1
Q
Stats for ischemic and hemorrhagic stroke
A
Ischemic: 87%
Hemorrhagic: 13%
2
Q
Mortality prognosis: 7/30/90 days
A
Higher mortality in hemorrhagic stroke
No difference after 3 months
3
Q
Recurrence prognosis: 30 days/1 year/5 years/10 years
A
30 days = 3%
1 year = 11.1%
5 years: 25%
10 years: 40%
4
Q
Cerebral thrombosis/embolism
A
Thrombosis - forms in the brain
Embolism - travels to the brain
5
Q
Zone of injury: core ischemic + ischemic penumbra zones
A
Core ischemic - severe ischia with blood flow between 10-25% = death of neurons
Ischemic penumbra - regions surround severe, considered mild to moderate = where neuroplasticity is targeted
6
Q
Crescendo TIA
A
2 occurrences within 24 hours
3 within 3 days
4 within 2 weeks
7
Q
ABCD2 Prediction Rule
A
Age >60 years Blood pressure >140/>90 Clinical presentation - unilateral weakness with or without speech impairment OR speech impairment without weakness Duration >60 minutes OR 10-59 minutes Diabetes - higher score = more likely
8
Q
Hemorrhagic risk factors
A
HTN
Alcohol and drug abuse
Use of anticoagulants
(not DM, obesity, previous stroke, oral contraceptives)
9
Q
Saccular aneurysm
A
Roused or irregular swellings in arteries - commonly occurs at sides of vessel bifurcation
**>10 mm are at critical risk to rupture
10
Q
Use of CT
A
Serves to rule out hemorrhagic stroke during initial evaluation of stroke; may identify ischemic lesion; ischemic lesion may not be detected in early hours after stroke
11
Q
CT Angiogram
A
Provide clear images of cerebral blood vessels to allow identification of stenosis, occlusion, aneurysms, and vascular abnormalities
12
Q
MRI
A
Detects edema in the sub-acute phase
More sensitive than CT scans but takes 1 hour to complete
13
Q
Magnetic Resonance Angiogram
A
Can detect high grade atherosclerotic lesions and less common causes of ischemic stroke (vertebral after dissection, venous thrombosis, etc)
14
Q
Positron Emission Tomograph (PET)
A
Imaging of regional blood flow and cerebral metabolism
**Used to determine the ischemic penumbra and where areas of tissue are reversible
15
Q
tPA
A
Administered within 3 hours of sx onset (up to 4.5 hours in some patients)
16
Q
MCA stroke
A
- Contralateral weakness (UE/face)
- Contralateral sensory impairment (UE/face)
- Aphasia
- Neglect
17
Q
Lacunar stoke
A
- **Deep branches of MCA; supplying the BG and IC
- Contralateral weakness
18
Q
PCA stroke
A
- *Supplies occipital lobe, inferior temporal lobe
- Contralateral homonymous hemianopsia
- Contralateral sensory impairment/weakness
19
Q
ACA stroke
A
- *Primary motor/sensory, supplementary motor, prefrontal cortex
- Contralateral LE weakness/sensory
- Frontal lobe behavioral abnormalities (poor judgement, attention, motivation, regulating emotions)
20
Q
Watershed strokes
A
- aka border zone infarcts
- occur at the border areas between vascular territory where the tissue is furthest from vascular supply and thus more venerable to reductions in perfusion.
- occur at distal branches of major cerebral arteries (MCA/ACA and MCA/PCA)
- Results from hypoperfusion
- Proximal arm and leave weakness with distal preservation of strength (man in a barrel syndrome)
- Tend to occur in the elderly, who have a higher incidence of arterial stenosis and hypotensive episodes, as well as microemboli.
