Week 1-Stroke Flashcards
(40 cards)
Frontal Lobe damage
-Loss of:
-Common deficits:
-Pt presentation when injured:
-Frontal lobe expresses emotion, personality, conscious thought, MOTOR FUNCTIONS
-Loss of: executive function, goal-directed behaviors
-Common deficits: paralysis (contralateral side), personality changes, language deficits (L-side Broca’s area-expressive speech)
-Presentation: distractible, apathetic
Parietal Lobe damage
-Common deficits:
-pt presentation when injured:
-L vs R hemisphere damage presentation
-Parietal lobe SENSORY FUNCTIONS
-Common deficits: sensory loss (light tough, kinesthesis), sensory-processing issues (afferent issues), visual-spatial perceptual problems
-Pt presentation: contralateral sensory loss, perceptual issues
-L hemisphere: L/R confusion, agraphia, math difficulties
-R hemisphere: ataxias, neglect (don’t perceive the L side of the body for example)
Temporal Lobe damage
-Function of temporal lobe:
-Pt presentation with damage here:
-Function: auditory and olfaction processing center, houses Wernicke’s area (typically L side; receptive language), interpretation of emotions, memory
-pt presentation: receptive aphasia, learning difficulties, memory issues
Occipital Lobe damage
-Function of this lobe:
-Pt presentation when damaged:
-Function: vision processing center
-pt presentation: homonymous hemianopsia, color recogniton issues, cortical blindness, difficulties with reading/writing, problems with depth perception
may need auditory instructions in rehab
L cortex vs R cortex functioning
L cortex: Language comprehension and production, logics, rational, math/science, express positive emotions, good verbal processing
R cortex: information processed in holistic manner/general concept comprehension, eye-hand coordination, artistic capabilities, spatial awareness, express negative emotions, kinesthetic awareness, good non-verbal processing
Presentation of L-hemiplegia (R-sided lesion) vs R-hemiplegia (L-sided lesion)
-L- hemiplegia: visual perception issues, impulsive behavior, rigid in thought and issues with problem solving, difficult to express negative emotions
performance fluctuation more common
-R-hemiplegia: language/speech issues, cautious behavior, distractible or perseverate (repeat or prolong an action even after being prompted to stop), difficulty expressing positive emotion
verbal apraxia more common
Broca’s vs Wernicke’s aphasia presentation
-Broca’s: expressive; non-fluent; difficulty articulating and vocabulary is limited; “broken language”, FRONTAL LOBE
-Wernicke’s: receptive; fluent/sensory; smoothness of speech but lacks comprehension of spoken language so may say things that don’t make sense; “word salad”
-Global aphasia: speech production and comprehension is impaired
Stroke Syndromes:
-ACA
-MCA
-PCA
*weakness LE vs UE
*sensation deficits
*other information to know
-ACA (Anterior cerebral artery)
-weakness: LE > UE
-sensation deficit: LE >UE
-Other info: incontinence, apraxia (difficulty with motor mvts), bradykinesia (basal ganglia issue), motor inaction
-MCA (middle cerebral artery)
-weakness: UE>LE
-sensation deficit: face & UE>LE
-other: aphasia, perceptual deficits (neglect, spacial disorganization), sensory ataxia, limb apraxia
MOST COMMON
-PCA (posterior cerebral artery)
Vetebrobasilar Artery Syndromes information
-Wallenberg’s syndrome: medulla affected; crossed sensory issues; ipsilateral (face) vs contralateral (body) symptoms; Horner’s Syndrome (drooping of ipsilateral upper eyelid, constriction of ipsilateral pupil, skin vasodilation, absence of sweating on ipsilateral face/neck)
-Complete basilar artery syndrome: locked-in (can’t speak or move; can only do up/down eye mvts)
-Medial medullar syndrome: tongue deviates towards side of lesion
Two types of stroke with each of its subsequent types of stroke
1.) Ischemic (MOST COMMON; lack of blood flow of nutrients/O2 leading to infarct)
-atherosclerosis (artery narrowing)
-thrombus (clot on artery)
-embolus (moving clot/plaque)
2.) Hemorrhagic (bleeding within brain; MORE DEADLY; BETTER FUNCTIONAL RECOVERY)
-intracerebral-aneurysm (rupture of blood vessel from trauma; weakens vessel wall and bursts)
-Subarachnoid (bleed in subarachanoid space (between pia and arachnoid space; Increased ICP; venospasm can occur)
-Arteriovenous malformation (congenital defect; capillaries dilate and lead to hemorrhagic stroke)
Lacunar stroke vs TIA
-Lucunar stroke: white matter stroke from small vessel disease; multi-infarct dementia; can be purely motor OR purely sensory
-TIA (transient ischemic attack): symptoms are <24 hr; is a precursor or warning sign for a stoke
Warning sings of a stroke
-sudden numbers or weakness of face, arm, leg especially on 1 side of body
-sudden confusion, trouble speaking, or understanding
-sudden trouble seeing in one or both eyes
