Stroke and TBI Flashcards

Question

Practice! New pt w/ LEFT CVA. Initial exam, what s/s most likely present? OLD lady! slow cautious, R motor and sensory loss, R weakness, language defs aphasias, personality changes, decd memory,

Answer 1

Clonus of gastroc mm R. lower limp (abnorm reflexes) NOT rigidity! Spasticity in CVA present

Answer 2

UE abnorm synergy: **FLEX more common** LE abnorm synergy: **EXT more common**

Answer 3

FLEXION synergy more common - Scapular **retraction, elevation, hyperext** - Shoulder **ABD, ER** - Elbow **Flex** - Forearm **SUP** - Wrist and finger **Flex** *AND THEN YOU KNOW THAT EXT IS OPP OF ALL OF THESE!*

Answer 4

EXTENSION synergy more common - Hip **EXT, ADD, IR** - Knee **EXT** - Ankle **PF, INversion** - Toe **Ext** *Now you know w/ Flexion LE synergy it is just the OPP* | Circumducted gait bc LE "longer"

Answer 5

- Flaccidity of involved limbs - NO reflex OR voluntary mvmts

Answer 6

- Min. voluntary mvmt or **assocd reactions** - Mvmts in **partial or whole** synergy patterns - Spasticity BEGINS to develop **Assocd reactions-- contraction elsewhere in body causes contract where observing**

Answer 7

- Voluntary control of mvmt synergies - Mvmt may NOT be full ROM - **Spasticity @ peak--HypERtonia (severe)**

Answer 8

- SOME mvmts OUT of synergy - Spasticity DEC, but observable **- Indiv can: ** place hand behind body, elevate arm to forward horz pos (flex), PRO/SUP w/ elbow @ 90deg

Answer 9

- Declining spasticity**** - INC in complex mvmt; able to perform more diff mvmts OUT of synergy - **Ind can:** abduct arm, flex arm and OH, Pro/Sup w/ elbow ext'd

Answer 10

- Indiv jt mvmt, coord'd mvmt (nearly norm) - NO spasticity! - **Ind can:** hand from lap to chin, hand from lap to opp knee (MAJOR PROGRESS d/t isolating elbow is diff)

Answer 11

Normal motor function

Answer 12

See pics and note the INC in spasticity to DEC and moving from synergies to controlling synergies to isolated mvmts!

Answer 13

L. sided hypERreflex and + Babinski (toes fan out)

Answer 14

Want to BREAK OUT of all synergies! Put them in pos's OPP of synergies!

Answer 15

HOW TO SET THEM UP: Head/Neck: Neutral and symmetrical; support on pillow Trunk: Aligned @ midline **More affected UE (flexor syn common):** Scapular **protracted;** Shoulder **forwrd/slight abd'd;** arm supported on pillow; Elbow **ext'd w/ hand resting on pillow;** Wrist **neutral;** Fingers **ext'd;** Thumb **abd'd**

Answer 16

HOW TO SET THEM UP: **More affected LE (EXT synergy more common)** - Hip **forward (pelvis PROtracted);** Knee on small pillow or towel roll to **prevent hyperEXT;** NOTHING against soles of feet. - *If persisten PF, **splint** can be used to pos. foot/ankle in **neutral pos.**

Answer 17

Head/Neck: Neutral/Symmetrical Trunk: Alignment in **midline** More affected**UE (Flexion common):** Scapular **protracted;** Shoulder **forward;** Arm in **slight ABD/ER;** Elbow **Extd;** Forearm **sup;** Wrist **neutral** Fingers **extd;** Thumb **abd'd**

Answer 18

Head/neck--see prev Trunk--see prev **More affected LE (EXT synergy):** Hip **extd and knee flexed and supported by pillows.** ALTERNATIVE pos--> Slight hip and knee flexion w/ pelvic rotation

