2.5- Stroke III: Impairments Flashcards Preview

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Flashcards in 2.5- Stroke III: Impairments Deck (53):
1

When does a stroke patient experience flaccid paralysis?

very early due to cerebral shock (systems shut down)

2

What happens to muscles during flaccid paralysis?

* they can't contract or initiate movement

* no reflex activity, atrophy of muscle, some fasciculation

3

How long does the period of low tone last?

It is very transient- lasts minutes to weeks. (48 hours is fairly common)

* longer it lasts the worse the prognosis

4

T or F: A PT should start therapy as soon as a patient goes into flaccid paralysis.

False.

Generally doesn't pay to start PT until shock is over (can only position, can't do much else)

5

First sign of flaccid paralysis recovery occurs _______ and works its way ______.

Tone increases first in ____________.

proximally to distally

shoulder and hip

6

What occurs as cerebral shock dissipates?

Spastic Paralysis

7

Spastic paralysis is characterized by __________.

exaggerated deep tendon reflexes and increased muscle tone

8

Normal reflexes becomes hyperreflexive _______>______. What causes this?

proximal > distal

loss of upper motor neuron influence (no more upper motor neuron inhibition) and abnormal processing of sensory info

9

Spastic paralysis clinical findings:

1. increased resistance to _________

2. _________ of deep tendon reflex

3. Posturing of extremities into _______

4. May eventually develop true ____ as a result

1. passive stretch

2. hyperreflexia

3. synergies (muscles, specifically antigravity muscles, increase tone in characteristic patterns)

4. contractures

10

Upper Extremity Flexion Synergy~

a. develops initially in _____ with _____ and ______ of ________

b. elbow _____, forearm _____, wrist and finger _____

a. develops initially in shoulder girdle with adduction and downward rotation of scapula

b. elbow flexion, forearm pronation, wrist and finger flexion

11

Lower Extremity Extensor Synergy~

a. pelvis ______, hip ______ and ______

b. knee ______, ankle ______, toes _____

a. pelvis retracts, hip adduction and IR

b. knee extension, ankle PF with supination, toes flex

12

What is the Ashworth Scale?

a clinical tool used to assess the presence of abnormal tone

13

What is the Brunstrom's Stages of Recovery?

stages to describe the characteristic pattern of development of muscle tone and recovery

14

Brunstrom's Stages of Recovery~

a. she believed that each patient passes through each stage but you don't _____________

b. can get ________ and patient will not ______

a. don't always see them

b. can get stuck in any stage and patient will not improve further

15

What is Paresis?

muscle weakness

16

What is Apraxia?

have motor capability to do a specific movement combination, but unable to put steps together (ex. ambulation, dressing)

17

What is:

force production on involved side decreases making initiation and control of movement, maintaining posture difficult

motor units atrophy and are easily fatigued

Parasis

18

T or F: The opposite side of the stroke is not affected.

False.

Opposite side of the stroke ("good side") is also affected and becomes weaker from inactivity

19

Motor Planning Deficits~

a. difficulty __________________

b. most often with _______ hemisphere stroke (motor area)

a. difficulty sequencing movement properly

b. most often with left hemisphere stroke

20

What happens if Apraxia occurs in right hemisphere strokes? (most often in left hemisphere)

problems dressing because the right hemisphere has body image

21

What is proprioception?

affects posture and perception of being upright

22

Proprioception causes problems with ________ and ______. It also causes problems perceiving _______ (also affects weightbearing).

problems with balance and ADL's

problems perceiving upright posture

23

What is Aphasia?

difficulty with language comprehension, oral expression, and use of symbols

24

Communication Problems: Aphasia
a. Broca's - _______ communication
b. Wernicke's - ___________ communication
c. Global - _____________ communication

a. Broca's- expressive
b. Wernicke's- receptive
c. Global- both types of communication

25

________ - difficulty articulating words due to weakness and incoordination of speech muscles.

Dysarthria

26

Flaccid dysarthria - _______ voice

Spastic dysarthria - ________ voice

Flaccid- "breathy" voice

Spastic- irregular voice

27

Facial deficits are often associated with _____________.

cranial nerve involvement

28

What causes facial asymmetries?

weakness of facial muscles, eye muscles, and muscles around the mouth

29

Facial asymmetries limits ability to ________ and may cause ________ or ___________.

limits ability to make facial expressions (social problem) and may cause drooling (social problem) or food to pocket in cheeks.

