Cerebrovascular Accident (CVA) (Exam 4) Flashcards Preview

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Flashcards in Cerebrovascular Accident (CVA) (Exam 4) Deck (87):
1

A sudden, focal neurological deficit resulting from ischemic or hemorrhagic lesions in the brain. Disturbance of blood supply to the brain.

CVA or Stroke

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Characterized by motor deficits on the side of the body opposite the site of the lesion.

CVA

3

Paralysis

Hemiplegia

4

Weakness

Hemiparesis

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Hemi refers to ____.

Side of the body effected.

6

Hypoxia due to poor blood supply. 70% _____ stroke.

Ischemic

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Death of brain tissue occurs when blood flow drops below 20% and can be caused by thrombosis or embolus.

Cerebral Infarct

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Traveling blood clot. Associated with atrial fibrillation, MI, valvular disease.

Embolus

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Blood clot. Associated with atherosclerosis.

Thrombosis

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Bleeding due to rupture of a blood vessel in brain causing compression of brain tissue and vessels. 20% of ____ stroke.

Hemorrhage

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_____ is caused by changes in the vessel integrity comply due to HTN, aging, or can just occur.

Hemorrhage

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Subarachnoid, Berry Aneurysm, and Intracerebral.

Types of Hemorrhages

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Abnormal dilation of bifurcation.

Berry Aneurysm

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Developmental defect that produces weakness in blood vessel walls; arteries and veins communicate without conjoining capillary beds. 10%.

Arteriovenous Malformation

15

Risk Factors for Stroke

HTN, Heart Disease (Source of Emboli from walls and valves), Diabetes, Peripheral Arterial Disease, Smoking, Inactivity, Obesity, Alcohol Consumption, Elevated cholesterol and lipids.

16

Begins shortly after onset of stroke and reaches maximum in 3-4 days.

Ischemic Brain Edema (Swelling)

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Swelling gradually subsides by _____.

3 Weeks

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This is not a CVA. Temporary interruption of blood supply to brain. Symptoms resolve in 24 hours. Indicative of thrombotic disease and increased risk for CVA.

Transient Ischemic Attack (TIA)

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Stable, severe deficits.

Major Stroke

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Deteriorating neurological status after admission.

Deteriorating Stroke

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Affecting persons younger than 45.

Young Stroke

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4 Stroke Syndromes

Anterior Cerebral Artery Occlusion
Middle Cerebral Artery Occlusion
Vertebrobasilar Artery Occlusion
Posterior Artery Occlusion

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Frontal and parietal lobes. Contralateral hemiparesis. Contralateral sensory loss. R Hemi (L CVA) aphasia, apraxia, agraphia, unilateral neglect.

Anterior Cerebral Artery Syndrome

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Lateral Cerebral Hemisphere. Most commonly affected. Contralateral spastic hemiparesis. Contralateral sensory loss. L CVA aphasia. R CVA perceptual problems.

Middle Cerebral Artery

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Supplies brainstem and cerebellum. Balance. Basic Needs.

Vertebrobasilar

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Supplies the occipital and temporal lobes, thalamus, and upper brain stem.

Posterior Cerebral

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Contralateral weakness and sensory loss LE.

Anterior Cerebral

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Contralateral weakness and sensory loss face and UE.

Middle Cerebral

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Cranial nerve involvement.

Vertebrobasilar

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Contralateral sensory loss.

Posterior Cerebral

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Patients with CVA in the posterolateral thalamus. Push and lean toward their hemiplegic side.

Pusher Syndrome

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Motor function _____ at onset changing to _____.

Flaccidity, Spasticity
Hyporeflexia, Hyperreflexia

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Unable to move isolated limb segment without movement in remainder of limb.

Abnormal Synergy Patterns

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Most common UE synergy.

Flexor Synergy

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Most common LE synergy.

Extensor Synergy

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Scapular Retraction/Elevation. Shoulder Abduction 90 Degrees with ER or hyperextension of shoulder. Elbow flexion. Forearm supination. Wrist and finger flexion.

Flexor Synergy UE

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Scapular Protraction. Shoulder adduction with IR. Elbow extension. Forearm pronation. Wrist extension with fist closure.

Extensor Synergy UE

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Hip flexion. Hip abduction and ER. Knee flexion 90 Degrees. Ankle DF, Inversion. Toe DF.

Flexor Synergy LE

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Hip extension. Hip adduction and IR. Knee extension. Ankle PF, Inversion. Toe PF.

Extensor Synergy LE

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Abnormal Reflexes

ATNR, STLR, STNR, TLR

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Pressure on bottom of foot results in co-contraction and rigidly extended and fixed limb.

Positive Supporting Reaction

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UMNL, DF - PF Uncontrollably.

Clonus

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Extension and separation of fingers when UE raised above 150 Degrees.

