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OTA 233 > Quiz 3 > Flashcards

Quiz 3 Flashcards

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1
Q

Cerebrovascular Accident

A

sudden loss of blood supply resulting in loss of oxygen supply to the brain
damages kills brain cells
neurological deficits related to areas affected
affects opposite side of the body to the hemisphere of the brain affected

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2
Q

Ischemic stroke

A

87%

caused by thrombus- blood clot or embolus traveling blood clot

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3
Q

Hemorrhagic stroke- 10%

A

caused by rupture of blood vessel with bleeding into the brain
blood is leaked into adjacent brain tissue
often more severe than ischemic strokes
anurism is a type
usually die of complications if live after stroke

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4
Q

Risk Factors for CVA

A 
Risk Factors:
controllable:
hypertension
cigarette smoking
excessive alcohol intake
high cholesterol intake
obesity

uncontrollable:
increasing age
male sex
black race
history of DM
previous CVA or TIA
family history
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5
Q

Effects

A 
mental functions
sensory functions
neuromuscular
movement-related functions
voice speech functions
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6
Q

Dysfunction:

A 
flaccid paralysis or hypotonicity
absent or reduced reflexes
impaired posture
sensory deficits
visual impairments
perceptual dysfunction
cognitive dysfunction
behavioral and personality changes
impaired speech and language skills
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7
Q

Early Treatment:-Warning Signs

A

warning signs:
early treatment can reduce progression and residual effects if within 4 hours of start treatment
use of clot buster drugs
FAST- face, arm, speech, time

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8
Q

Medical management:

A

emergency treatment: open airway, establish fluid balance, and treat medical problems
give medicine
surgery may be indicated

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9
Q

*Hemispheric Lateralization:

A

Left cerebral hemisphere- Right hemipharesis
responsible for language, time concept, and analytic thinking
often have aphasia- partial or total loss of language communication and apraxia- motor planning problems

Right cerebral hemisphere- left hemipharesis
controls visual-perceptual function and perception of the whole
neglect/inattention more common
may retain good verbal but poor functional performance- dysarthria

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10
Q

Cerebellum Stroke:

A

abnormal reflexes of the head and torso
coordination and balance problems
ataxia
dizziness
problems with swallowing and articulation
cranial nerve deficits- vertigo, nausea, vomitting, headaches, nystagmus, slurred speech

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11
Q

Brainstem Stroke

A

controls primary functions- breathing, heart rate, blood pressure and arousal
dizziness
problems with swallowing and articulation
cranial nerve deficits
paralysis
likely to be critically ill- to need mechanical ventilation

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12
Q

MCA- Middle Cerebral Artery

A

most common
largest vessel branching off the internal carotid artery
most common cerebral occlusion site
feeds- femoral, temporal, parietal lobes of brain and basal ganglia and internal capsule

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13
Q

MCA- Effects

A

Effects of complete MCA CVA
facial asymmetry, arm weakness, and speech deficits
hemiplegia or hemiparesis of contralateral side
affecting lower part of face arm and hand
sensory loss in same areas
homonymous hemianopsia- visual field deficits affecting the same half of the visual field in both eyes

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14
Q

ACA- Anterior Cerebral Artery

A 
least common- frontal and parietal lobes
classic signs:
contralateral leg weakness and sensory loss
behavioral abnormalities
incontinence may occur
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15
Q

PCA- Posterior Cerebral Artery

A

feeds the medial occipital lobe and inferior and medial temporal lobes
vision- contralateral homonymous hemianopsia
larger strokes- aphasia and neglect

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16
Q

Cognitive Dysfunction:

A 
Inatention and memory deficits
attention and concentration deficits
disorientation
insight deficits
judgement and safety awareness deficits
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17
Q

Transient Ischemic Attack: TIA’s

A

incomplete stroke with symptoms lasting from a few minutes to 24 hours

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18
Q

Role of OT: Tx of CVA

A

improve motor function
integrate sensory-perceptual and cognitive functions
facilitate maximum level of functional independence
encourage resumption of life roles
promote health management and maintanence behaviors to prevent recurrent stroke

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19
Q

Grading of treatment:

A

increase length and complexity of activity
consider time for completetiong, extend of steps, number of steps, amount of physical assistance, verbal cues used and adaptive equipment

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20
Q

Remedial vs Compensatory Treatment:

A

remediation- restoring function
compensation- adaptation of task or environment
usually use a combination of both