30

What is Dysphagia?

inability to swallow

* may aspirate into lungs with any food or drink

31

Lower motor Cranial Nerve VII involvement~

a. can't protect ___________

b. lack of ___________ - can cause infection

a. can't protect eye by closing

b. lack of tearing and closing

32

Cardiopulmonary~
a _________% decrease in lung capacity due to decrease in __________, _______, & _______

30-40% decrease due to decrease in chest expansion, decreased function of diaphragm, and fatigue

* reduced vital capacity- must increase respiratory rate to compensate
* shallow breathing can lead to pneumonia

33

Why do stroke patients have decreased cardiac function?

because of a reduced activity level

****significant fatigue with patients

34

Reflexes~
1. Primitive reflexes-
2. Deep tendon reflexes-
3. Spinal level reflexes (withdrawal)-

1. Primitive- lost soon after birth may return
2. Deep tendon- decreased during flaccid stage, exaggerated during spasticity
3. Spinal level- function may remain (even in flaccid limbs) but not purposeful

35

How can a patient regain control of incontinence?

early weightbearing (bridging, standing)

36

Neglect- CVA in _________ lobe

parietal
*don't recognize impaired side of body
*impaired perception of vertical

37

______________ - involuntary persistence of the same motor response regardless of stimulation or its duration
* may repeat same action over and over

Motor preservation

38

_______________________ - right CVA

*actively lean and push towards affected side

*___________ & _____________ to the right

*absences of _______________

*______________ deficits

Pusher Syndrome


cervical rotation and lateral flexion

tactile awareness

visual

39

What happens if you try to redistribute weight on a patient with Pusher Syndrome? What side of the body has increased weightbearing?

they will resist

they have increased weightbearing on the left

40

Patients with Pusher Syndrome have problems with ______ - they push back and away with uninvolved extremities.

transfers

41

Where does a stroke happen to cause intolerable burning pain, often long after stimulus has been removed?

in the Thalamus

called Thalamus Pain Syndrome

42

What are the two traditional treatment approaches?

1. Neurodevelopmental Theory (NDT)

2. Proprioceptive Neuromuscular Facilitation (PNF)

43

Name a non-traditional approach to therapy treatment.

Constraint Induced Movement Therapy (Forced non-use)

44

What is Constraint Induced Movement Therapy?

forcing the use of the involved side by taking away use of uninvolved side

*uninvolved extremity (most often UE) is restrained 90% of the day for 10-14 days

45

What is "Shaping"?

repetitive actions gradually made harder as improvements occur

46

T or F: Constraint Induced Movement Therapy and Shaping are the same thing.

False.

They are different but can be used together

47

Constraint Induced Movement Therapy~

research finds increased _____ and _____ of movement and increased use in _______

increased quality and skill of movement and increased use in real life

48

What are the 2 theories on why Constraint Induced Movement Therapy works?

1. overcome learned non-use after stroke

2. use dependent cortical reorganization (theory is to force area of cortex to take over damaged area of cortex)

49

How might dependent cortical reorganization work? (3 ways)

a. remaining connections are strengthened
b. silent pathways are unmasked (thru repetition)
c. increased axonal sprouting to overcome gaps

50

Why might the Constraint Induced Movement Therapy positive results exist?

research had very inclusive criteria
- must have some ROM of hand/wrist
- no excessive spasticity
- no serious cognitive deficits
- willing to be compliant

51

TPA is still the gold standard but what 3 methods were discussed to increase the rate of perfusion to the affected stroke area.

1. mechanical clot retrieval (go up, grab it, pull it out)
2. suction devices
3. intra-arterial ultrasound (to bust the clot up_

52

____________________ - designed to limit the natural cascade that occurs after an injury

Neuroprotective therapies

53

Neuroprotective therapies~

*limit the over-aggressive actions of the ____ cells

*some of these drugs are delivered ____, some are inserted via ____ right into the area of the brain which has been damaged

* glial cells

* some delivered IV, some inserted via catheter