Exam 3- Stroke part 1 Flashcards Preview

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Flashcards in Exam 3- Stroke part 1 Deck (70):
1

A stroke usually ___ but can ___

~usually appears suddenly

~can appear slowly

2

Some of the slow appearing strokes (2)

  1. ~TIAs,
    • pin stroke,
    • mini strokes
  2. ~hemorrhagic

3

2 main types of strokes

Ischemic/ Occlusive and Hemorrhagic

4

what is the most common type of stroke and by how much?

80% of strokes are occlusive

5

Hemorrhagic- some details (2 things associated with it)

~High blood pressure

~Associated with headaches

6

Hemorrhagic- Common types (5)

  1. ~berry aneurism
  2. ~AVM (arteriosus venous malformation)
  3. intracerebral hemorrhage
  4. cerebral hemorrhage
  5. subarachnoid hemorrhage

7

Hemorrhagic- what is berry aneurism?

an out pouching of the circle of willis

8

Hemorrhagic- what is AVM? (stands for and what it is)

abnormal connection of the artery and vein

(AVM = arteriovenous malformation)

9

Hemorrhagic- 3 courses for an aneurism

  1. It never bursts
  2. It is detected and fixed before it bursts
    • Pick up on a scan when looking for it
    • Pick it up on a another scan (looking at something different) 
  3. ~it bursts and pt has CVA

10

2 ways to fix an aneurism

Clip and coil

11

Clip for an aneurism: when can it be used and how invasive is it?

  • ~can be used for an aneurism that has or has not burst
  • ~Need a craniotomy

12

Coil for an aneurism:

when can it be used?

what does it do?

and how invasive is it?

  • ~for people for not ruptured~
  • a birds nest of wire that fills the hole
    • ~will cause the body to fill back in the aneurism
  • ~Do not need a craniotomy

13

Hemorrhagic- how does it injure the brain? (5)

  1. ~cell starved of blood distal to bleed
  2. ~pressure on cells right at the site; usually occlude broken artery
  3. ~pressure away from the site; can act like a contra coup injury
    1. ~other arteries can be occluded
  4. ~may have uncal herniation and/or
  5. midline shift

14

Hemorrhagic- four typical characteristics of pt in PT

  1. ~wide spread injury/problems
  2. ~will be hard to decide where their symptoms came from
  3. ~will be younger
  4. ~rarely will fully recover

15

Occlusive- 2 types

~thrombolytic

~embolytic

16

Occlusive- what is Thrombolytic

Build up of plaque, etc that will cause a blockage in the artery

17

Occlusive- what is Embolytic?

Blood/plaque/ air/ fat/cancer breaks off and moves (and plugs the artery)

18

Occlusive- Embolytic- blood clot, three characteristics of emergency treatment

  1. the easiest embolytic occlusion to treat
  2. ~We can do a good a good job getting rid of blood clots with TPA tissue plasminogen activators- thins blood and gets rid of blood clots
  3. ~need to give tPA to someone within 3 hours
    • ~More than 3 hours, the structures distally already starting to die
    • ~Its not worth the risk to thin the blood that much after 3 hours

19

Occlusive- Embolytic- fat bock: what is a common source?

can caused post surgery

20

TIA

what does it stand for?

what defines it?

Transient ischemic attack

defined by: symptoms resolve within 24 hours

21

Six characteristics of a Major stroke

  1. ~Complete paralyze on one side
  2. ~High cortical processes loss
  3. ~Has come cognitive loss
  4. ~Speak problems
  5. ~Visual problems
  6. ~Much harder for pt to return to function

22

Three characteristics of a minor stroke

  1. ~Still the same person you were before- personality stays the same
  2. ~Steppage gait; foot drop; some limb paresis
  3. ~A little sensory or motor deficit; distal portion of the UE or LE

23

What is a shower stroke?

what is a common cause?

 

(3 points)

  1. ~Lots of little strokes all over
  2. ~Occlusive, sometimes when a clot breaks off a lot of little clots will break off too
  3. ~Can occur after surgeries when you are trying to prevent/correct for a stroke-
    1. endarterectomy (plaque build up in the carotids)
    2. ~The plaque can lead to a shower stroke if all the plaque is not sucked up

24

some Diagnosis Tests to test for possible stroke (3)

  • ~Echocardiogram- did it happen from a build up of blood settling in the heart
  • ~CT/ MRI
  • ~Carotid US- did it happen form a build up from plaque in the carotids