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21
Q

Abnormal Reflexes/ Postural Mechanism post CVA

A

delayed righting, equilibrium, and protective response

address balance and trunk control of head and trunk-normal postural mechanisms

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22
Q

Positioning Techniques:

A 
reduce abnormal tone
promote alignment
prevent contracture & skin breakdown
Bed--
alternative positions
AE use as needed
prevent decupitus ulcers
affected arm is supported
resting hand splint in functional position
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23
Q

Balance Impairments:

A

poor automatic & postural adjustments against gravity

decreased weight bearing on affected side

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24
Q

Positioning Treatment

A 
NDT- handling techniques- plevis, shoulders, chest & head)
use wedges for anterior pelvic tilt
encourage crossing midline
co-treat with PT for balance 
sit on PB to improve righting reactions
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25
Sensoriomotor Interventions- | Occupation-based Treatment Ideas
Weight shifting ---- prepare for wheelchair transfer by weight shifting to front of seat Weight bearing prone, side lying, then progress to sitting— watch a movie or read a book on a wedge in prone or side lying, in sitting rest arm on lap tray Practice sit<>stand transfers - toilet transfers segmental rolling/trunk rotation- in side lying, reach for clock pelvic tilt- in sitting reach for snacks forward and overhead and place in bowl at elbow height
26
Abnormal Muscle Tone:
Flaccid paralysis: often replaced by spastic paralysis more affective synergies- want to break out to prevent contractors choose activities move away from synergies Spasticity is described as minimal, moderate, or severe can fluctuate through out the day
27
Motor Control Deficits:
``` Voluntary muscle control absent immediately after stroke function returns in stages and may stop at any stage return proximal to distal ```
28
Common motor problems:
movement dominated by synergy patterns impairment of coordination, including ataxia fine motor- last to recover
29
Motor Control Treatment:
PROM/AROM: full mobility of scapula, clavicle, and humerus is required for pain-free ROM 2 x a day ROM AROM: used with minimal active movement
30
Treatment of shoulder subluxation and pain:
avoid overhead pulley and pain pain prevented by positioning PROM proper handling sling use- givmohr
31
Motor Retraining
sensorimotor, task-oriented, or functionally based approaches CIMT-usedful with learned disuse robotic-assisted therapy may be used for retaining movement
32
Influence muscle tone:
hypotonic muscles are stimulated through sensation | hypertonic muscles are inhibited through positioning and handling
33
bilateral integration
important to start early, progression of the affected arm with motor return
34
strength and endurance
used with caution is spasticity is presents strengthening of unaffected side only if spasticity is no increased on affected side endurance training graded to each clients needs
35
Elevation and retrograde massage:
severe edema may be early sign of complex pain syndrome- RSD | treatment includes elevation, AROM, retrograde massage, compression wraps, and pneumatic compression devices
36
Compensatory techniques
possible hard dominance retraining | teaching one handed techniques
37
Hypotonicity: | Sensorimotor intervention------------Occupation Based treatment-
quick stretch- patient performs a stretch with unaffected arm before ADL resistance- squeezing shampoo bottle traction- grasp tub grab bar and lean back to prepare for transfer light touch- tactile cues during ADL vestibular stimulation- take elevator to treatment room and then perform transfers rhythmic initiation- therapist assists reach into closet for shirt, then pt reaches for pants
38
Hypertonicity: | Sensorimotor intervention------------Occupation Based treatment-
prolonged stretch - hold book open with affected hand compression- lean on affected extremity to sit up in bed before reaching for face cloth firm pressure- encourage use of affected arm for reach with firm touch vs light tactile cues rocking rhythmically- sit in rocking chair relaxation- contract relax, hold relax- squeeze face cloth then release
39
Contracture: | Sensorimotor intervention------------Occupation Based treatment
prolonged stretch- weight bearing through hand during ADL splinting - use arm while in splint- don/dof splint positioning- place hand to hold cup while pouring with unaffected hand
40
Ataxia: | Sensorimotor intervention------------Occupation Based treatment-
weight bearing- lean on affected arm while performing hygiene tasks quadruped- spot clean carpet D1/D2- putting away groceries
41
visual deficits
may affect distance vision, peripheral awareness, or accommodations or may cause diplopia
42
auditory deficits
usually from normal aging | should not be misinterpreted as confusion
43
Tactile deficits:
changes in touch, pain, pressure, temperature, vibration and proprioception
44
Olfactory and gustatory deficits:
may have a dulled sense of smell and taste
45
Visual Perceptual Dysfunction:
remediation of visual- perceptual deficits focuses on the restoration of skills compensatory strategies for visual- perceptual and perceptual motor impairment intact skills compensate for deficits repetitive practice may be needed to learn a strategy- Safety
