10/21 CVA Exam, eval Flashcards

Question

Name the likely type and location (if applicable) of stroke: | A 52-year-old man complained of severe headache prior to loss of consciousness

Answer 1

Hemohhragic, subarachnoid - No seizure

Answer 2

Hemorrhagic conversion

Answer 3

``` 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 ```

Answer 4

``` 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 5

<30 Berg Balance Score Apraxia Cognitive deficits Low Functional Independence Measure (FIM) scores

Answer 6

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

Answer 7

While incontinence, medications, and history of falls are predictive of falls in older adults, they are not predictive post-CVA

Answer 8

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 9

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

Answer 10

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 11

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 12

Broca's tends to be more expressive, Wernicke's receptive

Answer 13

Give them time to speak Reduce environmental noise Try other, non-verbal means of communication Confirm that the pt uses yes and no correctly

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.

Answer 15

Persistent neglect is a negative functional outcome predictor

Answer 16

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

Answer 17

Hemispatial neglect of contralateral stimuli within reaching distance.

Answer 18

Hemispatial neglect of contalateral stimuli beyond reaching distance

Answer 19

Difficulty producing speech

Answer 20

Difficulty swallowing Difficulty eating Dealing with secretions

Answer 21

``` 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 22

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

Answer 23

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 24

``` 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 25

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 26

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

Answer 27

Assesses EYE OPENING, MOTOR RESPONSE, VERBAL RESPONSE TOTAL (3–15): _______

Answer 28

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

Answer 29

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

Answer 30

``` 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 ```

Answer 31

``` Level of Consciousness Best Gaze Visual Facial Palsy Motor Arm Motor Leg Limb ataxia Sensory Best Language Dysarthria Extinction and Inattention (neglect) ```

Answer 32

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 33

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%) ```