25

12 risk factors for stroke

  1. ~Birth control
  2. ~smoke
  3. ~high blood pressure
  4. ~diabetes
  5. ~high cholesterol
  6. ~sedentary
  7. ~history of CVA
  8. ~A-fib
  9. ~age
  10. ~postmenopausal
  11. ~drinker
  12. ~African American

26

anterior cerebral artery syndrome- symptoms (7)

  1. ~Contralateral issues
  2. ~LE more than UE- hemiparesis and hemisensory loss
  3. ~More apraxia (inability to perform a task)
  4. ~Problems with imitation and bimanual tasks
  5. ~Slowness, delay, lack of spontaneity, motor inaction
  6. ~High risk of Incontinence issues
  7. ~Higher risk of skin break down

27

middle cerebral artery syndrome- symptoms (8)

  1. ~80% have MCA
  2. ~80% of MCA have occlusive
  3. ~UE worse than LE- hemiparesis and hemisensory loss
  4. ~Aphasia (problems with speak)- motor speech impairment
  5. ~Perception deficits
  6. ~Limb-kinetic apraxia
  7. ~Homonymous hemianopia (be able to draw this);
  8. Unilateral neglect (think of Bob)

28

posterior cerebral artery syndrome- symptoms (3)

  1. ~Visual issues
    • *homonymous hemianopsia
    • *can be bilateral homonymous hemianopsia with some degree of macular sparing
    • *visual agnosia
    • *prosopagnosia
  2. ~Cerebellar issues- balance and coordination
  3. ~Memory defect

29

locked in syndrome is the same as _______, and two characteristics

Vertebrobasilar stroke

  1. ~They can feel and hear everything
  2. ~They can understand

30

Stroke on the Right- symptoms (10)

  1. ~Visual problems
  2. ~Unilateral defect
  3. ~Impulsive
  4. ~Poor judgment
  5. ~Quick with movements
  6. ~Unaware of impairments
  7. ~Rigid in their thoughts (stubborn)
  8. ~Emotional with negative emotions (and expressing them) and get upset with constructive criticism
  9. ~Have problem with time;
  10. trouble with spatial awareness

31

Stroke on the Left- symptoms (7)

  1. ~Right motor issues
  2. ~Speak issues (know problems with W and B; Express and receptive)
  3. ~Local aphasia
  4. ~Disorganized
  5. ~Slow and cautious;
  6. overly aware of their impairments
    • ~They think they are doing horrible/ afraid/ etc;
    • have to talk them into doing something 
  7. ~Have some processing delays

32

bilateral hemipshere stroke symptoms (5 major)

  1. ~Visual- homonymous hemianopsia
  2. ~Lability- unstable personality (person can be crying and they don’t have a reason to)
  3. Affective:
    • ~Apathy,
    • irritable,
    • anxiety,
    • depression
  4. Cognitive
    • ~Confusion,
    • short attention span,
    • loss of memory
  5. ~Inability to preform executive functions

33

When people are recovering from a stroke, they will often ask...

When am I going to get better?

34

Recovering from a stroke: what are some things that are going on that are helping (4)

  1. Blood flow
    • ~Angiogenesis,
    • collateral blood flow helps with recovery
    • ~Thinning the blood,
  2. keeping the inflammatory response down
  3. ~Pts are going to sleep a lot!
  4. ~Neuroplasticity- need stimulus (we will help to cause it) to help cause new connections and strengthen the old ones
    • ~Have to start moving them fast so that something will start to form in the brain

35

Recovering from a stroke: what is something that will help if they are flaccid?

why?

what should you be careful of?

  1. ~go into weight bearing to cause compression in jts
  2. ~will get them to have muscle firing
  3. ~Be careful to make sure that when you are doing this that the pt is in proper alignment so that they do not have impingements later

36

Roods techniques- types (10)

 

when performed they can be ______ or ________.

***Can be facilitative or inhibitory

  1. ~Stretch
  2. ~Jt manipulation
  3. ~Cutaneous touch
  4. ~Ice
  5. ~Heat
  6. ~Vestibular
  7. ~Auditory
  8. ~Visual
  9. ~Gustatory
  10. ~Olfactory

37

Roods techniques- Facilitative

  • ~To increase the threshold- excitatory inputs
  • ~produces contraction

38

Roods techniques- Inhibitory

~To decrease the threshold ~relaxation

39

Roods techniques- 3 type of Stretch techniques

  1. ~quick
  2. ~repetitive
    • ~CMP (continuous passive motion)
  3. ~Prolonged

40

Roods techniques- Quick Stretch:

what is it/how does it work?

facillitaive or inhibitory?