Answer 19

Head/Neck: Neutral and Symmetrical Trunk: Aligned in MIDLINE; small pillow or towel can be placed under rib cage to **elongate the hemiplegic side.** **More affected UE (flexion more common):** Scapular **protracted,** Shoulder **forward;** Arm on a supporting pillow w/ Elbow **Extd,** Wrist **neutral,** Fingers **extd,** Thumb **abd'd**

Answer 20

Head/neck: Neutral/Symmetrical; **head directly above pelvis** Trunk: Spine **EXT** Pelvis: Aligned in neutral w/ **WB on buttocks** More affected **UE:** Shoulder **protracted and forwrd;** Elbow supported on arm trough or lapboard; Forearm/wrist **neutral,** Fingers **extd,** Thumb **abd'd (resting splint prn)** BOTH **LEs:** Hips **flexed to 90/90,** pos'd in **neutral w/ respect to rotation.**

Answer 21

Head/Neck: neutral L. scapular protracted L arm in sligh ABD/ER Elbow EXTd Forearm sup'd Wrist neutral Fingers EXTd Thumb ABD'd

Answer 22

Head/Neck: neutral L. scapular protracted L arm in sligh ABD/ER Elbow EXTd Forearm sup'd Wrist neutral Fingers EXTd Thumb ABD'd

Answer 23

**Contraversive pushing** - Push **ONTO WEAK side-->** using STRONG side to push to weak side Tx's: - Have pt push/lean onto you AWAY from weaker side - Mirror tx - Have strong side next to wall and ask them to lean onto wall

Answer 24

Kickstand Tactile cueing on quads w/ clasped hands

Answer 25

D1 **Flex:** - Shoulder: Flex, Add, ER - Forearm: Sup - Wrist: Radially flexed - "Eating" D1 **Ext:** - Shoulder: Ext, ABD, IR - Forearm: PRO - Wrist: Ulnarly ext'd - "Pushing away"

Answer 26

D2 **Flex:** - Shoulder: Flex, Abd, ER - Wrist: Radially Extd - **Drawing a sword** D2 **Ext:** - Shoulder: Ext, ADD, IR - Wrist: Ulnarly flexed - **Putting sword BACK**

Answer 27

Lead arm (**weak arm)** BEGINS D1 flex and moves into D1 ext *use Opp arm (strong) arm to assist (opp arm moving in D2 patterns--dont memorize this) | Head, neck, and trunk must all go WITH WRIST/HAND

Answer 28

Lead arm (**weak arm)** BEGINS D2 EXT and moves into D2 FLEX | Upper trunk, head and neck extend/rotate TOWARD lead hand--MUST FOLLOW

Answer 29

LE/**D1--** F**AdER**; E**ABIR** LE/**D2--** F**ABIR**; E**AdER**

Answer 30

LE D1 **Flexion** - Hip flex, add, ER - Knee flex or ext - Ankle DF, Inv - Toe ext - "Putting pants on or socks, cross" LE D1 **Extension** - Hip ext, abd, IR - Knee flex or ext - Ankle PF, EV - Toe flex - "Getting out of car"

Answer 31

LE D2 **Flexion:** - Hip flex, abd, IR - Knee flex or ext - Ankle DF, EVersion - Toe flexion LE D2 **Extension** - Hip ext, add, ER - Knee flex or ext (SAME @ KNEE FOR ALL) - Ankle PF, INV - Toe flexion

Answer 32

B/L D2 Flexion **Draw 2 swords!!!**

Answer 33

Obj way to describe pts **Lvl of Consciousness** - **E**ye: 1 (never)-4(spont.) - **M**otor: 1(none)-6(obeys commands) - **V**erbal: 1(none)-5(Oriented) Scores: - **3-8= SEVERELY ABNORMAL** - 9-12= MOD abnorm - 13-14= Mild abnorm - 15= MILD TBI

Answer 34

4: Spontaneous 3: To sound 2: To pain 1: Never

Answer 35

6: Obeys commands 5: Localizes pain 4: Normal flexion (w/drawal) 3: ABnormal flexion 2: Extension 1: None

Answer 36

5: Oriented 4: Confused conversation 3: Inapprop words 2: Incomprehensible sounds 1: None

Answer 37

Decorticate== FLEXION one in UEs D**e**c**e**r**e**brat**e** (all the E's)== **E**XT one!

