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Week 2 Flashcards

1
Q

Primary neuromuscular impairments after CVA

A
  • damage to descending cortical drive
  • type 1 increase, type 2 decrease - loss of force production
  • loss of motor units and asynchronous/abnormal motor unit firing
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2
Q

Secondary muscular impairments after CVA

A
  • increased fatigue
  • delayed reaction times
  • prolonged movement times
  • disuse muscular atrophy
  • length-tension changes
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3
Q

A set of internal processes associated with feedback or practice leading to relatively permanent changes in the capability for motor skill

A

motor learning

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4
Q

The reappearance of motor patterns present prior to CNS injury performed in the same manner as prior to injury

A

motor recovery

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5
Q

Sequential Motor Recovery Stages Following Stroke

A

Stage 1 – flaccidity and no movement of limbs
Stage 2 – minimal voluntary movement responses and spasticity begins
Stage 3 – voluntary control of movement synergies and increased spasticity (can be severe)
Stage 4 – movement combos that don’t follow the paths of either synergy and spasticity begins to decline
Stage 5 – difficult movement combos are learned, and synergies lose their dominance
Stage 6 – disappearance of spasticity and individual joint movements are possible with coordination

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6
Q

Fugl-Meyer Assessment MDC and MCID

A

MDC - 5.4 UE and 5 LE

MCID - 10 UE/LE

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7
Q

Rivermead Motor Assessment MCID

A

3 points

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8
Q

dysmetria

A

inability to judge distance or ROM

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9
Q

Dyssynergia

A

fragmented movement patterns

  • Movements occur in sequence of component parts rather than a single & coordinated smooth output
  • jerkiness, have to break down complex movements to individual movements
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10
Q

Asynergia

A

loss of ability to associate muscles together for complex movements

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11
Q

Rebound phenomenon

A

inability to rapidly and sufficiently halt movement of a body part after a strong isometric force

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12
Q

Typical patterns of spasticity in scapula

A

retraction, downward rotation

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13
Q

Typical patterns of spasticity in shoulder

A

adduction and IR, depression

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14
Q

Typical patterns of spasticity in elbow

A

flexion

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15
Q

Typical patterns of spasticity in forearm

A

pronation

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16
Q

Typical patterns of spasticity in wrist

A

flexion, adduction

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17
Q

Typical patterns of spasticity in hand

A

finger flexion, clenched fist thumb, adducted in palm

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18
Q

Typical patterns of spasticity in pelvis

A

retraction (hip hiking)

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19
Q

Typical patterns of spasticity in hip

A

adduction, IR, Extension

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20
Q

Typical patterns of spasticity in Knee

A

flexion and extension

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21
Q

Typical patterns of spasticity in foot and ankle

A

PF, INversion, Equinovarus, toes claw, toes curl

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22
Q

Typical patterns of spasticity in hip and knee

A

flexion, sacral sitting

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23
Q

Typical patterns of spasticity in trunk

A

lateral flexion w/ concavity, rotation

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24
Q

Typical patterns of spasticity in posture forward (prolonged sitting posture)

A

excessive forward flexion and forward head

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25
Q

Acute endurance recommendations

A

< 11-12 RPE (3-4 mRPE)
Resting HR + 10-20bpm
walking, ADLs, standing activities

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26
Q

IP/Outpatient Rehab endurance recommendations

A

RPE 11–14 (3-5/6 mRPE)
40%–70% VO2 reserve or HR reserve; 55%–80% HRmax

20-60min/session, 3-5x/week
+adequate warm-up and cool-down

large muscle groups

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27
Q

General slowing of cognitive & motor processes

A

lethargy

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28
Q

Dulled or blunted sensitivity, difficult to arouse

A

obtundation

29
Q

State of semi-consciousness, only arouses with intense stimulation

30
Q

Unconsciousness

31
Q

What are the cutoff scores for the Glasgow Coma Scale (GCS) and what do they tell you?

A

scores 3-15
< 8 severe
9-12 moderate
13-15 mild

measures level of consciousness

32
Q

R hemisphere lesion behavior

A
  • difficulty perceiving emotions
  • difficulty w/ expression of negative emotions
  • irritability, confusion
  • impulsive, quick movements
  • poor judgement
  • rigidity of thought
  • poor insight/absent awareness of impairments
  • high safety risk
33
Q

L hemisphere lesion behavior

A
  • difficulty w/ expression of positive emotions
  • slow, anxious, cautious
  • disorganized and distracted when attempting to complete a task
  • compulsive behavior
  • aware of impairments
  • need extra coaxing to participate
  • high safety risk
34
Q

R hemisphere lesion perceptual deficits

A
  • body scheme impairments - unilateral neglext, Pusher’s syndrome, anosognosia (unaware of condition/think they are fine), somatagnosia, R-L discrimination
  • difficulties w/ spatial relationships - hand eye coordination, figure-ground, position in space
  • agnosias - visual, auditory, sensory
35
Q

L hemisphere lesion perceptual deficits

A
  • apraxia - ideational and ideomotor
36
Q

Where is the lesion for most patient’s with Pusher’s syndrome? Which side do they push to?