- Can be associated with seizures , mild / progressive presentation
21
Q
PICA stroke
A
- *Cerebellum and medulla
- LATERAL MEDUALLRY SYDNROME
- Loss of pain/temp on contralateral side of body and ipsi face
- Ipsi limb ataxia
- Dizziness/diploplia/dysphagia/dysarthria
- Horner’s syndrome
22
Q
Horner’s syndrome
A
- *Damage to sympathetic trunk lateral to vertebral bodies
- associated with PICA strokes
- Ptosis (eyelid droop)
- Decreased sweating
- Miosis (pupil constriction)
- symptoms are same side
23
Q
AICA stroke
A
- *Cerebellum and cranial nerves 7 and 8
- LATERAL PONTINE SYNDROME
- Ispi ataxia
- Contralateral weakness/sensory
- Dizziness/vertigo
24
Q
Thalamic pain syndrome
A
- Initially presents as numbness but evolves into a burning sensation
- May be accompanied by allodynia
25
Visual tracts
Optic nerve - optic chiasm - opic tract - lateral geniculate nucleus - primary visual cortex
26
Right optic nerve lesion
Blindness of right eye
27
Optic chiasm lesion
Loss of temporal fields in both eyes = bitemporal hemianopsia
28
Lesion to uncrossed fibers from right eye
Loss of nasal field of right eye = right nasal hemianopsia
29
Right optic tract lesion
Loss of left visual field (temporal field of left eye, nasal field of right eye) = left homonymous hemianopsia
30
Lesion to the right optic radiation projecting directly to the occipital lobe
Loss of inferior quadrant of left visual field
31
Lesion to right optic radiation in Meyer's loop
Loss of superior quadrant of left visual field
32
Lesion to entire right optic radiation
Loss of left visual field = left homonymous hemianopsia
33
Lesion to medial surface of right visual cortex
Loss of left visual field with macular sparing
34
Muscles not involved in synergies
```
Finger extensors
Lats
Ankle evertors
Teres major
Serratus anterior
**FLATS
```
35
MAS
0 No tone
1 Slight increase in muscle tone, manifested by catch and release
1+ Slight increase in tone, manifested by catch and minimal resistance through less then half of range
2 Marked increase in tone through entire range but easily moved
3 Considerable increase in tone, passive movement difficult
4 Rigid
36
Sogue's phenomenon
Finger ext and abduction when arm is elevated above horizontal
37
Raimiste's phenomenon
Resisted hip abduction/adduction elicits abduction/adduction in contralateral limb
38
Bilateral simultaneous extinction
- Failure to respond to stimuli on affected side when both sides are stimulated concurrently (able to identify unilaterally though)
39
Unilateral neglect brain involvement
R posterior inferior parietal lobe
40
Anosognosia
* *Associated with damage to R posterior insula
| - Denial of sxs
41
Somatotopagnosia
* *Damage to the Right parietal or Right posterior temporal lobe
- Lack of awareness of body structure and relationship of body part to one another in self or other.
- aka body image or autotopagnosia
- IE ask patient to point to elbow and they point to their knee. OR ask to perform LAQ and therapist demonstrates, but they perform marching
- Treatment: increase sensory input to the desired joint
42
Gerstmann syndrome
* *Damage to parietal lobe of region of angular gyrus
- Right-left discrimination disorder
- Finger agnosia (inability to recognize, name, select, and differentiate own or another person's fingers. Most common with middle 3 fingers. Will move as if fused together resulting in poor hand dexterity.
