CVA

Question 1

TIA

Answer 1

Transient ischemic attack:

Briefly episode of neuro dysfunction caused by a focal disturbance of brain or retinal ischemia, w/ clinical symptoms lasting less than 1 hour and WITHOUT EVIDENCE OF INFARCTION

Question 2

Mini stroke

Answer 2

Very minor stroke

Small lesion size -> minimal to no functional deficit

Question 3

CVA management - clot

Answer 3

Restore blood flow and perfusion to damaged area

TPA, asprin and other anti-coagulants
Carotid endarterectomy, angioplasty, stents

Question 4

CVA management - bleed

Answer 4

Control bleeding, reduce pressure in brain

Transfusion of clotting product
Bed rest
Surgical BV repair

Question 5

TPA

Answer 5

Plasminogen activator
Pt must be >18 yo w/ dx of CVA and symptoms <3hours

Contras: internal bleeding, minor stroke, heparin w/in 48 hours

Question 6

CVA- AVA

Answer 6

Not very common 
Contra hemiplegia (LE>EU)
Minimal sensory loss
Apraxia (L inf parietal, frontal, corpus callosum)
Cog. Deficits
Aphasia (broca’s)

Question 7

CVA- MCA

Answer 7

Most common site

Contra hemiplegia w/ hemisensory loss 
UE>LE
Head/eye deviation toward side of lesion
Homogenous hemianopia contralateral
Global aphasia
Inattention/neglect

Question 8

CVA - PCA

Answer 8

Contralateral hemisensory loss
Contralateral homogenous hemaniopshia
Unilateral neglect

Question 9

CVA - lacuna infarction

Answer 9

Small vessel
Affect subcortical structures
Can be pure motor, pure sensory, silent
20% of all strokes

Good outcome b/c few deficits
Low mortality

Question 10

CVA - cerebellar

Answer 10

Ipsi hemiparesis
May have gen. Weakness/decrease tone in trunk
Poor extensor strength
Impaired coordination (dysmetria, ataxia)
Impaired proprioception

Question 11

> 1 TIA w/in 1 week

Answer 11

30% greater risk of stroke w/in the week

Question 12

NIH stroke scale

Answer 12

Neurologist performs

Decision making related to use of thrombolytic therapy

Question 13

NIH stroke scale scoring

Answer 13

<5 mild
5-14 moderate
15-24 moderate to severe
>25 neuro impairment

Question 14

NIHSS D/c predictions

Answer 14

<5 d/c home
6-13 d/c to rehab
>13 strongly assoc w/ rehab

Question 15

NIHSS cutoff for function

Answer 15

Initial score of 7 found to be important cut off - 45% functionally normal at 48 hours

Question 16

VCA functional assessments

Answer 16

Mobility - FIM, transfers 5x sit to stand, STREAM
Gait - analysis, speed, 6 min walk test
Balance - romberg, berg, TUG, FGA, ABC

Question 17

CVA testing

Answer 17

Functional! Get them upright and allow them to move so you see what they’re actually capable of

Question 18

Supine hip extensor test

Answer 18

Not true mmt, gross functional assessment

Knock one grade off formal MMT

Question 19

Supine hip extensor test grade 5

Answer 19

Netural pelvis, full hip ext

Question 20

Supine hip extensor test grade 4

Answer 20

Hip flexion before pelvis elevates

Question 21

Supine hip extensor test grade 3

Answer 21

Full elevation of leg w/out lift of pelvis

Good resistance

Question 22

Supine hip extensor test grade 2

Answer 22

Full elevation of leg w/out lift of pelvis,

Poor resistance

Question 23

Upright motor control - hip and knee flexion grades

Answer 23

Strong- >60, 3x in 10 sec
Mod- 30-60, 3x in 10 sec
Weak - no motion/<30, 3 takes over 10 sec

Question 24

Upright motor control - ankle flexion

Answer 24

Strong - at least 0 deg of DF 3x in 10 sec

Weak - no motion/ less than right angle OR 3 reps in >10 sec

Question 25

Upright motor control -hip ext grades

Answer 25

Weak - uncontrolled trunk flex Mod - unable to maintain fully erect trunk Strong - pt remains erect trunk at end of available hip flex range

Question 26

Upright motor control knee ext

Answer 26

Strong - able to hold weight and stand into full knee ext Mod - able to hold weight but not stand on the one left Weak - knee collapses

Question 27

Upright motor control test - ankle ext

Answer 27

Strong - lift heel of floor w/ neutral knee Mod - pt can control knee and ankle in neutral Weak - knee collapse, knee wobble, ext thrust

Question 28

UE flex synergy

Answer 28

``` Scap retraction Shoulder AB, ER Elbow flex Forearm sup Wrist/finger flex ```

Question 29

LE flexion synergy

Answer 29

Hip flex, AB, ER Knee flex Ankle DF

Question 30

UE ext synergy

Answer 30

Shoulder IR Elbow ext Pronation

Question 31

LE ext synergy

Answer 31

Hip ext, ad, IR Knee ext PF

Question 32

Cause of synergy

Answer 32

Lack of voluntary muscle control Spasticity Weakness