stroke

Question 1

Agnosia

Answer 1

inability to recognize objects, persons, smells, or sounds despite having normal sensory functions

Question 2

Dysarthria

Answer 2

inability or impaired ability to produce written language

Question 3

Dyslexia

Answer 3

inability or impaired ability to read written language

Question 4

Aneurysm

Answer 4

weakening of an artery wall, resulting in distension of the artery

Question 5

Anomia

Answer 5

inability to name objects or persons

Question 6

Anosognosia

Answer 6

unawareness or denial of neurological deficit

Question 7

Aphasia

Answer 7

an acquired language disorder that results from damage to the language centres

Question 8

Apraxia

Answer 8

inability to perform purposeful actions

Question 9

ideational apraxia

Answer 9

the inability to correctly order or sequence a series of movements to achieve a goal

Question 10

ideomotor apraxia

Answer 10

deficits in the ability to carry out skilled movements when given a verbal command

Question 11

Contracture

Answer 11

abnormal shortening of a muscle tissue; resistant to passive stretching

Question 12

Contralateral homonymous hemianopia

Answer 12

ocular condition in which vision has been lost in the same field halves of both eyes

Question 13

Dysarthria

Answer 13

speech disorder resulting from paralysis, weakness, or incoordination of the muscles involved in speech production dysphagia

an eating disorder with difficulty manipulating and transporting from the mouth the pharynx

Question 14

Spasticity

Answer 14

a velocity dependent increase in tonic stretch reflexes

Question 15

Subluxation

Answer 15

an incomplete or partial dislocation of a joint

Question 16

Ischemic Stroke

Answer 16

• Insufficient blood flow to meet the metabolic demands
  o An obstruction of the blood vessels supplying the brain
  o Thrombosis = a blood clot that forms within a cerebral vessel
  o Embolism = a blood clot that originates in the heart or other arterial sources outside the brain. They become dislodged from their origin sites and block vessels supplying the brain

Question 17

Hemorrhagic stroke

Answer 17

Caused by a rupture of a weakened blood vessel. The most common causes of weakened vessel are aneurysms

Question 18

Transient ischemic attack (TIA)

Answer 18

An event that results in symptoms resembling a stroke

Considered a warning sign of an impending stroke

Question 19

Right Hemisphere Stroke

Answer 19

o Left-sided weakness or paralysis and sensory impairment
o Left neglect = Denial of paralysis or impairment and reduced insight into the problems created by the stroke for the left side of the body
o Visual problems, including an inability to see the left visual field of each eye
o Spatial problems with depth perception or directions
o Inability to localize or recognize body parts
o Inability to understand maps and find objects, i.e., clothing or toiletry items
o Memory problems
o Behavioural changes, such as lack of concern about situations, impulsivity, inappropriateness, and depression

Question 20

Left hemisphere Stroke

Answer 20

o Right-sided weakness or paralysis and sensory impairment
o Problems with speech and understanding language (aphasia)
o Visual problems, including the inability to see the right visual field of each eye
o Impaired ability to do maths or to organize, reason, and analyze items
o Behavioural changes, such as depression, cautiousness, and hesitancy
o Impaired ability to read, write, and learn new information
o Memory problems

Question 21

Impact of stroke on daily occupations (6)

Answer 21

1. Trunk and postural control
2. UE impairments
3. Cognitive and perceptual impairments
4. Language
5. Visual impairments
6. Psychosocial impairments

Question 22

Trunk and postural control

Answer 22

o Multidirectional trunk weakness
o Reduced and delayed activation of trunk muscles and postural control muscles
o Loss of automatic postural reactions (i.e., walking)
o Asymmetrical trunk movements when walking
o Asymmetrical weight bearing in sitting, and standing
o Soft tissue contractures
o Inability to perceive midline

Question 23

UE impairments

Answer 23

o Weakness, loss of selective motor control, changes in muscle tone, and somatosensory loss
o Secondary complications = edema, overstretching of the glenohumeral joint, muscle imbalances (lengthen= triceps; and shortening= bicep); shoulder joint subluxation
o After the initial period of weakness, hypertonia, hyperactive stretch reflexes, spasticity may develop

Question 24

Cognitive and perceptual impairments

• right vs left
• Daily life

Answer 24

o Left side = ideational apraxia, ideomotor apraxia, poor organization, decreased ability to sequence, and impaired judgement
o Right = left side visual neglect, unilateral body neglect, decreased attention, and spatial dysfunction
o Daily life = decreased independence in basic ADLs and functional mobility; decreased efficiency and independence in performing IADLs; inability to RTW; inability to drive

