CVA Pathophysiology Flashcards
(106 cards)
1
Q
S/S of a stroke
A
disorganized speech, facial droop, muscle weakness, visual disturbances, sensation deficits, altered mental status, loss of control of extremities
2
Q
How is a thrombus formed?
A
- injury to area, 2. increase of plague, 3. stress response (constriction), 4. HTN
3
Q
What medication helps break up clots?
A
tissue-plasmigin activator
4
Q
What causes thrombotic CVA?
A
atherosclerosis and HTN
5
Q
What is a thrombotic CVA also known as?
A
stroke in progress
6
Q
What are TIA indicative of?
A
- thrombolytic disease, 2. vasospasm, 3. arterial hypotension (not enough blood getting to area)
7
Q
Medical management of T-CVA or TIA?
A
prevention, improve circulation, pharmaceuticals, surgery
8
Q
What medications are prescribed for T-CVA?
A
T-PA, anticoagulants, and antiplatelets
9
Q
What is the surgery used for T-CVA?
A
thromboendarterectomy to carotid or subclavian arteries (clean out the arteries)
10
Q
Embolic stroke is a sign of what?
A
cardiac disease
11
Q
where do embolus originate from?
A
heart, internal carotid artery, carotid sinus
12
Q
What branches are the most commonly affected by ECVA?
A
MCA - middle cerebral artery
13
Q
medical management of ECVA?
A
prevention, anticoagulant, and surgery
14
Q
What are the causes of H CVA?
A
HTN, ruptured aneurysm, AV malformation
15
Q
How long does it take for the blood to be re-absorbed?
A
6-8 months
16
Q
what does blood-reasportion lead to?
A
full recovery
17
Q
medical management of H CVA?
A
prevention and HTN management
18
Q
For a ruptured aneurysm, what is the medical management?
A
surgery - HOB precautions
19
Q
With L brain damage, what are the s/s?
A
paralysis on R, speech and memory deficits, and slow/cautious behavior
20
Q
with R brain damage, what are the s/s?
A
paralysis on L, perceptual and memory deficits, impulsive and quick behavior
21
Q
with either side damage, what are common s/s?
A
sensory dysfunction, visual field defects, and cognitive impairment
22
Q
What are considered primary “impairments” of CVA? (6)
A
spasticity, seizures, respiratory dysfunction, trauma, DVT, CRPS/pain
23
Q
What are motor/movement dysfunctions associated with CVA?
A
decreased force production/regulation, abnormal synergistic movement and muscle tone, delayed responses, and altered muscle contraction timing
24
Q
What are the sensory dysfunctions associated with CVA?
A
awareness/attention, interpretation, any modality affected, visual disturbances
25
What are the secondary impairments associated with CVA?
changes in alignment/mobility/muscle and ST length, pain and edema (b/c of lack of muscle pump)
26
What are the composite impairments associated with CVA?
movement deficits, abnormal movements, undesirable compensations
27
When is the optimal predictive power for OPS?
2 weeks post-stroke
28
When should you use the OPS?
when the patient is neurologically stable
29
What score is associated with a high likelihood of patient returning home?
<3.2
30
What is a score of <3.2 indicative of?
mild to moderate deficits
31
what is a score of 3.2-5.2 indicative of?
moderate deficits
32
what percentage of patients with a score of 3-5 were eventually discharge home?
90%
33
What score requires long term care?
>5.2 (OPS scores range from 1.6-6.8), increased likelihood of institutionalization
34
According to the FHS, only one CVA =
good change for full functional recovery
35
Is age a determinant of recovery? (according to FHS)
NO
36
What are the two components of recovery?
functional gains and neuroplasticity
37
initial functional gains are attributed to (3)...
1. reduced cerebral edema, 2. absorption of damaged tissue, 3. improved vascular flow
38
initial return of UE movement in _______________ is predictive of possible _____________________.
first 2 weeks; full arm recovery
39
Failure to ______________ by ________ is predictive of ______________.
some grip strength; 24 days; no UE recovery at 3 months
40
What percentage of patients have no arm recovery?
30%
41
______% of functional recovery is predictable at ________.
86%, at one month
42
What are non-progressive insults to the cerebellum?
CVA, tumor, TBI
43
What are progressive insults to the cerebellum?
MS, spinocerebellar degeneration, friedreich's ataxia, cerebellar cortical atrophy, olivoponto-cerebellar atrophy
44
What is the prognosis of a patient following cerebellectomy?
poor
45
What has a better prognosis - bilateral or unilateral?
unilateral; bilateral experience severe vertigo and nausea
46
what has a better prognosis - deep cerebellar nuclei or cortex?
cortex
47
what are the treatments for a cerebellar stroke? (6)
1. postural stability activities, 2. proximal stability activities, 3. developmental sequence, 4. coordination exercises, 5. gait and 6. motor learning
48
Why is postural stability important?
truncal ataxia = difficult for patient to use extremities because the don't have proximal stability for distal mobility
49
How do you allow the patient to do exercises requiring distal mobility?
decrease the degrees of freedom to allow the patient to focus on a particular portion of the task
50
what are frenkel's exercises?
coordination exercises that should be done 2x a day - control is the most important aspect
51
what is the progression of the frenkel exercises?
lying, sitting, standing
52
What are visual cues used for during coordination exercises?
controlling direction and accuracy of the patient's extremities
53
how do you treat with a temporary reduction of dysmetria and tremor?
wrist, ankle, waist weights
54
what are some aspects of therapy to use when practicing gait?
