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Stroke Flashcards

1
Q

CVA definition

A

Disruption in cerebral circulation causing loss of neurons and neurological function

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2
Q

Types of stroke

A

Ischemic (roughly 80% of all strokes)
-thrombus (1st common) or embolus (2nd)
- low systemic perfusion
Hemorrhage
- aneurysm, artery or AVM
- increases mortality rate
- intracerebral (future or leak in brain) subarachnoid (due to an AVM)
- increase pressure causes compression and cellular death

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3
Q

TIA

A

Ischemia without tissue death. Symptom resolve in less than 24 hrs

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4
Q

Ischemia penumbra

A

Area surrounding ischemic event
- one of the main priorities is to save the penumbra area

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5
Q

Ateriovenvous malfomation

A

A congenital defect causing a tangle
Progresses dilation with age
50% of AVMs will burst

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6
Q

Major risk factors of stroke for woman

A

Early meno
Estrogen suppl
Preeclampsia
Pregnancy, birth, 6 weeks post birth

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7
Q

Warning sign

A

Face
Arms
Speech
Time to emergency services

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8
Q

Vascular syndromes

A

Anterior cerebral artery (ACA)
Middle MCA
Internal ICA
Posterior PCA
Vertebrobasilar artery syndrome
Lacunar

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9
Q

ACA

A

Frontal and parietal lobses, basal ganglia, anterior fronix, corpus callosum
Contra lateral patterns
LL affected
Urinary incontinence
Abulia (inability for will power)
A kinetic mutism
Apraxia
Broca’s aphasia

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10
Q

MCA

A

Most common
Lateral aspects (Frontal, temporal, parietal lobes) (internal capsule, corona radiata etc)
Extensive neurological damage
UL
Contralateral
Wernickes aphasia
Broca aphasia
Global aphasia
Perceptual deficits (neglect, agonsognosia, apraxia, depth perception/ disorganization)

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11
Q

Hemianopia

A

Loss of visual field on one side of midline

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12
Q

Homonymous

A

Loss on same side of both eyes

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13
Q

ICA

A

Supplies both MCA and ACA
Large obstruction of area supplied by MCA
uncal herniation

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14
Q

PCA

A

Occipital lobe, medial/inferior temporal lobe, upper brain stem, mid brain,
Peripheral territory: Homonymous hemianopia, visual agnosia, prosopagnosia, dyslexia
Central territory: central post stroke (thalamic) pain, hemianesthesia, sensory impairments, contra lateral hemiplegia, oculomotor nerve palsy

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15
Q

Vertebrobasilar artery syndrome

A

Cerebellum and medulla. Pons, internal ear, and cerebellum
Ipsilateral, contralateral S&S

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16
Q

Locked in syndrome

A

Aware and awake but has complete paralysis
Sudden onset
There is preserved consciousness and sensation
When the eyes are paralyzed as well, the syndrome is known as total locked in syndrome

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17
Q

Lacunar syndrome

A

Caused by occlusion of small penetrating arteries supplying the brains deep structures
20 of all strikes
Associated with hypertension and diabetes
Could be silent

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18
Q

Dysarthria

A

Motor speech disorder (lip tongue etc)
Speech may be slow

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19
Q

Aphasia

A

Impairment of language (written and spoken) affecting comprehension and/or production

Receptive/ Wernickes
- difficulty with comprehension of language
- can speak normal cadence but is random

Expressive/ Brocas
- difficulty with speech production
- flow is slow and hesitant, limited vocabulary, and impaired syntax

Global
- difficulty with language comprehension and production
- indicative of extensive brain damage
-limits patients ability to learn, therefore affects outcomes of rehab

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20
Q

DysphaGia

A

Difficulty swallowing
Aspiration occurs in 1/3 of patients
Can cause respiratory distress, aspirations pneumonia, and possibly even death
Nothing per oral (NPO) precautions are given

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21
Q

Cognitive Dysfunctions

A

Impairments in alterness, orientation, attention, memory or executive fxns
memory
Perseveration
- repeating a word or act over and over again

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22
Q

Altered emotional status

A

Pseudobulbar affect- random outbursts of emotions
Apathy- blunted emotional response
Euphoria- exaggerated feelings
Depression- feelings of sadness

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23
Q

Hemispheric behavioral differences- left

A

Slow, cautious, anxious
Hesitant for new tasks
Aware of deficits
Difficulty with communication and info processing

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24
Q

Hemispheric behavioral differences- right

A

They are almost reckless presenting
Unaware of their deficits
Increased safety risk

