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Adult Rehab Week 5 > Willard Spackman -- Cerebrovascular Accident > Flashcards

Willard Spackman -- Cerebrovascular Accident Flashcards

1
Q

CVA results in ___.

A

CVA results in anoxia and damage or death of brain tissue

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2
Q

Two forms of CVA

A

Ischemic and hemorrhagic

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3
Q

Ischemic

A

80% of strokes. Blockage of a blood vessel supplying the brain

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4
Q

Hemorrhagic

A

Rupturing of an artery, causing blood to leak into brain

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5
Q

Incidence and Prevalence of CVA

A
  • Nation’s 4th leading cause of death (133K+ in 2008)
  • About 795K CVAs each year in US w/about 610K of those being first stroke
  • Higher incidence among caucasians
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6
Q

Typical Course

A
  • Course of recovery remains unpredictable
  • Most report decrease in activity, social interaction & overall life satisfaction post stroke
  • Decline in functional status over time after ischemic stroke
  • Cortical reorganization and recovery of function remain possible for years after
  • Approx 25% of stroke survivors will have another stroke within 5 years
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7
Q

Symptoms of CVA

A

Warning Signs = Sudden Onset of:

  • Numbness or weakness of face, arm or leg, especially one side of body
  • Confusion or trouble speaking or understanding
  • Difficulty seeing in one or both eyes
  • Dizziness, trouble walking, loss of balance/coordination
  • Severe headache with unknown cause
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8
Q

Effects of stroke

A
  • Hemiplegia/hemiparesis
  • Apraxia - motor planning problems
  • Dysphagia - difficulty swallowing
  • Dysarthria - oral motor difficulties characterized by poor articulation
  • Aphasia - receptive and/or expressive language & communication deficits
  • Cognitive deficits
  • Visual-perceptual deficits (i.e. homonymous hemianopsia)
  • Somatosensory deficits: impairment of sensation
  • Psychosocial Deficits
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9
Q

CVA Precautions

A
  • During recovery, assess medical status daily before intervention, be attentive to symptoms of progressive or recurring stroke
  • Monitor cardiac and respiration fluctuations (dizziness, breathing difficulties)
  • Fall prevention during all transitional movements
  • Never move individual by affected UE, shoulder injury or pain
  • Skin integrity, monitor frequently especially w/visual field deficits or unilateral neglect
  • Refer to ST to determine swallowing ability and follow safe techniques during feeding
  • Poor safety awareness and impulsive behavior
  • Follow prevention programs set in place to prevent contractors
  • Educate the individual and family regarding general safety concerns
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10
Q

CVA Risk Factors & Prevention

A
  • Risk factors: alcohol/tobacco use, inactivity, high BP & cholesterol, heart disease, diabetes, sickle cell anemia, obesity, previous stroke, family history and aging
  • Prevention: healthy diet & weight, physically active, avoiding tobacco use, limiting alcohol, managing other medical conditions
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11
Q

Interdisciplinary interventions

A

Medications, surgery, rehabilitation therapies

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12
Q

Medications

A
  1. Thrombolytic agents - For ischemic stroke. Dissolves blood clot blocking flow to brain. Administer w/in 3hrs of stroke symptom onset. Effectiveness decreases w/time.
  2. Antithrombotics (anticoagulants and antiplatelets agents) - Prevents formation of blood clot that could block a cerebral artery. Prescribed appropriately, could decrease risk of first or recurrent stroke. Antiplatelets (aspirin or clopidogrel) prevent clotting by reducing activity of platelets in blood. Anticoagulants (warfarin or heparin) decrease risk by diminishing blood’s clotting property.
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13
Q

Surgery

A
  1. Carotid endarterectomy - plaque removed from walls of one of the carotid arteries, one of the main blood supplies to the brain. Effective prevention for people with constricted or narrowed vessels.
  2. Angioplasty - Less invasive. Inflated balloon widens clogged artery and a stent inserted to prevent narrowing.
  3. Extracranial/intracranial bypass - Controversial procedure for prevention or treatment. Reroutes a healthy artery from scalp, to area of brain where tissue is deprived of blood from a blocked artery.
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14
Q

