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711 Adult Neurological Rehab > Vascular Syndromes > Flashcards

Vascular Syndromes Flashcards

1
Q

2 types of stroke

A

Ischemic Stroke and Hemorrhagic Stroke

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2
Q

Ischemic Stroke (most common)

A

Results from thrombosis (static clot) or embolism (traveling clot)

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3
Q

Hemorrhagic Stroke (most fatal)

A

Bleeding into the brain tissue. Can result from hypertension, aneurysm, or head injury.

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4
Q

Risk Factors for CVA

A

Age, Sex (men more likely), Race (African Americans more likely), HTN, High cholesterol, cigarette smoking, diabetes, prior stroke, obesity, heart disease

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5
Q

Define Thrombi

A

clots formed by plaque development in a vessel wall

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6
Q

Define Cerebral infarct

A

Death of a portion of the brain resulting from a thrombolytic CVA

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7
Q

Define Lacunar Infarct

A

Small clot located in the deep region of the brainstem and subcortical structures.
Result in less severe impairment.

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8
Q

Define Emboli

A

Clots that dislodge from their site of origin and travel to a cerebral blood vessel where they become trapped and interrupt blood flow.

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9
Q

Define Aneurysm

A

Bulge occurring in a blood vessel wall as a result of a clot formation.

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10
Q

Transient Ischemic Attack (TIA)

A

“mini stroke”

Focal ischemic cerebral incidents lasting for less than 24 hours

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11
Q

Signs and Symptoms of TIA

A 
Numbness and mild weakness on one side of the body.
Transient visual disturbances.
Dizziness
Falls
Confusion with possible blackouts
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12
Q

Middle Cerebral Artery Supplies:

A

Lateral surfaces of the frontal, temporal, and parietal lobes.
Also, the inferior surface of the portions of the frontal and temporal lobes.

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13
Q

Most common artery occlusion resulting in CVA

A

Middle cerebral artery

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14
Q

Middle Cerebral Artery Left Hemisphere CVA S&S:

A 
Contralateral Hemiplegia
Contralateral Hemiparesthesia
Aphasia
Cognitive Involvement
Affective Involvement (emotional lability and depression)
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15
Q

Middle Cerebral Artery Right Hemisphere CVA S&S:

A 
Contralateral Hemiplegia
Contralateral Hemiparesthesia
Left neglect syndrome
Apraxia
cognitive involvement
Euphoria
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16
Q

Posterior Cerebral Artery Supplies:

A

Medial and Inferior surfaces of temporal and occipital lobes.

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17
Q

Posterior Cerebral Artery CVA s&s:

A

Memory loss
Visual Perceptual Deficits
Visual Field Cuts

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18
Q

Anterior Cerebral Artery Supplies:

A

Superior, lateral, and medial aspects of the frontal and parietal lobs. Basal Ganglia and Corpus Callosum

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19
Q

Anterior Cerebral Artery CVA S&S:

A 
Contralateral Hemiplegia
Contralateral Hemiparesthesia
Cognitive Involvement
Frontal Lobe Involvement
Apraxia
Affective Involvement
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20
Q

Posterior Inferior Cerebellar Arterial Supplies:

A

Cerebellar peduncles and medulla

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21
Q

Posterior Inferior Cerebellar Arterial CVA S&S:

A

Ipsilateral hypertonicity
Ipsilateral Hyperactive Reflexes
Vertigo, Nausea, Nystagmus

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22
Q

Anterior Inferior Cerebellar and Superior Cerebellar Arterial Occlusion May Result in:

A 
Ipsilateral ataxia
ipsilateral hypotonicity
hyporeflexia
dysmetria
adiadochokinesia
movement decomposition
asthenia
rebound phenomenon
staccato voice
ataxic gait
intention tremor
incoordination
facial sensory impairment
dysphagia
dysarthria
Bell's Palsy
Nystagmus, vertigo, nausea
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23
Q

Anterior Spinal Artery Supplies:

A

Medulla (pyramids, vestibular, hypoglossal, glossopharyngeal, and vagal nerve nuclei)

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24
Q

Anterior Spinal Artery CVA S&S:

A

contralateral hemiplegia (pyramids)
deviation of tongue to affected side (hypoglossal)
Dysphagia and loss of Gag Reflex (glossopharyngeal/vagus)
Nystagmus and Balance Disturbances (vestibular)

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25
Q

Vertebral Artery Supplies:

A

lateral aspect of the low medulla, including accessory nuclei

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26
Q

Vertebral artery CVA S&S:

A

dysphagia

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27
Q

Basilar Artery Supplies:

A

Pons( including corticospinal tract and the abducens, trigeminal, and facial nerve nuclei)

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28
Q

Basilar Artery CVA S&S:

A

contralateral hemiplegia (corticospinal tract)
medial/internal strabismus (abducens)
Loss of masseter and corneal reflex (trigeminal)
Bell’s Palsy and hyperacusis (facial)

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29
Q

Acute CVA Management

A

Monitor patient’s neurological function
prevent secondary complications
regulate: BP, cerebral perfusion, intracranial pressure

