2.5- Stroke III: Impairments Flashcards Preview

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

When does a stroke patient experience flaccid paralysis?

very early due to cerebral shock (systems shut down)


What happens to muscles during flaccid paralysis?

* they can't contract or initiate movement

* no reflex activity, atrophy of muscle, some fasciculation


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


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


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


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

Tone increases first in ____________.

proximally to distally

shoulder and hip


What occurs as cerebral shock dissipates?

Spastic Paralysis


Spastic paralysis is characterized by __________.

exaggerated deep tendon reflexes and increased muscle tone


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


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


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


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


What is the Ashworth Scale?

a clinical tool used to assess the presence of abnormal tone


What is the Brunstrom's Stages of Recovery?

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


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


What is Paresis?

muscle weakness


What is Apraxia?

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


What is:

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

motor units atrophy and are easily fatigued



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


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


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


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

problems dressing because the right hemisphere has body image


What is proprioception?

affects posture and perception of being upright


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

problems with balance and ADL's

problems perceiving upright posture


What is Aphasia?

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


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


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



Flaccid dysarthria - _______ voice

Spastic dysarthria - ________ voice

Flaccid- "breathy" voice

Spastic- irregular voice


Facial deficits are often associated with _____________.

cranial nerve involvement


What causes facial asymmetries?

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


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.


What is Dysphagia?

inability to swallow

* may aspirate into lungs with any food or drink


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


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


Why do stroke patients have decreased cardiac function?

because of a reduced activity level

****significant fatigue with patients


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


How can a patient regain control of incontinence?

early weightbearing (bridging, standing)


Neglect- CVA in _________ lobe

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


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

Motor preservation


_______________________ - right CVA

*actively lean and push towards affected side

*___________ & _____________ to the right

*absences of _______________

*______________ deficits

Pusher Syndrome

cervical rotation and lateral flexion

tactile awareness



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


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



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

in the Thalamus

called Thalamus Pain Syndrome


What are the two traditional treatment approaches?

1. Neurodevelopmental Theory (NDT)

2. Proprioceptive Neuromuscular Facilitation (PNF)


Name a non-traditional approach to therapy treatment.

Constraint Induced Movement Therapy (Forced non-use)


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


What is "Shaping"?

repetitive actions gradually made harder as improvements occur


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


They are different but can be used together


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


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)


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


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


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_


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

Neuroprotective therapies


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