Flashcards in Cerebrovascular Accident (CVA) (Exam 4) Deck (87):
A sudden, focal neurological deficit resulting from ischemic or hemorrhagic lesions in the brain. Disturbance of blood supply to the brain.
CVA or Stroke
Characterized by motor deficits on the side of the body opposite the site of the lesion.
Hemi refers to ____.
Side of the body effected.
Hypoxia due to poor blood supply. 70% _____ stroke.
Death of brain tissue occurs when blood flow drops below 20% and can be caused by thrombosis or embolus.
Traveling blood clot. Associated with atrial fibrillation, MI, valvular disease.
Blood clot. Associated with atherosclerosis.
Bleeding due to rupture of a blood vessel in brain causing compression of brain tissue and vessels. 20% of ____ stroke.
_____ is caused by changes in the vessel integrity comply due to HTN, aging, or can just occur.
Subarachnoid, Berry Aneurysm, and Intracerebral.
Types of Hemorrhages
Abnormal dilation of bifurcation.
Developmental defect that produces weakness in blood vessel walls; arteries and veins communicate without conjoining capillary beds. 10%.
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.
Begins shortly after onset of stroke and reaches maximum in 3-4 days.
Ischemic Brain Edema (Swelling)
Swelling gradually subsides by _____.
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)
Stable, severe deficits.
Deteriorating neurological status after admission.
Affecting persons younger than 45.
4 Stroke Syndromes
Anterior Cerebral Artery Occlusion
Middle Cerebral Artery Occlusion
Vertebrobasilar Artery Occlusion
Posterior Artery Occlusion
Frontal and parietal lobes. Contralateral hemiparesis. Contralateral sensory loss. R Hemi (L CVA) aphasia, apraxia, agraphia, unilateral neglect.
Anterior Cerebral Artery Syndrome
Lateral Cerebral Hemisphere. Most commonly affected. Contralateral spastic hemiparesis. Contralateral sensory loss. L CVA aphasia. R CVA perceptual problems.
Middle Cerebral Artery
Supplies brainstem and cerebellum. Balance. Basic Needs.
Supplies the occipital and temporal lobes, thalamus, and upper brain stem.
Contralateral weakness and sensory loss LE.
Contralateral weakness and sensory loss face and UE.
Cranial nerve involvement.
Contralateral sensory loss.
Patients with CVA in the posterolateral thalamus. Push and lean toward their hemiplegic side.
Motor function _____ at onset changing to _____.
Unable to move isolated limb segment without movement in remainder of limb.
Abnormal Synergy Patterns
Most common UE synergy.
Most common LE synergy.
Scapular Retraction/Elevation. Shoulder Abduction 90 Degrees with ER or hyperextension of shoulder. Elbow flexion. Forearm supination. Wrist and finger flexion.
Flexor Synergy UE
Scapular Protraction. Shoulder adduction with IR. Elbow extension. Forearm pronation. Wrist extension with fist closure.
Extensor Synergy UE
Hip flexion. Hip abduction and ER. Knee flexion 90 Degrees. Ankle DF, Inversion. Toe DF.
Flexor Synergy LE
Hip extension. Hip adduction and IR. Knee extension. Ankle PF, Inversion. Toe PF.
Extensor Synergy LE
ATNR, STLR, STNR, TLR
Pressure on bottom of foot results in co-contraction and rigidly extended and fixed limb.
Positive Supporting Reaction
UMNL, DF - PF Uncontrollably.
Extension and separation of fingers when UE raised above 150 Degrees.
Resistance to hip abduction or adduction noninvolved side evokes same movement on involved side. (LE/LE Both)
A response in one extremity facilitates the same response in the other extremity. (UE/LE Same Side)
Homolateral Limb Synkinesis
Patient may have the motor capabilities to perform movement combination but unable to determine or remember the steps necessary.
Automatic movement, but no movement on command.
No purposeful movement either automatic or on command.
Inability to sustain movement or posture.
Acquired communication disorder caused by brain damage and characterized by impairment of language comprehension, oral expression, and the use of symbols to communicate ideas.
Difficulty articulating words due to motor weakness and inability to control muscles that produce speech.
Compulsive, Safety Issues, Poor Planning, Impaired Judgement
Left Hemi, Right CVA
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.
Can't see temporal sides.
Can't see nose sides.
L Homonymous Hemianopsia
Can't see L sides.
R Homonymous Hemianopsia
Can't see R sides.
Cautious, Anxious, Disorganized.
Right Hemi, Left CVA
No awareness of that side from midline.
L Side Neglect
Most Common R CVA
Urinary incontinence, bowel incontinence, seizures, flexibility, DVT, PE, de-conditioning, skin breakdown, shoulder dysfunction, shoulder impingement.
Acute Rehab 1. Strategy Development
PTA assist with learning task. Begin with demonstration, practice, and progress with self-assessment and problem solving.
Acute Rehab 2. Feedback
Early = Vision, Extrinsic (Mirror)
Mid = Proprioception
Late = Intrinsic (Self-correcting)
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.
Task-specific Learning. Verbal instructions.
Carr and Shephard Stroke Programme
Patient learns to control tone and movement through the use of patterns that promote normal selective movements during functional activities.
Neurodevelopment Treatment (NDT)
Patient learns movement control through structured activities that promote function, utilize reinforcement and repetitions.
Movement Therapy in Hemiplegia (Brunnstrom)
Select patterns to reinforce and develop selective patterns of control while avoiding synergy patterns.
Proprioceptive Neuromuscular Facilitation (PNF)
Classical muscle re-educatoin is the most basic form of ______.
NDT primarily used in treatment of ____ patients.
Kenny and Knapp developed and described the clinical techniques for training control of _____ _____.
Conscious activation of single muscle.
Discrete control of prime mover, minimal activity of synergists/stabilizers, no activation of antagonists or distant muscles, develop volitional control, ruling out undesired motion.
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.
Control is developed by monitoring _______ ________ from muscle spindles and joint receptors.
Developing coordination requires properly learned and frequently practiced ____ of activity.
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.
Used for patients with increased tone, slow rhythmic rotation.
Attack spasticity 24hrs a day. Reflex inhibition, specifically inhibiting tonic neck reflexes through the use of _____ and positioning.
Provide sensory stimulation to the hemiplegia side. Schedule.
Pelvic/Trunk Malalignment, Scapular Downward Rotation, GH Depression/Subluxation, UE Flexion Synergy in Sitting, LE Synergy in Standing/Supine.
Promote use of involved site to increase sensory input. Add sensory input by stretching, WB, etc. Safety education.
Sensory Training Strategies
Emphasis on pelvic/trunk, scapular alignment, early weight bearing, wrist/hand, shoulder/elbow independent movements.
LE D1 Flexion/Extension emphasis patterns used in gait, break up synergies, dynamic balance.