CVA assessment Flashcards
What are the three parts of the Glascow Coma Scale? and what is min max point to all?
Eye response 1-4
Verbal response 1-5
Motor response 1-6
What screening can be used for mental status?
MMSE ( mini mental status exam)
NCSE (neurobehavioral cognitive status exam)
Take BP on which arm for CVA case?
uninvolved side
What screening can you use for tone?
MAS
Modified Ashworth Scale
What are 0-4 values on the MAS?
0 no increase in tone
1 slight increase in tone by a catch and release or minimal tone at end of ROM
1+ slight increase in tone by a catch and no release and tone to remainder of ROM (less than half)
2 more marked increase in tone throughout most of ROM
3 considerable increase in tone, PROM is difficult
4 rigid in flexion or extension
DTRs: C5-C6, C7-C8, L2-L4, L5-S2?
C5-C6: biceps/bracihoradialis
C7-C8: triceps
L2-L4: Patellar
L5-S2: Achilles
Grading of DTRs?
0: no response 1+ somewhat diminished 2+ average 3+ hyperreflexive 4+ clonus, very brisk hyperreflexive
What is Righting rxn? What equilibrium rxn?
Righting: maintain head posture
Equilibrium: maintain balance in response to change in COG
What % of CVA cases present with paresis?
80-90%
Where and how is paresis most common in CVA cases and why?
UE>LE
contralaterally
distal>proximal
due to MCA is most common
What type of muscle fibers are lost and gained in CVA?
type II lost
type I gained
What are 4 major standardize test for CVA?
Which two are most commonly used for CVA?
- Brunstromm Evaluation
- FMA (Fugl-Meyer Assessment)
- MAS (Motor Assessment Scale)
- STREAM (Stroke Rehab Assessment of Movement)
Fugl-Meyer and STREAM is most common
What is min and max score of Fugl-Meyer?
0-226
What is STREAM X, 0, 1a, 1b, 1c, 2 scores?
X= not tested secondary to pain 0= flicker, no movement, or less than 10% ROM 1a= can only do part of the movement, with deviation, also tremor or dysmetria 1b= can only do part of the movement but comparable to other side 1c= can complete movement, at least 90%, some deviation still 2= complete movement
What are the 3 vessels related in coordination aka cerebellum-basilar arteries?
PICA
AICA
superior cerebellar artery
What occurs in cerebellar stroke?
IPS intention tremor & action tremor
How is Balance Tested?
Berg balance scale
TUG
Four square step test
funcitonal: sit to stand, walking
Whare are ADL measurements for CVA?
Barthel Index
FIM (in IP)
How often should you change CVA pt’s position in bed?
Q2
What are the 6 stages of Brunnstrom’s Stages of Recovery?
1- flaccid during acute onset
2- basic limb synergies, 1st as associated rxn
3- voluntary control of synergy develop with some spasticity
4- move start to break synergy and spasticity decrease
5- difficult movement combinations develop and synergies lose dominance
6- no more spasticity and individual joint movement is now possible. almost normal
What are the 3 stages of Bobath (NDT)?
1- initial flaccid stage
2- Stage of spasticity
3- stage of relative recovery
What is NDT (bobath) treatment concept?
decrease abnormal reflex patterns, by inhibition of synergy patterns, facilitate WB and normal movement patterns.
What is Compensatory Strategy treatment approach?
use of alt. strategies to complete a task, ie use unaffected UE to complete ADLs
What is MRP? motor relearning program
neuro system is flexible therefore teach and advance function specific motions and actions.
