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THER 120 > OT CVA > Flashcards

OT CVA Flashcards

1
Q

Agnosia

A

inability to recognize people, objects, and/or shapes

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2
Q

Apraxia

A

loss of ability to execute or carry out skilled movements and gestures, despite having the desire and ability to perform them

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3
Q

Aphasia

A

-difficulty of understanding language-
- In expressing wants ideas and thoughts

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4
Q

Anomia

A

problems recalling words, names, numbers- Type of aphasia

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5
Q

CVA on LEFT (R-hemi)

A
  1. Communication problems (aphasia) May include speaking, listening, reading, writing difficulty
  2. Impaired logic, time awareness, sequencing abilities
  3. Decreased analytical and mathematical ability (dyscalculia)
  4. Depression more common
  5. Cautious; slow performance, Anxious
    6.Are more likely to achieve self-care independence earlier
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6
Q

CVA on RIGHT (L-hemi)

A
  1. Visual/perceptual deficits
  2. Difficulty with spatial analysis, shape recognition, face recognition
  3. Decreased intuition, and music and art awareness
  4. Neglect of left side
  5. Distractible, Impulsive behavior, rapid performance of tasks
  6. Sudden outbursts of emotion (pseudobulbar effects)
    7.Lack of insight into their impairments (Anosognosia)
    8.May retain good verbal skills
    9.Slower to become independent
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7
Q

Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA)

A

5 domains, 155 items total
motor function
sensation
balance
joint ROM
joint pain

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8
Q

Brunstromm stages of recovery

A

0-Flaccidity
1-6- Spasticity
3-spasticity peaks
7-Normal

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9
Q

Ashworth stages of spasticity

A

0- no increase in tone
4- rigid in flexion/extension

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10
Q

Brain Stem

A
  • depending on the severity of the injury, it can affect both sides of the body.
  • Can leave them in a “locked in” state
    -HR, breathing, BP affected
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11
Q

Cerebellar stroke

A

Damage to the cerebellum can cause lack of balance and coordination (Ataxia), can also cause slurring of speech (Dysarthria)

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12
Q

Learned non-use syndrome leads to:

A

V strength
V ROM
V fine motor skills
Can lead to pain, contractures
**Make sure affected hand is used in all stages
** constraint induced therapy

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13
Q

General goals for CVA

A
  1. Prevention of deformity and contracture
  2. Prevention of injury
  3. Encourage normal posture and movement
  4. Maximize AROM, PROM, strength, coordination
  5. Achieve maximal use of affected side
  6. Remediate cognitive & perceptual deficits
  7. Maximal independence in all areas of occupation
  8. Maximize mobility skills
  9. Achieve functional communication and social skills
  10. Facilitate realistic adaptation to residual problems
  11. Facilitate re-entry into social participation
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14
Q

Typical pattern of stroke arm

A

Scapular retraction
Shoulder depression and internal rotation
Elbow flexion
Forearm pronation
Wrist flexion
Flexion and adduction of the fingers

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15
Q

Hemiplegic shoulder can lead to?

A

If not handled properly this can lead to pain syndrome
-Avoid the development of shoulder pain

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16
Q

Painful shoulder:

A
  • Interferes with rehab
  • Makes sleeping difficult
  • Requires more medication
  • Clients avoid using arm
17
Q

Shoulder pain: 2 possible causes:

A

Impingement
Immobility

18
Q

Impingement

A

-Trauma to the joint
- Improper handling/poor positioning
- It is common for clients to have higher tone causing internal rotation and adduction
-This mm imbalance contributes to misalignment and puts them at greater risk of impingement

19
Q

Immobility of the shoulder causes?

A

Caused by NOT doing anything
Soft tissue tightening, and loss of ROM
Pts who have prolonged periods of bedrest or who have developed increased tone can find it difficult to move and are susceptible to pain syndrome

20
Q

Shoulder hand syndrome or CRPS is?

A
  • Pain in shoulder that progresses to the whole arm
21
Q

Signs of CRPS

A
  • Limited shoulder ROM
  • Swollen, shiny, hand with limited hand ROM
  • Pain in even the slightest wrist extension
22
Q

HOW TO PROTECT HEMIPLEGIC SHOULDER:

A
  • NEVER pull on the hemi shoulder
  • Do not hold on to the hemiplegic arm to support during sitting, standing, or walking
  • Avoid re-positioning in the w/c by putting your arms under their arms
  • Do not force painful ROM
  • Do not raise the arm in flexion or abduction past 90 degrees
  • Do not raise the arm in flexion or abduction without external rotation of the humerus
23
Q

Prevent shoulder pain : bed positioning

A

Bed positioning:
Position on hemiplegic side- best position
Make sure scapula is in full protraction
On supine, have arm on side of body palm up

24
Q

Prevent shoulder pain: Reduce edema

A

-ice slush
-retrograde massage
-active ROM

25
Q

Prevent shoulder pain: How to encourage movement of involved shoulder

A
  • make sure scapula is gliding BEFORE ROM to shoulder
    -ROM only to a point of discomfort
26
Q

Prevent shoulder pain: Wrist in slight extension

A
  • position on a wheel chair lap trat
    • possible use of splint
27
Q

Precent shoulder pain: How to maintain ROM of MCP/PIP/DIP joints

A

-gentle PROM; AROM
-facilitation of a gross grasp

28
Q

Principles of treatment

A
  • Make sure client is comfortable
  • If seated- feet flat on the floor
  • Respect pain at all times-never take PROM or AROM into painful range
  • Work proximal to distal
  • Monitor fatigue and frustration
  • Client-centered focus is important
  • On-going education of client and family
29
Q

Spasticity is?

A
  • 40% of people will develop spasticity- level will vary
  • Muscle stiffness
  • Upper extremity hypertonia
  • Loss of fine motor control
  • Soft tissue contracture
  • Muscle spasms and muscle fatigue
  • Changes in limb posture
30
Q

Constraint-induced movement therapy is used for?

A

For learned non-use
- CI is best if the client has some motor recovery
- Extend wrist, move arm, extend fingers, cognition
Mirror box therapy

31
Q

FACILITATION (EXCITE)

A

Cold
Light touch
Tapping, stroking
Fast movements
Pain
Fast stretch

32
Q

INHIBITION (RELAX)

A

Firm touch
Pressure
Slow movements
No pain
Prolonged stretch
Warm

33
Q

3 Ways to incorporate a non-functional arm:

A
  1. As a weight-bearing/stabilizer- arm on table
  2. Guided movement- hand over hand- good for apraxic and aphasic clients. Attempt to move the client as normally as possible
  3. Bilaterally- use both hands- using dynamic balance
34
Q

WC positioning:

A

Half lap tray to keep arm in sight
Lower seat to allow foot propelling
Plexiglass- allows them to see feet and floor

35
Q

Functional hand progress-stages

A

gross grasper- sweeping, holding a bowl
gross manipulator- catching/throwing ball, fold laundry
fine manipulator-tying knots, opening containers, typing

THER 120 (12 decks)

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