-sudden severe headache with no known cause
Body structure and function deficits:
-Lvl of consciousness
-emotional status
-behavior style
-communication and style
-circulation
-ventilation
-integ integrity
-pain
-cranial and peripheral nerve integrity
-posture
-sensory integrity
-Lvl of consciousness: alertness, attention, preservation (stuck on 1 thing), confabulation (false memories), confusion, disorientation distractibility
-emotional status: depression, pseudobulbar affect (inappropriately laughing/crying), euphoria
-behavior style: impulsive, overly cautious, frustration, irritability
-communication and language: aphasia, dysarthria
-circulation: HTN, CAD (coronary artery disease), CHF, DM
-ventilation: obstructive and restrictive lung disease
-integ integrity: pressure injuries, bruising
-pain: central stroke pain (hot/cold, sharpness, numbness), hemiparetic shoulder pain
-cranial and peripheral nerve integrity
-posture: CN visual field, CN V facial sensation, CN 5,7 facial mvts, CN 8 vestibular/auditory dysfunction, CN 9,10,11 dysphagia and dysarthria
-sensory integrity: tactile, kinesthesia, proprioceptive
Activity and Participation deficts
Activity deficits:
-UE fxn: ability to use functional tasks, hypertonia, contractures
-Gait/locomational speed, distance, temporal-spatial description (stance time, step length)
-Postural control/balance: balance strategies, safety, sensorimotor intergration
Participation deficits:
-participation/engagement in home, work, community, and leisure activities
Tests to perform based on:
-Cognition/attention/perception
-Tone
-Coordination
-Cranial nerves
-Postural Control/balance
-Gait
-Functional Measures
-UE function
-QOL
-Cognition/attention/perception: MOCA, Mini Mental, Clock Draw, Beck’s depression test, Digit repetition
-Tone: MAS, Tardieu scale
-Coordination: SARA-Scale for Assessment and Rating of Ataxia, 9-hole Peg Test
-Cranial nerves: all 12 cranial nerves
- Postural Control/balance: Berg balance scale, Functional reach, TUG, FIST, FGA, DGI, HiMAT
-Gait: 10MWT, Rancho observational gait analysis
-Functional Measures: 2/6 MWT, E-TUG, Barthel Index
-UE function: 9-hole Peg Test, Box & Blocks
-QOL: Stroke Impact Scale
Stroke EDGE 2 Tests:
-Acute Care setting
-IP & OP setting
-Acute: Postural Assessment Scale, Stroke Assessment Scale
-IP & OP: Fugle Meyer, FIM, Stroke Impact Scale, Postural Assessment Scale
Fugle Meyer Assessment
-Purpose: evaluate motor recovery in people post-stroke with hemiplegia
*Gold standard for measuring motor fxn post-stroke
*higher score=higher motor control fxn (ability to regulate/direct mechanisms essential for mvt)
*impairment test
Postural Assessment Scale for Stroke (PASS)
-Purpose: assessment and monitoring of balance during position changes in individuals with stroke, particularly acutely (<3 mths)
-includes transitional mvts, sitting and standing balance
*can monitor change over time
Cut-off Scores:
-Static PASS: 3.5 points
-Dynamic PASS: 8.5 points
-Total PASS: 12.5 points
Stroke Impact Scale
-Purpose: self-report questionnaire to evaluate disability and health related QoL
*OP setting; higher score=better fxn; scores your lvl of difficulty over the past 2 weeks
-domains include: strength, hand fxn, ADL/IADL, mobility, communication, emotion, memory and thinking, participation fxn
Trunk Impairment Scale
-Purpose: measure motor fxn of trunk, looks at static and dynamic sitting balance, and coordination of trunk mvts
*max score of 32 and NO PRACTICE ATTEMPTS
*Pts with stroke, PD
NIH Stroke Scale
-Purpose: measures severity of stroke impairments and early neurological recovery after stroke
*higher score= higher severity
-tests consciousness, vision, motor assessment (face, arm, leg), sensation, ataxia, language fxn
Scores:
-> or equal to 25: very severe stroke
-15-24: severe
-5-14: mild-moderate stroke
-1-5: mild stroke
*<5= D/C home
Stroke Rehabilitation Assessment of Movement (STREAM)
-Purpose: provide a quantitive evaluation of motor fxn following stroke
-looks at UE mvts (reach, grasp, release), LE mvts (stairs, walking with affected leg), basic mobility (balance, STS)
*MDC- 4.2 points
*MCID-UE: 2.2 & LE: 1.9
Brunnstrom Stages of Recovery After Stroke
-Stage 1: flaccid extremities; few hr to few days
-Stage 2: min volitional mvts with synergistic patterns; spasticity begins to develop
-Stage 3: voluntary control of synergies; spasticity peaks during this stage
-Stage 4: limited motions combined with synergistic mvts; spasticity declines
-Stage 5: more advanced mvt combinations
-Stage 6: isolated mvts possible with near normal coordination
Neuro Outcome Measures (6 test)
-BBS: Static and dynamic balance
-FGA: walking balance assessment
-ABC (Activities of Balance Scale): balance confidence assessment
-10 MWT: gait speed assessment
-5 STS: transfer assessment
-6 MWT: walking distance/endurance assessment
