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Neuromuscular 1 > Stroke > Flashcards

Stroke Flashcards

(51 cards)

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1
Q

Modifiable risk factors

A

HTN
High cholesterol
Diabetes
Physical inactivity*
Obesity*
Alcohol consumption
Drug/tobacco use
A-fib

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2
Q

Unmodifiable risk factors

A

Age over 55
History of stroke/TIA
Family history of stroke
Male

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3
Q

Ataxia

A

poor muscle control that causes clumsy voluntary movements

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4
Q

Apraxia

A

inability to execute movement despite having the physical ability to perform them

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5
Q

Dysarthria

A

Difficulty speaking due to weakness of muscles used for speech

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6
Q

Aerobic activity guidelines for aging adults

A

Vigorous: 20 min 3x/week

Moderate: 30 min 5x/week

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7
Q

Muscle strengthening guidelines for aging adults

A

8-10 exercises; 10-15 reps

2x/week non-consecutive days

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8
Q

Flexibility training guidelines for aging adults

A

8-10 exercises; 15-30 sec holds

At least 2x/week but recommended 5-7

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9
Q

Balance activity guidelines for aging adults

A

Challenging but successful

Daily

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10
Q

Hemorrhagic stroke types

A

HTN
AVM
Aneurysm
Trauma

Epidural, subdural, subarachnoid, intracerebral

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11
Q

Ischemic stroke types

A

Large vessel:
- thrombotic (local obstruction)
- embolism (traveling clot or debris)

Small vessel: lacunar
- basal ganglia, pons, internal capsule
- HTN, diabetes, high cholesterol, smoking, age

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12
Q

Anterior brain circulation

A

Internal carotid artery
- middle cerebral artery
- anterior cerebral artery

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13
Q

Clinical findings of MCA stroke

A

CL hemiplegia UE > LE
CL hemianesthesia

R hemisphere
- L homonymous hemianopia
- spatial neglect

L hemisphere
- R homonymous hemianopia
- aphasia

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14
Q

Clinical findings of ACA stroke

A

CL hemiplegia LE > UE
CL hemianesthesia
Delay in verbal and motor response (abulia)
Apathy
Incontinence
Impaired judgement
Apraxia

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15
Q

Posterior brain circulation

A

Vertebral arteries > basilar artery > posterior cerebral arteries

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16
Q

Clinical findings of basilar stroke

A

crossed symptoms on the ipsilateral face/contralateral body, locked-in syndrome

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17
Q

Clinical findings of PCA stroke

A

CL homonymous hemianopia
Hemisensory loss
Cortical blindness
Thalamic syndrome (abnormal sensation of pain, temperature, proprioception, touch)
Exaggerated sensation (light pressure may be painful)

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18
Q

Clinical findings of cerebellar stroke

A

Gait unsteadiness
Ataxia
Vertigo
Nausea/vomiting

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19
Q

Clinical findings of superior cerebellar stroke

A

Ipsilateral ataxia
Nausea/vomiting
Dysarthria
CL loss of pain and temperature
Ipsilateral UE dysmetria

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20
Q

Clinical findings of AICA stroke

A

Ataxia
ipsilateral deafness
facial weakness
vertigo
nausea/vomiting
nystagmus
CL loss of pain and temperature

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21
Q

Clinical findings of lacunar stroke

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A

Depends on location

Posterior limb of internal capsule: motor deficit

Anterior limb of internal capsule: weakness of face and dysarthria

Posterolateral thalamus: pure sensory loss

Pons: ataxia, clumsiness, weakness

22
Q

Clinical findings of PICA stroke

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A

wallenburg syndrome
ipsilateral ataxia
Ptosis (eyelid drooping)
Sensory impairment ipsilateral face, CL body

23
Q

Homonymous hemianopia

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A

field loss deficit in the same halves of the visual field of each eye

24
Q

Dysmetria

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A

inability to control distance, speed, ROM necessary to perform smoothly coordinated movements

25
Dosing for PT
Frequency: 2-5x/week acute care (subacute) 1-2x/week outpatient (chronic - stop w/ functional plateau; monthly/yearly follow ups) Intensity: amount person can be successful cardiovascular training effect Time: 20-60 min Type: neuromotor/skill acquisition cardiovascular/pulmonary strength flexibility
26
Subacute stroke PT intervention
CIMT E-stim (NMES and FES) BWSTT Cardiovascular exercise
27
Gait speed and function classification
Limited household ambulation: .4 m/s Limited community ambulation: .4-.8 m/s Full but slow community ambulation: .8 m/s
28
Chronic stroke PT intervention
Cardiorespiratory training Promote long-term activity E-stim (NMES and FES)
29
Which is the best window of timing for use of tissue Plasminogen Activator (tPA) for ischemic stroke?
30
Which is a possible window of timing for thrombectomy for an ischemic stroke of the posterior, anterior, vertebral or basilar arteries?
6-8 hours from last known well (LKW)
31
Ischemic stroke vs. TIA
Ischemic: disruption of blood supply leading to cell death; seen with CT or MRI; 4% risk of recurrence TIA: temporary disruption of blood supply w/o evidence of cell death; not visible on imaging; 3-20% risk of recurrence Work up for both is the same
32
Intervention for pusher syndrome
- get pt. to realize disturbed perception - use visual aids to understanding body's relation - learn movements to get vertical - maintain vertical while performing other activities
33
Brunnstrom stage 1
no voluntary movement, areflexia, flaccidity
34
Brunnstrom stage 2
minimal voluntary movement in primitive synergies DTRs begin to appear spasticity begins
35
Brunnstrom stage 3
most or full movement in primitive synergies hyper-reflexia spasticity peaks
36
Brunnstrom stage 4
partial fractionated movement DTRs decrease toward normal spasticity decreasing
37
Brunnstrom stage 6
full fractionated movement is possible may still have some decreased coordination
38
BSF test: strength/force/power
MMT, dynamometer 30 sec STS Stair-climb
39
BSF: motor control and fractionated movement
Selective motor control - STREAM Fine motor control - cross body reach
40
BSF: coordination
Lack of coordination w/ cerebellar stroke - TNF - HTS - RAM
41
BSF: sensation/pain
Light touch, extinction Sharp/dull Vibration Pain
42
BSF: endurance/fatigue
6 min walk test
43
BSF: ROM, joint mobility, soft tissue flexibility
ROM measurements Spasticity - ashworth - tardieu Tone
44
BSF: cognition, perception, communication
Wernicke's and/or Broca's aphasia Spatial neglect or decreased spatial awareness Impaired judgement Locked-in syndrome (severe basilar)
45
Acute/subacute remediation
- regain as much lost function as possible - increase strength and motor control (CIMT, NMES) - bed mobility, transfers, gait, balance, WC mobility, BWSTT - aerobic conditioning
46
Acute/subacute compensation
- caregiver training - short-term orthotics or other bracing - FES - gait aids - wheelchair
47
Acute/subacute prevention
- second stroke - pneumonia - skin integrity - injury - falls
48
Prefabricated orthotics
carbon fiber plastic external AFO ACE wrap
49
custom orthotics
solid AFO articulated AFO ground reaction AFO KAFOs
50
shoe inserts
UCBL orthosis foot orthotics
51
Medications for physical sequelae
Thrombolytics Skeletal muscle relaxants (spatiscity) Pain killers

Neuromuscular 1 (3 decks)

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