Rehabilitation therapies

A
  1. PT - restore movement, balance and coordination
  2. Speech - relearn language & speaking skills, communication & swallowing
  3. Psychological/psychiatric - talk therapy and meds to address depression, anxiety, other mental or emotional problems
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15
Q

OT Evals - Comprehensive Evaluations

A
  1. American Heart Association Stroke Outcome Classification (AHA. SOC) - evaluates extent & severity of impairment, level of functional independence
  2. FIM - measures type and amount of assistance needed
  3. National Institutes of Health Stroke Scale (NIHSS) - assesses level of independence
  4. Chedoke-McMaster Stroke Assessment - physical impairment & functional ability
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16
Q

ADL/IADL Evals

A
  1. Assessment of Motor and Process Skills (AMPS) - observational, ADL & IADL performance
  2. Barthel Index (BI) - self-care abilities & level of assistance needed
  3. Activity Card Sort - clients describe their instrumental, social & leisure activities
  4. Frenchay Activities Index - measures ADL & IADL participation
17
Q

UE Function Evals

A
  1. Fugl-Meyer Assessment of Motor Function (FMA )
  2. Functional Test for the hemiplegic/paretic UE
  3. Modified Ashworth Scale (MAS) → muscle spasticity
  4. Goniometry → ROM
  5. MMT, dynamometer, pinch meter → assess strength
  6. Volumeter → edema
18
Q

Balance Evals

A
  1. Berg Balance Scale (BBS)
  2. Postural Assessment Scale for Stroke Patients (PASS)
  3. Motor Assessment Scale (MAS)
19
Q

Cognition/Perception Evals

A
  1. Behavioral Inattention Test (BIT)
  2. Rivermead Behavioral Memory Test (RBMT)
  3. Executive Function Performance Test (EFPT)
  4. Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) - assess orientation, visual & spatial perception, visuomotor organization & thinking operations
  5. Catherine Bergego Scale - behavioral assessment for unilateral neglect
20
Q

Quality of Life Evals

A
  1. COPM
  2. Short-form 36 Health Survey (SF-36) - evaluates health-related quality of life
  3. Stroke Impact Scale (SIS) - self-report health status measure
  4. Stroke-Specific Quality of Life Scale (SS-QOL) - self-report questionnaire
21
Q

Occupational Therapy Interventions

A

May be used in conjunction with one another

  • Neuromuscular: balance training, postural awareness, motor-learning, CIMT
  • Musculoskeletal: strengthening, manual therapy, stretching/passive ROM, edema control, aerobic exercise
  • Cognitive/Perceptual/ Sensory: cognitive therapy, perceptual/visual training, sensory retraining, mental imagery
  • Physical agent modalities/orthotics/splinting: compression, e-stim, biofeedback, robotic therapy
  • Skill acquisition/task-specific training in all areas of occupation
  • Adaptive/compensatory: one-handed, energy conservation, adaptation, AE/AT
  • Educational: family, client, staff
  • Psychosocial: relaxation, stress management, coping skills
22
Q

OT and the Evidence

A
  • Improves role participation and performance in ADL & IADL
  • Increased independence in ADL and maintenance of abilities
  • Enhance OT post-stroke: instruction & feedback, practice of meaningful activities w/in natural contexts, adaptations
  • OT treatments that focus on remediation of impairments, especially those of meaningful occupations or functional goals, have better outcomes
  • Combination of mental & physical practice & feedback is effective for improving upper limb motor recovery
  • Evidence supports use of task-specific, task-oriented and repetitive practice
  • All of above reflects a shift away from previous models of practice
23
Q

Caregiver Concerns

A
  • Various common challenges: lack of info and training, distress, uncertainty of future, lack of support, social isolation, lack of freedom
  • Research should also focus on the positives of caregiving: satisfaction, pride, closeness
  • Caregivers must be educated in caring for themselves physically, emotionally, mentally, spiritually and interpersonally.
  • Caregivers need to be realistic of what they can/can’t do, think positively, take time to themselves, maintain healthy lifestyle, seek support and communicate with others

Adult Rehab Week 5 (7 decks)

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