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Flashcards in CVA intro/syndromes Deck (33)
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1

CVA special considerations

Monitor vitals:
SBP: 90-200
DBP under 110
HR: 50-100.

Monitor INR.

DVT: 30-75% after stroke.

Respiratory Insufficiency: >90%.

2

Common Problems post-CVA

Seizures: 10% after ischemic, 34% after hemorrhagic.

Cognitive problems.

Dysphagia.

Visuospatial and perceptual disturbances.

Language deficits.

3

Dyspagia

Compensatory strategies: thicken liquids, chin tuck during swallow, small sips.

TreatmentL VitalSTIM NMES, biofeedback c mirror, posture/environment set up.

Generally treated by SLP, but must know whether you can give pt water.

4

Agnosia

The inability to recognize familiar objects using one or more of the sensory modalities, while often retaining the ability to recognize the same object using other sensory modalities

5

Anosognosia

the severe denial, neglect, and lack of awareness of the presence or severity of one's deficits

6

Dysarthria

Muscle dysfunction leads to impaired verbal communication.

May affect: respiration, phonation, articulation, resonance.

Treatment: tongue and oral-motor exercises, functional speaking practice, posture.

7

Aphasia

DOMINANT hemisphere injury

Impairs the expression and/or understanding of language.

8

Broca's aphasia

Expressive aphasia-may or may not be able to write it down.

Know what to say, cant get it out, may be able to piece together meaning.

9

Wernicke's aphasia

Receptive aphasia: cant understand questions-can check understanding by seeing if pt can follow commands.

"word salad"

10

CVA presentations

Hemiplegia: lack of movement on one side of body.

Hemi-neglect: test with double simultaneous stimulation: may not recognize own are-treat with forced WB.

Pusher syndrome.

Apraxia.

Severe spasticity: not common immediately post stroke (usually 3 mo-1 yr post stroke).

11

Apraxia

Mild form: dyspraxia.

Loss of abilityo execute or carry out skilled movements and gestures despite having desire and physical ability to perfrom them.

Parietal lobe injury.

Various types.

12

Buccofacial or Orofacial apraxia

Most common.

Inability to carry out facial movements on command.

ex: pt cannot blow on command, but if given bubble wand, they can spontaneously blow

13

limb-kinetic apraxia

inability to make fine, precise movements with an arm or leg

14

Ideomotor apraxia

inability to make proper movement in response to a verbal command.

Ex: pt cannot walk if requested, but if asked to get something on other side of room, the will go get it.

15

Ideational apraxia

Inability to coordinate activities with multiple sequential movements.

ex: dressing, bathing, eatin

16

Verbal apraxia

difficulty coordinating mouth and speech movements on command

17

constructional apraxia

inability to copy, draw, or construct simple figures

18

Oculomotor apraxia

Difficulty moving eye on command

19

Shoulder-Hand Syndrome Stage 1--CRPS

limited shoulder ROM
swelling of dorsum of hand
shiny skin
limited ROM in fingers
hypersensitivity
wrist extension painful

20

Shoulder-Hand Syndrome Stage 2

Hard to reverse
Shoulder pain subsides, ROM increases
Edema of hand subsides, but fingers more stiffer
Hair and nails are coarse
Sensitivity decreased
Osteoporosis on X-ray

21

Shoulder-Hand Syndrome Stage 3

Progressive atrophy of bones, skin, muscle
Limitation of hands, wrists, and fingers increases.
Hand is painless but useless in a clawed position.

22

Shoulder-Hand Syndrome treatment

Reduce edema
Maintain/increase ROM
Maintain wrist extension ROM
Encourage movement of involved shoulder
Bed positioning.

23

Hemiplegic UE

Shoulder pain in 70-84% of stroke pts, but isnt normal-starts as pain with movement.

Capitate may dislocate with inappropriate support

24

Inferior shoulder subluxation

lack of active movement
downward rotation of the scapula
loss of passive locking mechanism
stretching of the soft tissue and capsule

--Graded by number of fingers that can fit in subluxed space

25

Anterior shoulder subluxation

new control is unbalanced
side bending of head toward affected side
downward rotated scapula pulled superiorly
extension of humerus with IR

26

Superior shoulder subluxation

Flexion syngergy
shoulder elevation
head of humerus pressed against acromion
lack of isolated humeral movement
may lead to impingement

27

Impingment c CVA

spasticity
superior subluxation
muslce imbalace
loss of SH rhythm

28

UE hemiplegic management

0/5 strength, 2 cm inf. subluxation

Sling for standing (GivMohr, Bobath)
E-stim
awareness of UE for bed mobility
PROM c massage: limit ff to 90*
WB
use UE to stabilize

29

UE hemiplegic management

1-2/5 strength, 2 cm inferior sublux

PNF
fluido c physical and mental practice
WB
sling for standing
E-stim

30

UE hemi management

2-3/5 strength, no sublux

have pt ue arm for EVERYTHING
distal: self ROM, massage, isometrics
prox: AROM, theraband

PNF, WB, functional tasks

31

1-2/5 strength, mod ashworth 2, 1 cm sublux

E-stim
AAROM prox
WB isometrics distal
PNF
WB POE
FES

32

3-4/5 strength, mod ash 2, p! c flex/abd

dont push through pain
encourage shoulder ER
scap taping

33

0-1/5 strength, mod ash 4

PROM for shoulder /
WB to facilitate triceps
rhythmic rotation
POE
tricep estim