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30
Q

Flexor Synergy Pattern

A 
Scapula elevation & retraction
shoulder abduction & ER
elbow flexion
forearm supination
wrist flexion and ulnar deviation
fingers flexion and adduction
thumb flexion and adduction
hip flexion, ABD, and ER
Knee flexion
ankle DF and inversion
toes DF
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31
Q

Extension Synergy Pattern

A 
scapula protraction and depression
shoulder horizontal ADD and IR
elbow extension and pronation
forearm pronation
wrist extension
fingers flexion and ADD
thumb flexion and ADD
hip extension, ADD, and IR
knee extension
ankle PF and Inversion
Toes PF
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32
Q

Define Associated Reactions

A

Stereotyped movements in which effortless use of one extremity influences the posture and tone of another extremity.

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33
Q

What may have the strongest body of evidence of any therapy intervention for stroke

A

Constraint Induced Movement Therapy (CIMT)

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34
Q

Forced Use (in CIMT)

A

Wearing splint/mitt/sling on unaffected arm for 90% of waking hours

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35
Q

Shaping (in CIMT)

A

6 hours a day of progressive task-related practice

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36
Q

Minimum criteria for CIMT

A

10 degrees of active wrist extension, thumb abduction, and finger extension

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37
Q

Limitations of CIMT

A

Time (6 hours a day), personnel hours (6 hours a day), must have partial function intact in hand/wrist, difficult to maintain compliance with restraint schedule

38
Q

Modified CIMT reduces what compared to regular CIMT?

A

Time needed (from 6 hours down to 2 hours)

39
Q

One main potential problem with mental practice with motor imagery is ______ _______ _______.

A

limited cognitive function

40
Q

Placing a block on a shelf, simulated drinking from a glass, and transferring a peg from a table to a hole underneath a shelf are examples of _______ ___ _______.

A

Bilateral Arm Therapy (BAT)

41
Q

Seeing a loss in shoulder external rotation, followed by abduction and flexion would be indicative of _______ _______.

A

Adhesive capsulitis

42
Q

The best mobilizations to improve adhesive capsulitis are what?

A

Posterior and inferior joint mobs

43
Q

Treatment for subluxation may include what?

A

RTC muscle strengthening, shoulder girdle muscles and scapula muscle strengthening, taping, and NMES

44
Q

Requirements of balance include:

A

Ability to maintain quiet stance.
Ability to move within base of support.
Ability to correct for unexpected perturbations.
Ability to walk on even surfaces with sufficient stability naturally.
Ability to navigate obstacles and environmental constraints.

45
Q

To redistribute plantar flexion contractures that may arise from stroke is to insert what?

A

Heel lifts and/or shoe buildups

46
Q

A “pusher” stroke patient would push towards what side?

A

Towards the involved side

47
Q

T/F? Breaking the push in sitting will carry over to standing.

A

False, you must break the push in each position.

48
Q

3 steps in treatment of pushing syndrome

A

Self awareness, active correction, translation

49
Q

Sub-maximal measure of aerobic capacity that is targeted at people with at least moderately severe impairment

A

6-Minute Walk Test

50
Q

Outcome measure that analyzes walking speed of preferred vs. fast

A

10 meter Walk Test

51
Q

Four Subtests of the Action Research Arm Test

A

Grasp, Grip, Pinch, Gross Movement

52
Q

Test for passive muscle tone with patient in supine

A

Ashworth

53
Q

Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM. What is the Ashworth Grade?

A

1+

54
Q

No increase in muscle tone. What is the Ashworth Grade?

A

0

55
Q

What does PNF stand for? And what is it?

A

Proprioceptive Neuromuscular Facilitation, it is synergistic muscle contraction patters which are identified as components of normal movement

56
Q

More marked increase in muscle tone through most of the ROM, but the affected part(s) easily moved. What is the Ashworth Grade?

A

2

57
Q

14-tem scale designed to measure balance and fall risk of the older adult

A

Berg Balance Test

58
Q

Test that is useful in identifying gait deviations and improvements as a result of treatment with excellent test and re-test results

A

Dynamic Gait Index

59
Q

Measure of extremity impairment severity, measure more arm movement than leg, widely used quantitative measure of motor impairment

A

Fugl Myer Motor Performance

60
Q

Describe Fugl Myer Motor Performance Scale from 0, 1, and 2

A

0 = cannot perform, 1 = performs partially, 2 = performs fully

61
Q

True or False: Functional Reach Test allows the patient to reach as far they can with taking a step

A

False: Reach as far as patient can go without taking a step

62
Q

Variation for functional reach test for individuals who are unable to stand

A

Modified Functional Reach Test, patient sitting with hips, knees, and ankles positioned at 90 degree of flexion with feet positioned on floor

63
Q

Describe D2 Extension Pattern for PNF (lower body)

A

Extension, adduction, ER of hip, ankle PF and inversion

64
Q

Test utilized within the first 3 months after a stroke has occurred yet can be used with anyone with suspected balance deficits. (High validity and reliability).

A

Postural Assessment Scale for Stroke Patients

65
Q

59 item measure with 8 domains measured such as strength, hand function, ADL/IADL, mobility, communication, etc.