25
Perceptual dysfunction
Dysfunction of Body scheme and body image Agnosia (inability to processes any sensory information)
26
Unilateral neglect
Lack of awareness of own body on one side No reaction to sensory stimulation on one side Almost always seen in right hemisphere lesion
27
Spatial relations syndrome
Difficulty perceiving relationships b/w self and objects in space
28
Agnosia
Interpreting sensory info Visual, auditory, and tactile (asterognosis)
29
What is the stages of motor recovery
Twitches and Brunnstrom Stage 1-6 1- flaccid paralysis 6- disappearance of spacitiy
30
Why are people initiallly flaccid immediately afte stroke
Cerebral shock
31
What UMN responses may you expect in strokes
DTR: hyperreflexia, clonus, babinski, clasp knifed response
32
Flexion synergy- stand outs
Elbow flexion
33
Extensor synergy- standouts
Shoulder adduction an wrist pronation
34
Choreoathetosis
Twisting or wringing type mvmts of the wrist
35
Hemiballismus
Sudden uncontrolled mvmts
36
Apraxia (Motor programming)
A problem of doing and planning the task. No primary motor impairments
37
Ideational apraxia (Motor programming)
Inability to produce purposeful mvmts on command or automatically No idea how to do the mvmt
38
Ideomotor apraxia
Inability to do purposeful mvmts on command, but can automatically. Often perseverates
39
Which side to the usually fall?
Towards the hemispheric side
40
Pusher syndrome
A disorder of postural control- pushes weight to weaker hemiparetic side Altered sense of verticality
41
Scale for contraversive pushing
1- tilting toward paretic side often 2- abduction and extension of unaffected limbs 3- resistance to passive correction
42
PT implications for push’s syndrome
Avoid transfers to pare tic side Avoid gait aids Be aware of where and how you position patients
43
Interventions
Preventative - minimize potential complaications and secondary impairments (essentially move them) restorative - aimed at improving impairments and limitations Compensatory - aimed at modifying the task, activity or environment to improve function and participation
44
How to: improve sensory fxn
Sensory retraining/ stimulation approach - mirror therapy - sensory discrimination activities (different textures) - compression techniques (ie weight bearing) - electrical stimulations - thermal stimulation Saftey education (improve awareness of impairments and protection of anesthetic limb)
45
How to: Improve hemianopia or unilateral neglect
Encourage awareness and use of environment and hemipaetic side Active visual scannning mvmts Cueing UE exercises involving crossing midline toward hempareti side Functional activities involving bilateral interactions Prism glasses
46
How to: improve flexibility and joint integrity
PROM and AROM (if possible) should be performed daily in all motions Postioning to maintain soft tissue length and encourage proper joint alignment Use protective devices (eg wrist splint)
47
Side lying of affected shoulder
Benefits- allows patient to become more aware of affected side Weight bearing on weaker side will regulate abnormal muscle tone Inhibits abnormal postures
48
How to: improve strength
Progressive resistive strength training Combine resistance with functional activities Exercise precautions - specifically designed gloves with Velcro to help hand functions - increase risk with postural or sensations impairments - hypertension and cardiac disease is high in stroke patients
49
How to: improve mvmt control and UE fxn
Focus on dissociation of segments and selective out of energy mvmt patterns Aim for the mvmts to be normal- should be meaningful
50
Contrain-induced movement therapies
Promotes increase use of affected UE. Used in 90% of waking hours
51
shoulder pain (hemiplegic shoulder)
Flaccid stage (supraspinatus dis function) - inferior subluxations Spastic stage - poor scapula positioning may lead to mvmt restrictions and subluxations - frozen shoulder is common
52
How to: manage shoulder pain (hemiplegic shoulder)
Arm supported at all times (positioning, handling, use of tray, arm sling when transferring, strapping / taping) Gentle guided exercises PROM an gentle mobs Functional electrical stimulation FES/ NMES Don’t pull on arm or let it hang unsupported
53
How to: improve functional status
Bed mobility STS transfers Sitting Standing And other transfers
54
Improve balance and postural control
Train active mvmts shift toward strong side Encourage patient to problem solve Visual cues or stimuli Verbal cues or stimuli Tactile cues or stimuli
55
Improve gait an locomotion
BWS and motorized treadmills (gradually reduce to improve independence) Functional electrical simulation Orthsis and assistive devices Wheelchairs (hemi-height, one arm driving, power wheelchair
56
Different gait patterns
Circumduction -Foot flap or drop foot Hypertension of knee - weak quads or poor motor control of quads Decrease stance time on the affected limb - pain or weakness
57
Left Hemisphere lesions
slow, anxious, cautious, disorganized
58
Right hemisphere lesions
quick, implusive, poor judgement

Canadian Exam (55 decks)

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