Souges' Phenomenon

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Resistance to hip abduction or adduction noninvolved side evokes same movement on involved side. (LE/LE Both)

Raimiste's Phenomenon

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A response in one extremity facilitates the same response in the other extremity. (UE/LE Same Side)

Homolateral Limb Synkinesis

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Patient may have the motor capabilities to perform movement combination but unable to determine or remember the steps necessary.

Apraxia

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Automatic movement, but no movement on command.

Ideomotor Apraxia

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No purposeful movement either automatic or on command.

Ideational Apraxia

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Inability to sustain movement or posture.

Motor Impersistence

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Acquired communication disorder caused by brain damage and characterized by impairment of language comprehension, oral expression, and the use of symbols to communicate ideas.

Aphasia

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Difficulty articulating words due to motor weakness and inability to control muscles that produce speech.

Dysarthria

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Swallowing disorder.

Dysphagia

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Compulsive, Safety Issues, Poor Planning, Impaired Judgement

Left Hemi, Right CVA

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Double Vision

Diplopia

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Blindness in outer half of the visual field of the other eye resulting in inability to receive info from either the R or L half of the visual environment.

Homonymous Hemianopsia

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Bi-Temporal Hemianopsia

Can't see temporal sides.

57

Bi-Nasal Hemianopisa

Can't see nose sides.

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L Homonymous Hemianopsia

Can't see L sides.

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R Homonymous Hemianopsia

Can't see R sides.

60

Cautious, Anxious, Disorganized.

Right Hemi, Left CVA

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No awareness of that side from midline.

Neglect

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L Side Neglect

Most Common R CVA

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Secondary Impairments

Urinary incontinence, bowel incontinence, seizures, flexibility, DVT, PE, de-conditioning, skin breakdown, shoulder dysfunction, shoulder impingement.

64

Acute Rehab 1. Strategy Development

PTA assist with learning task. Begin with demonstration, practice, and progress with self-assessment and problem solving.

65

Acute Rehab 2. Feedback

Early = Vision, Extrinsic (Mirror)
Mid = Proprioception
Late = Intrinsic (Self-correcting)

66

Acute Rehab 3. Practice

Repetition. Adequate rest periods. Progression and challenge. Variable practice. Self-monitoring. Environment. Begin and end on positive note. Support and encourgagement.

67

Task-specific Learning. Verbal instructions.

Carr and Shephard Stroke Programme

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Patient learns to control tone and movement through the use of patterns that promote normal selective movements during functional activities.

Neurodevelopment Treatment (NDT)

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Patient learns movement control through structured activities that promote function, utilize reinforcement and repetitions.

Movement Therapy in Hemiplegia (Brunnstrom)

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Select patterns to reinforce and develop selective patterns of control while avoiding synergy patterns.

Proprioceptive Neuromuscular Facilitation (PNF)

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Classical muscle re-educatoin is the most basic form of ______.

Coordination Exercise

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NDT primarily used in treatment of ____ patients.

Polio

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Kenny and Knapp developed and described the clinical techniques for training control of _____ _____.

Prime Movers

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Conscious activation of single muscle.

Control

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Discrete control of prime mover, minimal activity of synergists/stabilizers, no activation of antagonists or distant muscles, develop volitional control, ruling out undesired motion.

Control Training

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Number of muscles into smooth patterns of contraction, sequences of contraction and relaxation, developed only to the extent that the person can inhibit all undesired activity.

Coordination Training

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Control is developed by monitoring _______ ________ from muscle spindles and joint receptors.

Proprioceptive Feedback

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Developing coordination requires properly learned and frequently practiced ____ of activity.

Patterns

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Learn by using a new movement pattern, use the good side. Promotes learned nonuse - negative approach, most appropriate for patient with limited ability to actively particpate.

Compensatory Training

80

Used for patients with increased tone, slow rhythmic rotation.

Inhibition Techniques

81

Attack spasticity 24hrs a day. Reflex inhibition, specifically inhibiting tonic neck reflexes through the use of _____ and positioning.

Air Splints

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Provide sensory stimulation to the hemiplegia side. Schedule.

Positioning

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Pelvic/Trunk Malalignment, Scapular Downward Rotation, GH Depression/Subluxation, UE Flexion Synergy in Sitting, LE Synergy in Standing/Supine.

Avoid Positions

84

Promote use of involved site to increase sensory input. Add sensory input by stretching, WB, etc. Safety education.

Sensory Training Strategies

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Emphasis on pelvic/trunk, scapular alignment, early weight bearing, wrist/hand, shoulder/elbow independent movements.

UE Control

86

LE D1 Flexion/Extension emphasis patterns used in gait, break up synergies, dynamic balance.

LE Control

87

Important motivational activity.

Gait Training