Question 25

Language

Answer 25

o Deficits common with left hemisphere
o Broca aphasia/ non-fluent aphasia = output that is slow and effortful. Phrase length is short and normal grammar is lacking. Sentences are simplified. Comprehension is intact but repetition is poor
o Wernicke aphasia/ Fluent aphasia = speech that is easily produced and prosody that is normal. Phase length is normal, and sentences are grammatically correct. Contains paraphrasing, neologisms, and lacks content words
o May require modification of testing procedures. With severe language or cognitive impairments, standardized testing is not possible

Question 26

Visual impairments

- functioning and occupations impacted

Answer 26

• Lower QOL, higher levels of depression and anxiety, higher fatigue levels, lower levels of ADL and mobility function
• Occupations impacted: inability to drive; impaired functional mobility; read or balance a chequebook; access electronic communication; locating objects in the environment required to perform basic ADL/IADLs

Question 27

Psychosocial impairments

Answer 27

o Decreased or inability to participate in the rehab process
o Suboptimal functional recovery
o Decreased overall social participation
o Interference with social relationships
o Altered sex drive and appetite

Question 28

Interventions: acute stage

Answer 28

o Positioning to prevent secondary complications: subluxation, muscle imbalances, joint contractures, skin breakdowns, and chronic pain
o Dysphasia management, fall prevention, early mobilization, retraining self-care activities
- hospital setting

Question 29

interventions: rehab setting

Answer 29

inpatient rehab
o Restoration or compensation of performance skill deficits that interfere with daily occupations
o Maximizing independence of ADLs and IADLs for discharge into the community

Question 30

interventions: Subacute-chronic stage

Answer 30

recovery phase
o Maximizing independence of IADLs
o Skills needed to RTW
o Resumption of driving
o Engagement in leisure activities and socialization
- Interventions should be selected based on evidence-based practice principles. Recommended to practice functional tasks to improve balance, mobility, UE function, and ADLs/IADLs

Question 31

interventions: Motor learning and intervention principles

Answer 31

o can be useful in developing treatment interventions.
o Assist clients in adjusting to role and task performance limitations
o Create a treatment environment that mirrors common challenges
o Practice functional tasks
o Encourage practice outside therapy
o Minimizing ineffective and inefficient movement patterns, the use of random and variable practice conditions, decrease amounts of physical guidance and verbal feedback

Question 32

interventions: Biomechanical approach

Answer 32

o Useful in addressing: decreased strength, muscle imbalances, joint mobility, edema, and pain

Question 33

interventions: IADL and ADL impairments

Answer 33

o Occupation and activity-based interventions are best
o Should be task specific, repetitive, graded to challenge the patients capabilities, and progressed as appropriate
o Depending on the degree of impairment, recovery stage, patient preferences, and the anticipated discharge environment, it may be appropriate to teach compensatory strategies or introduce adaptive equipment during ADL/IADL training

Question 34

interventions: Task-oriented training

Answer 34

o Interventions that involve practicing functional tasks that are graded to challenge the patients current motor capabilities
o Practiced repeatedly and progressed in difficulty so they are continuously challenged

Question 35

interventions: Constraint induced movement therapy

Answer 35

o A form of task training that involved (1) restraint of the unimpaired limb, forcing use of the impaired limb during daily activities; (2) repetitive task practice with the affected limb in the form of whole task practice and ‘shaping’ for 6 hours a day for 2 weeks

Question 36

interventions: Modified constraint induced movement therapy

Answer 36

o Modification of the original protocol in which the restraint time and the amount of intensive training of the impaired limb is reduced and/or distributed over a longer period of time.

Question 37

interventions: Mirror therapy

Answer 37

o Client performs movements and simple activities with the unimpaired limb while watching its mirror reflection superimposed over the (un)seen impaired limb

Question 38

interventions: Strength and exercise

Answer 38

o Considered as an adjust to functional task practice for improving UE function, balance and mobility, and activity and participation after stroke

Question 39

preservation

Answer 39

repeated movements or acts during functional performance as a result of difficulty shifting from one response pattern to another

Question 40

extinction

Answer 40

• part of neglect

- inability to perceive multiple stimuli of the same type simultaneously

Question 41

Abnormal reflexes and posturing (3)

Answer 41

1. decorticate: damage to cerebral hemispheres; UE= flex/IR/ADD; LE= Ext/IR/ADD
2. decerebrate: worst posture to see in a brain injury; UE & LE ext/IR/ADD, fingers/wrist flex, feet plantar flexed, trunk extended, head retracts
   - damage to brainstem and extrapyramidal tracts; poorer prognosis
3. primitive reflexes