CVA

Question 1

Controllable Causes of CVA

Answer 1

Diet high in salt, fat, sugar

Stress both internal (stressful situations at home) and external (environmental temp. related)

Stimulant Use/Illegal drug use

Inactivity

Not taking meds as prescribed

Use of contraceptives for some women

Diabetes Unmanaged

Excessive Alcohol consumption

Smoking

Question 2

Non-controllable Causes of CVA

Answer 2

Age – older

Genetics

Race

Gender

Diabetes

Heart Disease

Previous CVA

Hypertension

Atherosclerosis

Post Surgery blood clots

Question 3

Embolic Stroke

Answer 3

blood clot - after surgery - during sleep

Question 4

Thrombotic Stroke

Answer 4

most common type of CVA

Question 5

Hemorrhagic Stroke

Answer 5

massive damage - challenges in the integrity of the artery creating a brst

Question 6

Lacunar Stroke

Answer 6

small infarcts at the end of the capillaries - creates balance and coordination issues
(looks different than typical RLCVA)

Question 7

Aneurysm

Answer 7

associated with smoking and younger people
- artery wall forms a balloon like protrusion that bursts

Question 8

TIA Transient Ischemic Attack

Answer 8

3 types:
1. only one episode, brief, resolved within hours to days - no others
2. warning signs of the big stroke
3. multiple mini strokes - leading to disability

Question 9

Prevention methods for CVA

Answer 9

1) Regular check ups with your physicians
2) Diet and exercise
3) stop smoking
4) Dont drink excessively or take illegal drugs
5) look for alternative birth control methods
6) monitor BP and HR regularly
7) take meds as prescribed
8) manage stress

Question 10

L CVA characteristics

Answer 10

• Right Hemiplegia
• Language /aphasia
• more serious
• labile

Question 11

R CVA characteristics

Answer 11

• Left Hemiplegia
• perceptual issues
• neglect
• impulsivity
• indifferent
• dont recognize their problem

Question 12

Global Aphasia

Answer 12

unable to understand or produce speech

Question 13

Expressive Aphasia

Answer 13

Broccas aphasia - difficulty producing speech

Question 14

Receptive Aphasia

Answer 14

Wernickie’s Aphasia - difficulty understanding language and speech

Question 15

Anomic Aphasia

Answer 15

most minimal challenges - least amount of disability - difficulty naming things (best prognosis for recovery)

Question 16

Precautions for CVA

Answer 16

• Avoid MMT and strengthening of spastic muscles
  -protect affected extremities
• Avoid Fatigue
• Monitor and protect against subluxation
• Adress edema issues
• Prevent contracture
• Monitor for Autonomic Abnormalities - dizziness, sweating, cold and clammy skin, bowel and bladder issues
• Monitor for diabetic reactions
• monitor for signs of stroke
• observe aspiration precautions when indicated
• Observe intake and output precautions
• monitor for dehydration
• observe falls precaution
• Monitor HR and BP
• Prevent decubiti
• Prevent DVT

Question 17

How to address issue with edema for CVA

Answer 17

See edema treat edema: position elevation, retrograde massge, air splint, taping, sleeves

Question 18

What is subluxation and how does it happen

Answer 18

Subluxation is separation of joints when there are no stimulation or movement coming from the muscles. Prevent it by using slings for subluxation.

Question 19

Most difficult UE movement to recover following CVA

Question 20

Warnings signs of CVA

Answer 20

1) Numbness, weakness, one side of the body - burning or tingling in the face arm and or leg
2) Loss of speech or trouble talking or understanding speech
3) Vision problems particularly in one eye- dim or loss of vision
4) Dizziness, unexpected falls
5) Swallowing difficulties, choking, coughing with anything ingested
6) Severe headache (thunderclap), nausea, vomiting,
7. cognitive: loss of consciousness, lethargy, extreme fatigue, confusion

Question 21

Brunstrom Stage 1

Answer 21

Flaccid - no movement of UE

Equipment: edema glove, subluxation sling, positioning cushion, possible resting hand splint, commu board, elastic stockings

Transfers: Lateral Transfer

Use of UE as stabilizer

Question 22

Brunstrom Stage 2

Answer 22

Movement with Reflexive activity - start synergy pattern of UE into flexion with reflex action such as sneezing, coughing

Equipment: edema glove, subluxation sling, positioning cushion, possible resting hand splint, commu board, elastic stockings

Transfers: Lateral possibly SPT transfer

Use of UE as stabilizer

Question 23

Brunstrom Stage 3

Answer 23

Height of spasticity - with UE in synergy pattern when voluntary movement is initiated.

Equipment: WC lap tray, wedge cushion with high end in front to simulate hip flex, abduction splint

Transfers: bent pivot or stand pivot turn transfer (strong side leading)

Use of UE as gross assist

Question 24

Brunstrom Stage 4

Answer 24

UE deviating fromk synergy - can move UE into flex and abd of shoulder - pronate and supinate with elbow at 90 flex, external rotation and internal rotation (reach on opposite ear), hand extension of fingers and lateral pinch

Equipment: lap tray on WC, cushion for prevention of skin breakdown

Transfers: Stand pivot turn transfer to either side

Use of UE as gross assist

Question 25

Brunstrom Stage 5

Answer 25

UE can move to all ROM with stress can feel tone, hand can open into extension as a group, tripod pinch possible

Equipment:

Transfers: may perform SPT or transfer with an assistive device

Use of UE as gross assist