CVA intro/syndromes

Question 1

CVA special considerations

Answer 1

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

Monitor INR.

DVT: 30-75% after stroke.

Respiratory Insufficiency: >90%.

Question 2

Common Problems post-CVA

Answer 2

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

Cognitive problems.

Dysphagia.

Visuospatial and perceptual disturbances.

Language deficits.

Question 3

Dyspagia

Answer 3

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.

Question 4

Agnosia

Answer 4

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

Question 5

Anosognosia

Answer 5

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

Question 6

Dysarthria

Answer 6

Muscle dysfunction leads to impaired verbal communication.

May affect: respiration, phonation, articulation, resonance.

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

Question 7

Aphasia

Answer 7

DOMINANT hemisphere injury

Impairs the expression and/or understanding of language.

Question 8

Broca’s aphasia

Answer 8

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.

Question 9

Wernicke’s aphasia

Answer 9

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

“word salad”

Question 10

CVA presentations

Answer 10

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).

Question 11

Apraxia

Answer 11

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.

Question 12

Buccofacial or Orofacial apraxia

Answer 12

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

Question 13

limb-kinetic apraxia

Answer 13

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

Question 14

Ideomotor apraxia

Answer 14

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.

Question 15

Ideational apraxia

Answer 15

Inability to coordinate activities with multiple sequential movements.

ex: dressing, bathing, eatin

Question 16

Verbal apraxia

Answer 16

difficulty coordinating mouth and speech movements on command

Question 17

constructional apraxia

Answer 17

inability to copy, draw, or construct simple figures

Question 18

Oculomotor apraxia

Answer 18

Difficulty moving eye on command

Question 19

Shoulder-Hand Syndrome Stage 1–CRPS

Answer 19

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

Question 20

Shoulder-Hand Syndrome Stage 2

Answer 20

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

Question 21

Shoulder-Hand Syndrome Stage 3

Answer 21

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

Question 22

Shoulder-Hand Syndrome treatment

Answer 22

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

Question 23

Hemiplegic UE

Answer 23

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

Capitate may dislocate with inappropriate support

Question 24

Inferior shoulder subluxation

Answer 24

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

Question 25

Anterior shoulder subluxation

Answer 25

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

Question 26

Superior shoulder subluxation

Answer 26

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

Question 27

Impingment c CVA

Answer 27

spasticity superior subluxation muslce imbalace loss of SH rhythm

Question 28

UE hemiplegic management 0/5 strength, 2 cm inf. subluxation

Answer 28

``` 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 ```

Question 29

UE hemiplegic management 1-2/5 strength, 2 cm inferior sublux

Answer 29

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

Question 30

UE hemi management 2-3/5 strength, no sublux

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

dont push through pain encourage shoulder ER scap taping

Question 33

0-1/5 strength, mod ash 4

Answer 33

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