Answer 38

Opens to speech= 3 inapprop words= 4 w/drawals= 4 **=11= Mildly abnorm**

Answer 39

Lvl 4: Confused-Agitated-- Needs MAX ASSIST

Answer 40

Lvl I: NO response: **TOTAL** assist Lvl II: Generalized response: **TOTAL** assist Lvl III: Localized response: **TOTAL** assist **Lvl IV: Confused-Agitated: MAX assist** **(problem lvl)** Lvl V: Confused-Inapprop: MAX assist **(angry stage)** Lvl VI: Confused-Approp: MOD assist Lvl VII: Automatic-Approp: MIN assist Lvl VIII: Purpose-Approp: Stand-By assist

Answer 41

**RLA IV** **Confused-Agitated** - Alert, INCd state of activity - Aggressive or flight behavior - **absent STM** - UNable to cooperate w/ tx **Set up the environment!!!--more on this**

Answer 42

Set up environment + other deets: - Quiet room, Remove distractions, Remove objs that could be thrown or used aggressively - Simple instructions w/ process time - Watch frustration--know when to stop/change acts. - Safe choices--**allows pt to feel they have control over situation** Interventions?--next cards

Answer 43

**Motor probs:** - Prepare **MULT**. acts - Give pt **choices** (No y/n ?'s) **Behavioral probs:** - Be calm, Be consistent (SAME tx time, PT, loc) - Provide orientation - Know when to stop/change acts.

Answer 44

**Motor probs:** - Prepare **MULT**. acts - Give pt **choices** (No y/n ?'s) **Behavioral probs:** - Be calm, Be consistent (SAME tx time, PT, loc) - Provide orientation - Know when to stop/change acts.

Answer 45

- Unable to learn **new info** - Freq brief pds, NON-purposeful sustained attn - **Consist approp resp to SIMPLE commands in structured environ** - Demos INapprop use of objs **w/out ext. direction** Interventions? next cards

Answer 46

- Quiet environment, HIGHLY structured **functional tasks,** Give control to pt when safe/approp - Give **options** - Use **cues/ext. direction** - **Use Assistive devices** - Tx plans-- include using daily planner

Answer 47

- LITTLE carry-over for **new learning** - MAX A for new learning w/ little or no carry over - **Consistently follows SIMPLE directions** - **Unaware of impairs, disabilities and safety risks (KNOW THIS ONE!)** INTERVENTIONS? NEXT CARDS

Answer 48

- HIGHLY structured **functional tasks** - **DECREASE:** use of cues/ext direction, use of ADs (opp of RLA V: Confused-INapprop) - **INC:** speed and complexity of tasks as able

Answer 49

- Establish daily routine, orient pt place and time freq, use chart/whiteboard in pts room to doc progress **DO NOT:** challenge pt to provide loc/date---they have STM loss and you'll piss them off even more!!!

Answer 50

- MIN supervision for NEW learning, w/ **carry-over (into other tasks)** - Initiation AND follow thru of basic ADLs - MIN supervision for safety in home-routine/commun acts - **Able to attend to HIGHLY familiar tasks in non-distract environ for @ least 30mins w/ MIN-A to complete tasks Interventions? next cards

Answer 51

**Motor probs** - STRUCTURED **functional tasks** - INC **complexity of tasks** - Work on **coord/fine motor**

Answer 52

**RLA IV--FOCUSED, structured** RLA V, VI, VII-- MOVE from structured to more **complex environment**

Stroke and TBI Flashcards

(80 cards)