w/ no exertion
4-6 weeks
26
Those with a ruptured aneurysm will have (lower/higher) arterial blood pressure
lower
27
What type of imaging is preferred for strokes?
CT
28
definition: A recording of the position and motion of the heart walls, valves, internal structures, and neighboring tissues
echocardiography
29
definition: used After completion of a CT scan or MRI of the head
--> May be used to provide information on the condition of the carotid arteries in the neck and/or intracranial vessels
US
30
definition: May be used to identify aneurysms, vasospasm, and arteriovenous malformations, and to differentiate embolism from large artery thrombosis
cerebral angiography
31
When does a person have the highest risk of experiencing a seizure after a stroke?
immediately following the stroke
57% in 1 week
88% within the 1st year
32
What type of strokes have an earlier onset time of possible seizures?
thrombotic and embolic
33
Why will a stroke survivor have respiratory insufficiency?
due to paralysis of one side of the thorax
34
What are contraindications of rtPA?
hemorrhagic stroke
35
definition: Loss of tool use knowledge and Misordering steps of complex actions:
1. Not knowing what object to use and how
2. Unable to sequence
3. Not knowing what to do within the task
ideational adult-onset apraxia
36
definition: unable to carry out a motor command
ideomotor adult-onset apraxia
37
definition: defined as being unaware of sensory stimuli on the side of the body or space opposite the brain lesion
sensory neglect
38
definition: defined as the failure to generate a movement response to a stimulus even though the person is aware of the stimulus
motor neglect
39
definition: a person ignores the contralesional half of internally generated images
representational neglect
40
definition: defined as a lack of exploration or awareness of the side of the body opposite the brain lesion
personal neglect
41
definition: defined as a failure to acknowledge stimuli on the contra-lesional side of space
spatial neglect
42
What is the most common type of subluxation seen with strokes?
inferior subluxation (head of humerus drops below the glenoid)
43
What type of subluxations are often seen when patients are starting to regain control but not correct it?
anterior subluxation (LHOB)
44
How should you position a patients are with an anterior subluxation?
Position humerus in some FLX (stabilize prior to FLX)
45
definition: subluxation that results in movement before the person is ready... this is due to deltoid activation prior to the RTC
superior subluxation
46
Shoulder pain has up to ___% incidence
80%
47
(true/false) Proximal weakness is a kinetic chain of events that travel down the arm.
true
48
What are stereotypical patterns of movement after stroke?
- self effort to gain stability
- limiting DOF
- shortening lever arm
- attempt to use intact systems to complete difficult tasks
49
Test that assesses the ability to maintain a given posture and to ensure equilibrium in changing position both must be assessed
Applicable for patients with very poor postural performance
Contains items with increasing difficulty
12 items
- Maintaining to changing a posture
Postural assessment scale for stroke (PASS)
50
What are primary impairments of stroke?
- Muscle paralysis/weakness
- hypotonicity progressing to hypertonicity
- Inappropriate initiation of muscles
- impaired sensory awareness and interpretation
51
What are secondary impairments of stroke?
- altered alignment and mobility
- altered muscle and soft tissue length
- pain
- edema
52
What are the composite impairments of stroke?
- movement deficits
- stereotypical/atypical movements
- undesirable compensation
53
What are the treatment principles for stroke survivors?
Use it or lose it
Use it and improve it
54
(true/false) Permanent changes in the CNS can be induced due to extensive training
true (Use it and improve it)
55
What should you do after stroke to the UE?
- provide a sling
- maintain ER of the humerus
- Maintain scapular mobility with upward rotation
- keep the cubital fossa facing forward during tasks
- prevent orthopedic injuries (RTC lesion, biceps tendonitis, etc)
- task choice for regaining control (fixed distal point WB)
- manage contractures
- manage weakness
56
What precautions are there with HEP w/ the UE after a stroke?
- no overhead pulley
- no aggressive self-ROM
- no tabletop skates
57
(true/false) You can use axillary grip on a person during stroke treatment.
FALSE
58
What is most commonly seen with gait after a stroke?
Hip hiking on the involved side (often combined with pelvic retraction)
Upper trunk lean to the involved side
59
What is key to help break hip hiking after a stroke?
Flexing the knee
60
What can you do to help break upper trunk leaning after a stroke?
Encourage WB through the involved UE
61
(true/false) Strengthening increases spasticity.
false
62
What are locomotor training principles for after stroke treatment?
- maximize WB on the legs
- optimize sensory cues
- optimize kinematics
- maximize recovery/neural remediation, not compensation
63
definition: Inability to sustain mid-line of the eyes w/ an ocular drift
OR
to refer to the misconception of vertical posture with an involuntary tendency to drift or fall to one side when positioned upright.
Lateropulsion
64
definition: pushing towards the side of the lesion
ipsiversive lateropulsion
65
definition: pushing away from the side of the lesion
contraversive lateropulsion
66
definition: A term used to describe the behavior that individuals post-stroke have, using their non-paretic limb to actively “push” themselves towards their paretic/weaker side or away from their non-paretic side.
pusher syndrome
67
What is pusher syndrome often accompanied by?
severe inattention
neglect of self-awareness
sensory deficits
aphasia
68
Those with pusher syndrome will show ___ and ___ of the non-paretic extremity
ABD and EXT
69
Pusher syndrome is most commonly caued by a lesion where?
posterior thalamus
--> may also occur with damage to parts of the insular cortex and post-central gyrus
70
Is subjective vertical posture impaired w/ pusher syndrome?
yes
71
Hemiparesis with pusher syndrome is (mild/moderate/severe)
severe
72
Vertical vision is (intact/affected) when pusher syndrome is present.
intact
73
definition: neurological condition caused by a stroke in the vertebral or posterior inferior cerebellar artery of the brain stem.
Symptoms include difficulties with swallowing, hoarseness, dizziness, nausea and vomiting, rapid involuntary movements of the eyes (nystagmus), and problems with balance and gait coordination
Wallenberg syndrome
74
definition: inability to stand unsupported
thalamic astasia
75
A patient Must have score of > ___ in each of the 3 sections of the SCP assessment scale to be labeled as a pusher
> 0
76
What does the burke lateropulsion scale (BLS) include?
Supine (Perform log roll to both sides)
Sitting
Standing
Transfers
Walking
77
If a person with pusher syndrome has their eyes closed when sitting, what happens to their position?
They will sway 18 degrees to the lesioned side of the brain
78
TENS unit is applied to the _____ side of the neck when treating pusher syndrome.
contralateral
79
What physical activities are recommended for stroke survivors in an acute hospital setting?
low-level walking
intermittent sitting and standing
seated activity
active ROM
80
What physical activities are recommended for a stroke patient in an inpatient/outpatient rehab setting?
large muscle activity
graded walking
stationary cycle
ergometry
functional seated exercises
walking
81
Those receiving therapy in an acute hospital should have a __-__ bpm increase in their resting HR
10-20
RPE <11
82
Those in an outpatient/inpatient rehab center should reach __-___% of their HRR.
40-70%
83
Those in an outpatient/inpatient rehab center should reach __-___% of their HR max.
55-80%
RPE 11-14