A

R hemisphere centered in area of posterolateral thalamus

- Tendency to push strongly towards the paretic side with nonaffected limbs

37
Q

Additional symptoms w/ R hemispheric pusher’ syndrome

A
  • left hemiplegia

- High association with left spatial and sensory neglect

38
Q

Additional symptoms w/ L hemispheric pusher’ syndrome

A
  • right hemiplegia

- high association w/ aphasia

39
Q

clinical observations seen for vision post stroke

A
  • head turn or tilt during tasks
  • avoidance of near tasks
  • One eye appears to go in, out, up, or down
  • vision shifts from eye to eye as indicated by head tilting
  • closes or covers one eye/squints (double vision)
  • bumps into walls/objects when moving (field cut)
  • misjudge distance
  • difficulty finding things
40
Q

What are common visual dysfunction presentations seen post stroke?

A
  • refractive errors - near/farsightedness, astigmatism, blurry vision - CN 2 nuclei and associated CNS areas
  • impaired accommodation - CN 2 and visual tract/visual cortex
  • visual field loss - CN 2 and visual tract/visual cortex
  • impaired pursuits and saccades - cerebellum
  • diplopia - cerebellum
  • ptosis - CN 2-6 and associated CNS areas
  • ocular motility disturbance - CN 2-6 and associated CNS areas
41
Q

blood supply for retina and extra-cranial optic nerve

A

ophthalmic artery

42
Q

blood supply for intracranial optic nerve and optic chiasm

A

anterior cerebral
anterior comminicating
superior hypophyseal

43
Q

blood supply for optic tract

A

posterior communicating and anterior choroidal arteries

44
Q

blood supply for optic radiation

A

middle cerebral artery and posterior cerbral artery

45
Q

blood supply for lateral geniculate nucleus

A

anterior and posterior choroidal arteries

46
Q

What would VOR look like if stroke occurred in Pons?

A
  • loss of abducens nucleus
    When looking R, L eye doesn’t abduct
    When looking L, R eye doesn’t abduct
47
Q

What would VOR look like if stroke occurred in Midbrain?

A
  • loss of oculomotor nucleus
    When looking R, R eye wouldn’t adduct
    When looking L, L eye wouldn’t adduct
48
Q

What are different ways (in general) that sensory dysfunction can present post stroke?

A

cortical lesions - specific localized areas of dysfunction

thalamic lesions - diffuse involvement

49
Q

Hypo/hyperesthesia

A

decreased/increased sensitivity to sensory stimuli

50
Q

Paresthesia

A

abnormal sensation such as numbness, prickling, or tingling

51
Q

Dysesthesia

A

touch sensation experienced as pain

52
Q

allodynia

A

pain produced by non-noxious stimuls

53
Q

analgesia

A

complete loss of pain sensitivity

54
Q

hyperalgesia

A

increased sensitivity to pain

55
Q

atopognosia

A

inability to localize sensation

56
Q

What are the 3 most common predictors of falls for acute and subacute stroke survivors

A
  • functional impairment
  • cognitive deficits
  • impaired balance
57
Q

primary blood supply for primary visual cortex

A

posterior cerebral artery

58
Q

What are the functional implications of hypotonia?

A 
Reduced ability to resist pull of gravity
Increased stress on joints
Reduced postural control
Clumsy or incoordinated movements
Impaired balance
Reduced power
Increased fatiguability
59
Q

What are the functional implications of spasticity?

A
  • contractures
  • skin breakdown
  • pain
  • abnormal posture
  • abnormal movement patterns
  • impaired balance
60
Q

As a PT, when is it appropriate to advocate to the interdisciplinary team that your patient might be appropriate for anti-spasticity medical management?

A
  • tone is interfering w/ function
  • pain consideration
  • presence of clonus/risk of skin breakdown
61
Q

What are the post stroke strengthening recommendations put out by the AHA/ASA?

A
  • 1-3 sets of 10-15 reps
  • 8-10 exercises involving major muscle
  • 50-80% of 1 rep max
  • 2-3 days/week
  • resistance gradually increased over time as tolerated
62
Q

What stroke is pseudobulbar affect correlated with?

A

Correlated with inferior frontal and inferior parietal lobe damage (R or L)

63
Q

Where might the lesion be if a patient has apraxia?

A
  • premotor frontal cortex
  • left inferior parietal lobe
  • corpus collosum
64
Q

What plays a significant role in a patient’s progression through the 6 stages of motor recovery?

A
  • initial weakness
  • presence of spasticity
  • cognitive deficits
  • access to rehab
65
Q

potential exam findings for cerebellum CVA outside of ataxia, dysmetria, and balance

A

IPSILATERAL

  • oculomotor deficits
  • lack of check reflex
  • mild hypotonia
  • intentional tremor
  • slurred speech
  • significant difficulties w/ motor learning
66
Q

potential exam findings for basal ganglia CVA outside of ataxia, dysmetria, and balance

A

CONTRALATERAL

  • spasticity
  • resting and intentional tremor
  • difficulty initiating movements
  • slowed/smaller movements
  • considerable strength deficits
67
Q

potential exam findings for dorsal column CVA outside of ataxia, dysmetria, and balance

A

CONTRALATERAL

  • abnormal sensory exam - proprioception
  • no tremor
68
Q

What is most closely associated w/ depression post CVA?

A

fatigue - lack of physical and mental energy

69
Q

What are indications for immediate cessation of exercise?

A

1 - lightheadedness
2 - dizziness
3 - chest heaviness, pain or tightness; angina
4 - heart palpitations or irregular heart beat
5 - sudden SOB not due to increased activity
6 - volitional fatigue and exhaustion

Neuro 1 (11 decks)

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