10/11 - CVA Pathology and Medical Management Flashcards

Question

Physical Therapy Examination - Review

Answer 1

History and systems review Identify problem areas individual therapist Make hypotheses Test your hypotheses with your examination task analysis tests and measures Clinical Impression Link participation difficulties with activities and impairments Combined with the history what is the prognosis for change? How do you prioritize your interventions? Set goals that address impairments in body structure and function AND activities

Answer 2

``` History Age and living situation Participation and Activity level Type and location of stroke How long since stroke Medications Blood pressure parameters Co-morbid pre-morbid conditions ``` ``` Systems Review Neuromuscular Musculoskeletal Cardiopulmonary/Vascular Cognition/Communication Integumentary Genitourinary Gastrointestinal Endocrine ```

Answer 3

``` Lack of adequate force production Lack of adequate timing Abnormal synergistic movement patterns Muscle imbalance Lack of adequate motor planning Decreased postural control Sensory-Perceptual visual deficits ```

Answer 4

``` <30 Berg Balance Score Apraxia Cognitive deficits Low Functional Independence Measure (FIM) scores Predictive of increased fall rates ```

Answer 5

Self-reported persistent balance problems while dressing is predictive of falls

Answer 6

Incontinence Medications History of falls These factors are not predictive of falls post CVA

Answer 7

Loss of ability to execute skilled or learned movement patterns on command in the absence of weakness sensory loss comprehension difficulty abnormality of tone or posture or intellectual deterioration.

Answer 8

Planning of a movement fails | Patient is unable to conceptualize how a movement pattern must be organized.

Answer 9

Plan for the movement is intact but the execution fails. Damage within pathways connecting the areas in which the plan is conceived to those responsible for innervating the motor plan

Answer 10

Impairment of language associated with damage to the language dominant hemisphere. Nearly always involves damage to the left fronto-temporal and/or temporo-parietal regions. May affect verbal expressive output fluency comprehension naming reading writing and repeating.

Answer 11

commonly associated with a large lesion in the frontal temporal and parietal lobes of the brain causing an almost total reduction of all aspects of spoken and written language

Answer 12

loss of the ability to produce language (spoken or written)

Answer 13

loss of ability to understand language (spoken or written)

Answer 14

Failure to attend to respond to and/or report stimulation that is introduced contralateral to the lesion. Most often seen with non-dominant parietal association area lesions. Affects contralesional side. Persistent neglect is a negative functional outcome predictor.

Answer 15

Contralateral hemineglect of patient?s own body associated with anosagnosia (denial of deficit)

Answer 16

Hemispatial neglect of contralateral stimuli within reaching distance.

Answer 17

Hemispatial neglect of contalateral stimuli beyond reaching distance.

Answer 18

Difficulty producing speech

Answer 19

Difficulty swallowing Difficulty eating Dealing with secretions

Answer 20

``` 6MWT 10 m walk Modified Ashworth Scale Berg Balance Test Functional Reach Test Dynamic Gait Index Fugl-Meyer (Motor ) Orpington Prognostic Scale Postural Assessment Scale for Stroke Stroke Impact Scale Tardieu Spasticity Scale Action Research Arm Test (ARAT) Chedoke-McMasters ```

Answer 21

100 point motor domain is reliable valid and responsive to clinical change

Answer 22

Measure of impairments and disability level Impairments in 6 dimensions: shoulder pain postural control arm hand leg foot measured on a 7 point scale following Brunnstrom stages Disability measured by gross motor function and walking measured on same 7 point scale as FIM

Answer 23

``` Maintaining a Posture (0-3) Sitting without support with feet on floor Standing with support Standing without support Standing on non-paretic leg Standing on paretic leg Changing Posture (0-3) Supine to affected side lateral Supine to non-affected side lateral Supine to sitting EOT Sitting on edge of table to supine Sitting to standing Standing to sitting Standing picking up pencil from floor ```

Answer 24

Questionnaire 5 point scale - Not Difficult at all to Extremely Difficult Physical problems Memory and thinking Mood and emotions Communication Activities in a typical day Mobility in home and community Hand function Ability to participate in usual meaningful activities On a scale of 0=100 how much have you recovered?

Answer 25

Total score 0-57 Scored 0-3 on each item Minimal clinical important difference (MCID) 5.7 points

Answer 26

``` Glasgow Coma Scale (GCS) NIH Stroke Scale (NIHSS) Montreal Cognitive Assessment (MOCA) Modified Tardieu Scale Functional Independence Measure(FIM) ```

Answer 27

EYE OPENING None = 1 Even to supra-orbital pressure To pain = 2 Pain from sternum/limb/supra-orbital pressure To speech = 3 Non-specific response not necessarily to command Spontaneous = 4 Eyes open not necessarily aware MOTOR RESPONSE None = 1 To any pain; limbs remain flaccid Extension = 2 Shoulder adducted and shoulder and forearm internally rotated Flexor response = 3 Withdrawal response or assumption of hemiplegic posture Withdrawal = 4 Arm withdraws to pain shoulder abducts Localizes pain = 5 Arm attempts to remove supra-orbital/chest pressure Obeys commands = 6 Follows simple commands VERBAL RESPONSE None = 1 No verbalization of any type Incomprehensible = 2 Moans/groans no speech Inappropriate = 3 Intelligible no sustained sentences Confused = 4 Converses but confused disoriented Oriented = 5 Converses and oriented TOTAL (3?15): _______

Answer 28

``` Time Intervals: Baseline 2 hours post treatment 24 hours post onset 7-10 days 3 months other Scored 0 1 2 scale with 0 = normal Level of Consciousness Best Gaze Visual Facial Palsy Motor Arm Motor Leg Limb ataxia Sensory Best Language Dysarthria Extinction and Inattention (neglect) ```

Answer 29

MOCA Scale 0-30 Consider language difficulties

Answer 30

Velocity One = V1 Slow movement Goniometric measurement at this joint angle Velocity Two = V2 Fast movement Goniometric measurement at this joint angle May provide more precision in documenting amount of spasticity and amount of contracture

Answer 31

``` 20 functional items measured on 7 point scale: 7 = Independence 6= Modified Independence 5= Supervision (subject does 100%) 4= Minimal Assist (subject does 75%) 3= Moderate Assist (subject does 50%) 2= Maximal Assist (subject does 25%) 1= Total Assistance (subject does < 25%) ```

10/11 - CVA Pathology and Medical Management Flashcards

(55 cards)