  • ~will jar the muscle a little bit to cause a contraction
  • ~facilitative

41

Roods techniques- repetitive stretch

what is it/how does it work?

facillitaive or inhibitory?

Repetitive stretch

  • can place a vibrator over the muscle belly
    • > 100 Hz is Facilitatory
    • < 100 Hz is Inhibitory
      • CPM, continuous passive motion, fits in this category

42

Roods techniques- CPM stretch

what is it/how does it work?

facillitaive or inhibitory?

continuous passive motion stretch-

it is a type of repetitive stretch using < 100 Hz

  • it is inhibitory (< 100 Hz)

43

Roods techniques- prolong stretch

what is it/how does it work?

facillitaive or inhibitory?

  • ~Serial casting-
    • you will put the person at the end range, recast and move them farther into the range
    • ~trying to get spasticity to release

~inhibitory

44

Roods techniques-  three Jt manipulation types

  1. ~traction
  2. ~low grade manipulations
  3. ~approxiations

45

Roods techniques- Jt manipulation Traction

what is it/how does it work?

facillitaive or inhibitory?

creates space and relaxes muscles

inhibitory

46

Roods techniques- Jt manipulation Low grade

what is it/how does it work?

facillitaive or inhibitory?

movements relax muscles/reduce pain (grade 1-2)

inhibitory

47

Roods techniques- Jt manipulation Approximation

what is it/how does it work?

facillitaive or inhibitory?

compression in joint causes co-contraction of surrounding muscles

facillitative

48

Roods techniques- Cutaneous touch types (2)

  1. ~Quick touch
  2. ~Maintain touch

49

Roods techniques- Cutaneous touch light/quick

what is it/how does it work?

facillitaive or inhibitory?

Cutaneous Touch (must have sensation there)

  • light stroke usually helps with posture
    • touch over the muscle belly- contracts the muscle

facillitative

50

Roods techniques- Cutaneous touch maintained

 

what is it/how does it work?

facillitaive or inhibitory?

Cutaneous Touch (must have sensation there)

  • Maintaining touch will relax muscle (with a little pressure is nice)
    • same way that swaddling works (and tight clothing in peds rehab)
    • Hug
    • calmed the muscle- relaxation

inhibitory

51

Roods techniques- 2 Ice types

~quick strokes

~prolonged

52

Roods techniques- Ice quick

what is it/how does it work?

facilitative or inhibitory?

 quick cutanious strokes causes contraction

 

facilitative

53

Roods techniques- Ice prolonged

what is it/how does it work?

facilitative or inhibitory?

If you leave ice on skin long enough it causes relaxation

inhibitory

54

Roods techniques- Heat

what is it/how does it work?

facilitative or inhibitory?

heat Relaxes them

inhibitory (never used to provoke muscles)

55

Roods techniques- 3 Vestibular types

  1. ~rocking
  2. ~spinning
  3. ~bouncing on the ball

56

Roods techniques- Vestibular: rocking

facilitative or inhibitory?

inhibitory (relaxes us)

57

Roods techniques- Vestibular: spinning

facilitative or inhibitory?

causes contractions

facilitative

58

Roods techniques- Vestibular: bouncing on the ball

what is it/how does it work?

facilitative or inhibitory?

 

Bouncing on the ball (could either excite or inhibit)

  • ~Softly- relaxes (inhibitory)
  • ~Hard- contractions (and jt approx.) - excitatory

59

Roods techniques- 2 Auditory types

~loud

~soft

60

Roods techniques- Auditory loud

facilitative or inhibitory?

facilitative / contractions

61

Roods techniques - auditory: soft

 

facilitative or inhibitory?

relaxes (inhibitory)

62

Roods techniques- 2 Visual types

~bright

~soft

63

Roods techniques- Visual: bright

facilitative or inhibitory?

Bright loud colors- awake/ contraction

facillitative

64

Roods techniques- Visual: soft

facilitative or inhibitory?

asleep/ relaxation

inhibitory

65

Roods techniques- 2 examples of Gustatory types

~sour

~sweet

66

Roods techniques- Gustatory sour

facilitative or inhibitory?

Sour, etc- wake up/ contraction

facillitative

 

67

Roods techniques- Gustatory sweet

facilitative or inhibitory?

Chocolate, etc- relaxation

inhibitory

68

Roods techniques- two examples of Olfactory types

~bleach

~nice smells

69

Roods techniques - olfactory types: bleach

 

facilitative or inhibitory?

Bleach, etc- wake up/ contraction

facillitative

70

Roods techniques- Olfactory: nice

 

facilitative or inhibitory?

Relaxing smells (coffee :) )

inhibitory