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DPT 745 Neuro 1 > CVA impairments 2 (more sensory/perception) > Flashcards

CVA impairments 2 (more sensory/perception) Flashcards

1
Q

How many people who have had a stroke have visual deficits? What type of recovery is possible?

A

about 65% of stroke survivors may have vision problems

full recovery is uncommon
some recovery is possible

vision structures span entire brain so vision tends to be heavily involved in strokes

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2
Q

What is some visual dysfunction patient history we can ask to gather a baseline of vision function even prior to stroke?

A

-Do you wear glasses? Contact lenses? ​

  For distance, near, bifocals, or monovision?​

   Does your correction (glasses, contact lenses) work as well now as before the (stroke, accident, etc.)?​

-Do you notice anything different about vision?​

    Blurry vision, loss of vision? ​

   If blurry, near or far?​

-Do you ever see double? ​

   More than double?​

   Near or far?
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3
Q

What are some potential clinical observations we can make regarding visual dysfunction post-stroke?

A

-Head turn or tilts to tasks, or postural adjustments made to tasks
-Avoidance of near tasks
-One eye appears to go in, out, up, or down
-Seems to look past observer
-Closes or covers one eye, or squints
-During movement, bumps into walls or objects (either walking or in a wheelchair )
-Appears to misjudge distance, underreaches or overreaches for objects
-Has difficulty finding things

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4
Q

What visual dysfunctions are associated with CN II nuclei and associated CNS areas?

A

Refractive errors
-Myopia (nearsightnedness), hyperopia (farsightedness), astigmatism,
Blurry vision, headaches, dizziness

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5
Q

What visual dysfunctions are associated with CN II and various regions of visual tract, visual cortex?

A

Impaired accommodation
-blurry vision, dizziness, headaches
Visual field losses

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6
Q

What visual dysfunctions are associated with cerebellum?

A

Impaired pursuits and saccades
-Dizziness, nausea, balance difficulties
Diplopia without conjugate gaze dysfunction
-Nausea, balance difficulties

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7
Q

What visual dysfunctions are associated with CN III, IV, VI, II nuclei, and associated CNS areas?

A

Ptosis ​

Ocular motility disturbance​

      Diplopia, Visual distortions, dysconjugate gaze, impaired vergence​

      Dizziness, nausea, balance difficulties
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8
Q

Go study visual field loss slide ( slide 8)

A

:)

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9
Q

What is ocular misalignment?

A

When eyes are not aligned with each other
very common impairment

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10
Q

What are the types of ocular misalignment and which is the worst?

A

Tropia- overt deviation of the eye (this is the worst of the two)
Exo-outward(laterally)
Eso-inward (medially)
Hyper- upward
Hypo- downward

Phoria- Ocular deviation occurs when disassociation occurs

​

Eso- damage to abducens nerve and loss of abduction​

Exo, hypo, and hyper all can be seen with oculomotor dysfunction ​

Hyper- more so with loss of depression/trochlear nerve dysfunction

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11
Q

If there is severe ocular misalignment, what might we see?

A

Diplopia, head tilt, noticeable eye turn

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12
Q

If the ocular misalignment is subtle, what might we see?

A

Difficulty maintaining focus, cosmetically normal, ocular soreness, headaches, mental dullness

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13
Q

What is a very common complaint related to vestibular function following a stroke?

A

Dizziness

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14
Q

In what areas would a stroke typically cause vestibular symptoms, what areas would it not usually cause vestibular symptoms?

A

Typically see vestibular symptoms: Brainstem and cerebellar CVAs : PICA stroke (wallenberg’s syndrome)

AICA strokes

Transient ischemic attacks- most common site - vertebrobasilar artery - vertigo, vision symptoms typically tend to be very intense

Typically don’t:
MCA/PCA territory infarcts
Vertigo is typically not present, and vestibular symptoms tend to be milder (disequalibrium, vertical disorientation)

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15
Q

Damage to what would manifest in VOR dysfunction?

A

Brain stem strokes

Vestibular nuclei in midbrain (oculomotor nucleus) and pons (abducens nucleus)

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16
Q

What systems are we evaluating when looking at sensory deficits post stroke?

A

Medial lemniscus pathway, dorsal column, anterolateral system and seeing if it can properly ascend with information

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17
Q

Why will thalamic lesions have diffuse involvement in sensory systems?

A

Thalamus is the grand central station for all of our ascending information

18
Q

What is sensory dysfunction linked to?

A

reduced functional return, longer rehabilitation, learned non-use, safety, distal UE recovery​

Proprioception in particular linked to poorer functional recovery

19
Q

What are the most common predictors of fall risk post stroke?

A

Functional impairment​

Cognitive deficits​

Impaired balance

Falls and related fractures are very common in the time following a stroke

20
Q

How is balanced typically examined post CVA?