46
Visual Perceptual Treatments
``` Treatment Ideas: pen/paper tasks, visual scanning cancellation tasks reading, using anchor line alphabet/number board on wall with post its, reaching and crossing midline to locate sequential characters to promote visual scanning scavenger hunt in room/hallway ```
47
Spatial Relations Deficits:
clients may have difficulty with shape recognition, depth perception, figure-ground distinction, and vertical or horizontal orientation Functional Manifestation Dressing difficulties: unable to orient clothing, locate armholes, leg holes or bottom of shirt May put glasses on upside down attempts to put dentures in upside down difficulty orienting body to get out of bed
48
OT Treatment Spatial Relations:
``` use repetition and practice monitor amount & type of cueing required set up environment/task the same way every time use pictures/written instructions use mirror for visual feedback ```
49
Unilateral Body Neglect:
inability to interpret perceptual messages from the hemiplegic side of the body functional manifestations pt does not use involved extremity for ADL or position it correctly for transfers
50
Unilateral Spatial Neglect: | functional manifestation:
does not attend to person speaking on affected side keeps head rotated towards affected side does not use items on affected sides
51
Treatment: for Spatial Neglect
constant cueing- visual, verbal, and tactile set up activities the same way; repetitions set up environment to ensure safety provide stimulation from involved side promote head turning toward involved side
52
Ideomotor Apraxia
``` impaired motor planning functional manifestations: pt may appear clumsy, unable to adjust self to task pt may have problems sequencing task difficulty moving bolus poor coordination with utensils difficulty fasteners ```
53
Ideational Apraxia
inability to plan motor acts functional manifestations: pt does not know what to di in order to perform an activity does the pt attempt to use items incorrectly may perform task incorrectly
54
Treatment for Apraxia:
``` verbal and tactile cues positioning garmet in same position each time bottom up to top pull over clothes hand over hand assistance perform same way each time ```
55
Cognitive Dysfunction:
initiation and motivation deficits * difficulty starting and finishing a task * decrease in intrinsic motivation Attention and concentration deficits * deficits in ability to attend and maintain focus * tx: adjust environment, remove distractions
56
Disorientation and confusing
* awareness of person, place, time and situation * retain personal information the longest * forget situational information first * Tx: provide visual cues for place, date, situation: reinforce orientation but be careful about making pt frustrated or belligerent
57
Memory deficits
* CVA affects reception, integration, and retrieval of information * Tx: use external memory aides, repetition, and visual cues
58
Sequencing and organization
* affects understanding of time and space * may stop activity after each step of an activity * use familiar environment
59
Insight deficits
* unable to recognize deficits * Tx: frequency re-education into current status/stimulation occasionally may allow pt to fail at certain tasks to promote awareness of deficits
60
Judgement and safety
* impaired ability to understand the consequences of behavior * may be resistive to feedback * Tx: discuss consequences of actions, allow pt to fail at task and review why and what could have been done differently.
61
Generalization and learning deficits:
client should perform task in various context
62
Cognitive fatigue
build rest periods into treatment sessions
63
Behavior Manifestations: Impulsivity
* decreased insight can lead to impulsivity * functional manifestations: shovels food in mouth and swallows without chewing * does not test water temperature before showering * does not completely stand before transfer * does not lock w/c breaks * Treatment: * use clear instructions to ensure safety * setup environment to ensure pt safety
64
Behavior Manifestation: Perseveration
* Perseveration: * meaningless, non-purposeful repetition of an action * Functional manifestations: * pt repeats activity or part of activity over and over * Treatment: * use verbal cues to break up repetition
65
Dysarthria:
* oral-motor dysfunction resulting in difficulty in pronouncing sounds or combinations of sounds * Tx: oral motor exercises
66
Aphasia:
* acquired language disorder- range of deficits * broca- aphasia: expressive aphasia * wernicks aphasia: receptive aphasia * global aphasia: loss of expressive and receptive skills * anomia- word finding difficulty
67
Dysphagia:
* difficulty swallowing because of weakness * clinical signs- drooling, pocketing of food, coughing, or gurgling * high risk for aspiration * Treatment: * involves feeding program and modified diet- levels of food
68
Treatment of Unilateral Neglect:
reinforce attention to involved side with visual and tactile cues use of mirror during ADL’s tasks encourage use of involved side in all task as mush as possible reinforce safety and setup with functional transfers

OTA 233 (3 decks)

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