A

Stroke Impact Scale

66
Q

Scale which quantifies muscle spasticity by assessing the response of the muscle to stretch applied at specified velocities

A

Tardieu Spasticity Scale

67
Q

Hands-on problem solving approach which involves direct handling and guidance of patients to optimize function

A

NDT or Neurodevelopmental Treatment Approach

68
Q

Main problem in patients with UMN lesions (2 answers)

A

abnormal coordination, abnormal postural tone

69
Q

Aims or goals of NDT (2 answers)

A

selective movement patterns in preparation for functional skills, and reduction of spasticity

70
Q

By moving the (1-blank) part of the body it is possible to influence and change movements of the (2-blank) parts

A

1- proximal, 2 - distal

71
Q

What does PNF stand for? And what is it?

A

Proprioceptive Neuromuscular Facilitation, it is synergistic muscle contraction patters which are identified as components of normal movement

72
Q

Describe D1 Flexion Pattern for PNF (upper body)

A

flexion, adduction, ER (shoulder), flexion of wrist and fingers. “driver reaching back for seatbelt”

73
Q

Describe D1 Extension Pattern for PNF (upper body)

A

Extension, abduction, IR (of shoulder), extension of wrist and fingers, “driver buckling seatbelt”

74
Q

Describe D1 Flexion Pattern for PNF (lower body)

A

Flexion, adduction, ER of hip, dorsiflexion and inversion of foot, “crossing soccer ball kick”

75
Q

Describe D1 Extension Pattern for PNF (lower body)

A

Extension, abduction, IR of hip, plantarflexion (extension) and eversion of foot

76
Q

Describe D2 Flexion Pattern for PNF (upper body)

A

Flexion, abduction, ER of shoulder, wrist and finger extension, “drawing sword/holding tray”

77
Q

Describe D2 Extension Pattern for PNF (upper body)

A

Extension, adduction, IR of shoulder, wrist and finger flexion, “replacing sword”

78
Q

Describe D2 Flexion Pattern for PNF (lower body)

A

flexion, abduction, IR of hip, ankle DF and eversion

79
Q

Describe D2 Extension Pattern for PNF (lower body)

A

Extension, adduction, ER of hip, ankle PF and inversion

80
Q

Pelvic Patterns (PNF): Describe what anterior and posterior movements of the hip and what phase of gait they correspond with

A

Anterior elevation: swing phase, posterior depression: heel strike/midstance

81
Q

Typical adhesive capsulitis presentation

A

Loss of shoulder external rotation, followed by abduction and flexion

82
Q

Treatment for adhesive capsulitis

A

Inferior portion of the capsule most damaged, as well as posterior joint tightness, so inferior and posterior glides are most important joint mobs to apply

83
Q

Requirements for retraining balance

A

Ability to maintain quiet stance
Ability to move within base of support
Ability to correct for unexpected perturbations
Ability to walk on even surfaces with sufficient stability, mechanical energy, and foot clearance
Ability to navigate obstacles and environmental constraints

84
Q

Balance Specific Assessment Tests for patients with a stroke

A

Trunk Impairment Scale: Sitting balance test
Berg Balance Test: Predicts falls in the SUBACUTE phase, and determines length of stay (>20 on the test=home)
Postural Assessment Scale for Stroke (PASS): includes sitting balance and transfers and can predict functional outcomes

85
Q

Heel lifts to accomodate plantar flexion contractures works by:

A

Reducing spastic synergy
Reducing knee hyperextension
Improving ability to shift COG forward in BOS (for sit to stand)
Enables patient to relax which may allow for better passive stretching

86
Q

Which LE muscles are often most weak in stroke patients?

A

Hip extensors and abductors.

Although, If knee buckles, address quadriceps first in strength training

87
Q

Progression for TUG (Timed up and Go Test) in patients who need cognitive management

A

Cognitive= counting backwards by 3’s while performing TUG
Manual: Carrying a glass of water while performing TUG
Healthy adults are at an increased risk of falling if > 15 seconds on TUG

88
Q

Pusher syndrome is usually when a patient pushes towards or away from the hemiparetic side?

A

Towards the hemi side

89
Q

What lesion/area of the brain is most related to pushing syndrome?

A

lesion in the posterolateral thalamus, which is an area of the thalamus know to relay vestibular information to the cortex

90
Q

What postural disorders should you differentiate pushers syndrome from?

A

Thalamic Astasia- Unable to sit up and fall to hemiplegic side, but do not resist correction
Cerebellar and brain stem lesions- tilt of subjective visual vertical ; Lateropulsion without resistance to correction
Vestibular cortex lesions- tilt of subjective visual vertical without pushing behavior

91
Q

What are the three steps to treat pushers syndrome?

A

Self Awareness
Active Correction
Translation (sit on mat, bed, toilet…different environments)

92
Q

Do you transfer a pusher patient to the strong side?

A

No- modified stand pivot to the hemiplegic side, but need to progress to being able to transfer with strong side as well.

711 Adult Neurological Rehab (12 decks)

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