A

Typically though outcome measures

21
Q

What is perception?

A

Integration of sensory impressions into info that is meaningful to us

22
Q

Which hemisphere will perceptual deficits most often occur with?

A

Right sided hemispheric damage

23
Q

What are some signs of right hemisphere lesions?

A

Body scheme impairments​

      Unilateral neglect, Pusher’s Syndrome, Anosognosia, Somatognosia, R-L discrimination​

Difficulties in general with spatial relationships​

        Hand-eye coordination, Figure-ground discrimination, Position-in-space, depth and distance, Topographical disorientation​

Agnosias ​

Visual, auditory, sensory​

Some exceptions…

24
Q

What are some typical signs of left sided hemisphere lesions?

A

Apraxia common (very commonly seen with aphasia!!)​

Ideational ​

Ideomotor

25
Q

What is unilateral inattention?

A

Failure to orient toward, respond to, or report stimuli on the side contralateral to the lesion​

Despite normal sensory, motor, and visual systems

26
Q

Which side inattention is most common and due to what structures being damaged?

A

left inattention is most common due to right hemispheric damage

Mostly occurs with R temporoparietal junction, posterior parietal lesions​

Also: dorsolateral frontal, cingulate gyrus, thalamic, putamen lesions

27
Q

How can unilateral inattention be classified?

A

Modality​

-Sensory​

 -Auditory, Visual or Tactile​

 -Motor​

  -Representational​

Distribution​

 -Personal​

  -Spatial​

           -Peri-personal​

            -Extra-personal
28
Q

What are some tests we can use to examine inattention?

A

Observation ​

Double Simultaneous Stimulation test ​

Clock drawing, picture copying, cross-out tasks, line bisection

These tests are far from perfect, but all we have

29
Q

What type of infarct typically causes inattention and what is the most common manifestation of this inattention?

A

MCA infarct and visuospatial

30
Q

True or false: Inattention is a poor prognostic indicator for functional recovery

A

True

31
Q

What is vertical disorientation and what are the types? Also, what are typical infarcts these are seen with?

A

The brain believes it is standing upright, even if it is not
Lateropulsion​

Lateral lean​

Lean towards side of lesion/away from involved side of body​

​

​

Retropulsion (also commonly seen in Parkinson’s disease)​

Posterior lean​

​

Anteropulsion​

Anterior lean

and this is especially seen with cerebellar or brain stem infarcts

32
Q

What is pusher’s syndrome?

A

Lesion: R hemisphere centered in area of posterolateral thalamus

  1. Contralateral tilted posture with severe imbalance​
      Head can orient to vertical with cues ​
  2. Tendency to push strongly towards paretic side with nonaffected limbs​
  3. Resistance to external corrections

This is different than lateropulsion in the fact that the patient is pushing away from the lesion, towards the side of affected body

33
Q

What is post stroke fatigue defined as?

A

“lack of physical and mental energy”
occurs without specific exertion

Can manifest as problems related to self-control, emotional instability, reduced mental capacity, perceived reduction in energy

34
Q

What is post stroke fatigue most closely associated with?

A

Post CVA depression

correlates also found with sleep disturbances, anxiety, and pain

35
Q

What is central post-stroke pain/thalamic syndrome?

A

-Present in 10% of CVAs​

-Pain arising as a direct consequence of lesion to central somatosensory system​

  -Cortex, thalamus, medulla ​

         -Thalamus = “Thalamic Syndrome” – most common site of involvement (VPL)​

-“Neuropathic pain”

this is most associated with damage to VPL of thalamus

36
Q

Does thalamic/neuropathic pain respond to analgesic?

A

no

37
Q

What type of pain does central post-stroke pain/thalamic syndrome feel like?

A

severe, burning type pain

38
Q

Which medication has been found to be helpful with neuropathic pain and neuroplasticity?

A

fluoxetine

39
Q

What is the most common site of orthopedic pain post stroke?

A

shoulder
second most common is low back pain

40
Q

What are some common causes of orthopedic pain post stroke?

A

Weakness​
Rotator cuff ​
Impaired motor control​
Inappropriate muscle activation​
Chronic: muscle shortening and contractures ​
Acute hypotonicity​
Spasticity​
Direct versus indirect pain​
Positioning ​
Effects of gravity on UE ​

​

Severe UE hemiplegia and/or shoulder subluxation within 72 hours post-CVA = significantly higher risk of developing shoulder pain within first 8-10 weeks of CVA

41
Q

How do you examine hemiplegic shoulder subluxation?

A

Fingerbreadth method*​

Subluxation = 1⁄2 fingerbreadth or more ​

Radiographs ​

Ultrasound

DPT 745 Neuro 1 (6 decks)

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