1. visual cues, 2. weights, 3. biofeedback, 4. variety of surfaces
55
what do individuals with a cerebellar dysfunction have difficulty with?
generalization
56
For motor learning, what are some aspects of PT one would use?
increase repetitions, vary task constraints, vary environmental constraints, TASK SPECIFICITY
57
What vitals indicate that a patient can exercise post stroke
- SBP 90-200
- DBP <110
- HR 50-100
58
what is the max cut off for HR during exercise post-stroke?
140 bpm
59
What other special considerations (besides vitals) for exercise post CVA?
anticoagulant medication can affect INR, DVT due to decrease tone, LOE, and respiratory insufficiency
60
What are common problems post - CVA? (5)
1. seizures, 2. cognitive, 3. dysphagia, 4. visuospatial/perceptual disturbances, 5. language deficits
61
What is dysphagia?
difficulty swallowing
62
What is a common problem associated with dysphagia?
aspiration - can be silent, can lead to pneumonia
63
What are compensatory strategies for dysphagia?
thickening liquids, chin tuck during swallowing, small sips
64
What are the treatments of dysphagia?
e-stim, biofeedback, posture
65
What are some visuospatial and perceptual disorders? (4)
1. attention deficits, 2. homonymous hemianopsia, 3. somatagnosia, difficulty with R/L discrimination, 4. depth, distance, or vertical perceptual deficits
66
what is agnosia?
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
67
what is anosognosia?
severe denial, neglect, and lack of awareness of the presence or severity of one's deficits
68
when is anosognosia common?
L hemiplegia (R hemisphere stroke)
69
what is dysarthria?
muscle dysfunction leads to impaired verbal communication
70
what may be affected with dysarthria?
respiration, phonation, articulation, resonance
71
what is the treatment for dysarthria?
tongue/oral motor exercises, functional speaking, posture
72
when is aphasia present?
dominant hemisphere injury
73
what is aphasia?
impairs the expression and or understanding of language
74
what are the three common types of aphasia?
brocas, wernickes, global
75
what is broca's?
expressive aphasia - hard to talk
76
what is wernicke's
receptive aphasia - word salad; doesn't understand what you are asking
77
what is global aphasia?
combo of the 2... patients are really confused; don't know what you are saying and can't say anything
78
what would you do with patients that have global aphasia?
bed mobility, transfers, work of level of assistance
79
what is apraxia
loss of the ability to execute or carry out skilled movements and gestures (commands), despite the desire and the physical ability to perform them; disconnect of hearing and taking in the command and then doing the actual command
80
apraxia is found with ________ injury
parietal lobe
81
what is buccofacial or orofacial apraxia?
inability to carry out facial movements on command
82
what is limb-kinetic apraxia
inability to make fine, precise movements with an arm or leg
83
what is ideomotor apraxia?
inability to make proper movement in response to verbal command
84
what is ideational apraxia
inability to coordinate activities with multiple, sequential movements
85
what is verbal apraxia?
difficulty coordinating mouth and speech movements on command
86
what is constructional apraxia?
inability to copy, draw, or construct simple figures
87
what is oculomotor apraxia?
difficulty moving the eyes on command
88
Is pain a normal thing with CVA?
no
89
shoulder pain occurs in ______% of patients with stroke
70-84%
90
When can hand pain occur?
weightbearing through a flaccid flat hand = capitate will pop out of place
91
What is associated with inferior sublux?
shoulder joint hanging (lack of active movement), downward rotation of scapula, loss of passive locking mechanism, stretching of capsule
92
what is associated with anterior sublux?
new control unbalanced, downwardly rotated scapula pulled superiorly, see extension of humerus with IR
93
what is associated with superior sublux?
flexion synergy, elevation of shoulder, scapula elevated/abducted, impingement may occur
94
What can cause impingement?
spasticity, superior sublux, muscle imbalance, loss of SH rhythm
95
What is associated with 0/5 strength, hypotonia/flaccidity, 2 cm inferior sublux
use of sling, use of e-stim, awareness of UE with bed mobility, PROM with massage, WBing important, use of UE to stabilize objects
96
What is associated with 1-2/5 strength, hypotonia, 2 cm inferior sublux
PNF patterns, WBing (isometric contraction), sling, e-stim on posterior deltoid and supraspinatus
97
what is associated with 2-3/5 prox > distal strength, normal tone, no sublux
Pt needs to use arm for everything.
Distal UE = self ROM, massage, isometrics
Prox UE = AROM, theraband, PNF, WBing, functional tasks
98
what is associated with 1-2/5 prox > distal strength, modified ashworth = 2, 1 cm anterior sublux
e-stim, AAROM prox, WB isometrics distally, PNF, WB prone on elbows, aggressive PROM, functional e-stim, bi-manual activities
99
what is associated with 3-4/5 prox > distal strength, modified ashworth = 2, pain with shoulder flex/ABD AROM > 120
don't push through pain, enforce shoulder ER (shoulder ER and depression/ scapular ADD and retraction)
100
what is associated with 0-1/5 prox strength, modified ashworth = 4, unable to isolate muscle groups
PROM to maintain extension, WB to inhibit biceps and facil triceps, Rhythmic rotation, prone of elbows (WB), scapular retraction, e-stim on triceps
101
What are the first signs of shoulder hand syndrome?
hand edema and tenderness
102
what follows the first signs of SHS?
localized tenderness in the shoulder during ROM activities
103
Pain is primarily with?
movement
104
What happens in the later stages of SHS?
sympathetic vasomotor changes (warmth, redness and glossy, swollen skin), trophic changes of the fingertips
105
What happens in the final stages? (permanent condition)
1. marked atrophy of thenar/hypothenar muscles, 2. skin changes (cool, cyanotic, damp), 3. osteoporotic changes
106
what is the treatment?
PREVENTION - prevent microtrauma