- Agraphia (inability to write)
- Acalculia (inability to calculate)
43
Ideomotor apraxia
- Difficulty planning or completing actions on command
| - But can perform automatically
44
Ideational apraxia
- Difficulty conceptualizing and performing tasks, either on command or automatically
45
Recommended parameters for resistance training
1- rep max at 60-80%
3 sets each, 8-10 exercises
3x per week for 6-12 weeks
46
Contraindications to resistance training
- Hemophilia and other blood disorders
- Severely limited ROM
- Severe osteoporosis
47
Results of functional task practice (FTP) and power training
- Both FTP and power improve movement accuracy with fewer sub movements and reduced reach patio ratio
- FTTP: Shoulder flexion and elbow extension AROM decreased and there was increased trunk displacement = compensations
- POWR: Shoulder flexion and elbow extension AROM increased were associated with decreased trunk displacement = more normal movement patterns
- Perform POWER training then FTTP
48
Dose effect on cerebral blood flow (CBF)
Moderate intensity increases CBF
| Low intensity decreases CBF
49
Requirements of CIMT
- 20 degrees wrist ext
- 10 degrees finger ext
- no cognitive or sensory deficits
50
CIMT training protocol
6 hrs per day for 2 weeks
| constraint for 90% waking hours
51
Balance and self-efficacy conclusions
- Women reported lower levels of balance self efficacy
- Number of co-morbid conditions didn't effect balance self-efficacy
- Lower balance self-efficacy in those with cognitive impairments
- Functional walking capacity contributed little to perception of health unlike balance-efficacy
52
Intensity of balance training
- 2-3x/week sufficient
| * *90 minutes, 5x week NOT recommended
53
NMES improvements
- Gait speed but not other functional activities
- Shoulder pain/sub-luxation
- Improves motor impairment in UE especially with acute stroke and mild symptoms
54
Unilateral neglect and visual scanning
- 20 hours of reading task
| - Improvements remain at 1 year follow-up
55
Unilateral neglect and sensory awareness and spatial organization
- 20 hours of locating light touch
| - Improvements noted over control
56
Unilateral neglect and external/internal stimulus
- Loud auditory sound or knocking on desk to promote attenuation
- Improvement in attention to task, 2/4 measures
57
Unilateral neglect and visual and movement imagery
- Visualize items in home and spell words backwards
- Imagine the examiner changing posture
- Improvements lasted at 6 month follow-up
58
Unilateral neglect and prisms/patching
- Possible improvement, more likely compensatory/improvement in awareness vs functional improvement
59
StrokEDGE II Acute Care
- Orpington Prognostic Scale
- PASS
- STREAM
60
Orpington Prognostic Scale
Scoring of cognition, balance, proprioception, and motor function
**Ranges from 1.6-6.8
61
Orpington Prognostic Scale cut-off scales
Mild to moderate: <3.2
Moderate to severe: 3.2-5.2
Severe of major deficit: >5.2
62
Functional Reach
Less then 15 centimeters indicates fall risk
63
StrokEDGE II Inpatient/Outpatient Rehab
- Fugl-Meyer Assessment of Motor Performance
- FIM
- PASS
- Stroke Impact Scale
- STREAM
64
Fugl-Meyer Assessment of Motor Performance
Evaluates and measures recovery post-stroke
```
FIVE DOMAINS:
1. Motor function
2. Sensory function
3. Balance
4. Joint ROM
5. Joint Pain
MAX SCORE 226 points
```
65
Stroke Impact Scale
- 59 items based on 1-5 Likert scale (1: could not do at all, 5: not difficult at all)
- Lower the score the higher the impact
66
Cecorticate rigidity
UE flexed, LE extended, demonstrates a lesion superior to the red nucleus (midbrain)
67
decerebrate rigidity
UE and LE extended, demonstrates a lesion inferior to the red nucleus (mid brain)
68
BWSTT vs HEP program (LEAPS trial)
- no significant differences between locomotor training on treadmill vs HEP
- no difference between early locomotor training ( 2 months post stroke) and late training (6 months post stroke)
69
Research supported and not supported interventions of unilateral spatial neglect
Supported: visual scanning training with use of anchor (reading), light touch stimuli and estimating size of plexiglass rods, visual imagery (asked to described objects in home, visualize a word and spell it), and movement imagery (asked to verbally describe change in posture of the examiner).
somewhat supported: loud auditory sound and verbal command to attend to task progressing to patient providing their own cue
No well supported: trunk rotation to lengthen left posterior neck muscles, use of caloric stimulation, and use of prisms and patching. All have temporarily affects
