Stroke

Question 1

stroke

Answer 1

cerebrovascular accident
blood supply to the brain is interrupted, no O2, tissue dies

Question 2

ischemic stroke

Answer 2

87%
blocked blood vessel (clog in the drain)
*can use tPA (clot busting drug) within ~3 hours of symptom onset

Question 3

thrombotic stroke

Answer 3

type of ischemic stroke
blood clot
at the site of the clot

Question 4

embolic stroke

Answer 4

type of ischemic stroke
moving particle (often from the heart) that breaks off and gets lodged somewhere else

Question 5

hemorrhagic stroke

Answer 5

13%
BLEEDING - ruptured blood vessel
can be AVM or aneurysm that burst
often c/o headache first
no tPA
intracerebral (bleeding into the brain tissue)
subarachnoid (into the subarachnoid space)

Question 6

TIA

Answer 6

transient ischemic attack
“mini stroke”
- temporary obstruction of blood flow from blockage
- no lasting damage, but warning sign for future strokes

Question 7

risk factors

Answer 7

• older age, women, black, fam history, prior strokes, HTN (leading cause), diabetes, heart disorders, smoking, obesity

Question 8

FAST

Answer 8

Facial drooping
Arm weakness
Speech difficulties
Time to call 911

Question 9

motor impairment

Answer 9

contralateral to the lesion
paresis = weakness
plegia = paralysis
loss of trunk and postural control and sitting balance

Question 10

impaired reactions and strategies

Answer 10

requires automatic adjustments to prevent falls
1. ankle - slow sway at ankles
2. hip - big hip sway
3. stepping - to widen BOS

Question 11

UE impairments

Answer 11

subluxation: partial dislocation of shoulder joint from weak mx, gravitational pull, spastic mx
structural changes to soft tissue structures - shortened mx, contractures, over stretched

Question 12

communication impairments

Answer 12

1. global aphasia: loss of all language abilities
2. broca’s aphasia: broken speech, expressive, words are appropriate but pauses/omits, typically aware of deficit (be patient, may get frustrated)
3. wernicke’s: receptive, fluid, non sensical, lack of comprehension
4. anomic aphasia: trouble finding words
5. dysarthria: disorder of articulation (motor movements involved)

Question 13

perceptual impairments

Answer 13

1. spatial relations - where objects are in space
2. spacial neglect (inattention, not responding to stimuli, not visual field deficit)
3. body neglect - shaving only half of face, not using affected side
4. form constancy - ID object despite variations
5. figure ground - fore/background
6. visual closure - ID partially covered object

Question 14

perceptual impairments - agnosias

Answer 14

• visual: unable to ID an object by looking at it
• somatoagnosia: can’t recognize own body parts
• phosphagnosia: unable to recognize faces
• anosagnosia: lack of understanding of their deficits

Question 15

cognitive impairments

Answer 15

initiation, attention, organization, sequencing, problem solving

Question 16

apraxia

Answer 16

praxis = 2 step process resulting in purposeful movement (1. idea and 2. production)

difficulty completing planned movements

Question 17

ideational apraxia

Answer 17

no idea/concept of what to do

Question 18

ideomotor apraxia

Answer 18

knows what to do, but has a loss of kinetic memory to actually produce the movement

Question 19

visual impairments

Answer 19

homonymous hemianopsia: loss of visual field on same side in both sides (so you can just see R or L side)

saccades
pursuits
vergence
accommodation
fixation

Question 20

task oriented approach

Answer 20

• top down, client centered, occupation based
• person, environment, occupational performance, functional tasks help organize behavior

Question 21

5 steps of evaluation

Answer 21

1. Role identification (role checklist, occupational performance history review)
2. Assessment of occupational performance task (observation of ADL)
3. Task selection and analysis
4. Perform specific assessments (strength, sensory, pain, ROM, etc)
5. Evaluation of the environment

Question 22

formal stroke assessments

Answer 22

Barthel index
Stroke impact scale
Assessment of Motor & Process skills
COPM

Question 23

Eval while seated

Answer 23

can they assume a static sitting position?
how is the alignment? symmetric?
can the patient perceive midline?

Question 24

intervention while seated

Answer 24

good upright posture
proper alignment (so they can use their arms, etc)
- feet flat on the floor, pelvis in neutral/slight anterior, equal WB, spine erect, shoulders symmetric, head over shoulders

supported sitting at EOB

reaching activities - keep it functional

dynamic weight shifting (promotes pelvic weight bearing)

maintain trunk in midline, trunk strengthening and ROM against gravity

compensatory strategies

Question 25

task oriented treatment principle

Answer 25

minimize inefficient movement patterns align treatment to the pt's level mimic reality - include common challenges of everyday life

Question 26

eval while standing

Answer 26

- standing balance - postural alignments, symmetry - base of support - postural reactions and stability during dynamic movement

Question 27

formal balance assessments

Answer 27

berg balance scale timed up and go functional reach test

Question 28

intervention while standing

Answer 28

- proper alignment with good BOS - weight bearing and weight shifting activities - functional and dynamic reaching activities - automatic postural reactions

Question 29

eval of upper extremity

Answer 29

observation through functional task performance ROM, muscle tone, sensory function, motor control, strength and endurance, pain

Question 30

assessments for UE function

Answer 30

wolf motor function test arm motor ability functional test for the hemiplegic UE

Question 31

intervention for UE

Answer 31

- awareness and incorporation of the affected side (encourage use) - weight bearing (in sidling, on forearms - proximal stability, during transitions) - move objects across a surface (prepares for functional reach)

Question 32

motor learning principles

Answer 32

variable: practicing variations of the same tasks in different contexts random: repetitive practice of several tasks in a varied sequence within a session decrease physical guidance and feedback teach task analysis and problem solving

Question 33

generalization

Answer 33

applying the skills you learned for a specific task and transferring that same skill to another task

Question 34

Constraint Induced Movement Therapy (CIMT)

Answer 34

- reverses effects of learned disuse of effected side - constrain unaffected side and intensely training weaker side

Question 35

other UE intervention

Answer 35

orthotic devices NMES - electrical stim, can help with subluxation virtual reality mirror therapy mental practice and imagery

Question 36

important consideration for UE

Answer 36

- teach safe handling - don't pull on unstable joint - no overhead pulleys - don't let arm dangle unsupported - maintain passive ROM - address pain sling?? okay, but keeps it static/disuse - give mohr

Question 37

addressing shoulder pain movement

Answer 37

shoulder flexion within 90 external rotation scapular protraction

Question 38

velocity test

Answer 38

determine if they have spasticity

Question 39

MCA and ICA strokes

Answer 39

contralateral hemiplegia, homonymous hemianopsia, aphasia, neglect, spatial dysfunction

Question 40

ACA stroke

Answer 40

contralateral hemiplegia, grasp reflex, incontinence, confusion, mutism

Question 41

PCA stroke

Answer 41

homonymous hemianopsia, thalamic pain, semi sensory loss, alexia

Question 42

vertebrobasilar system

Answer 42

results in pseudo bulbar signs - dysarthria, dysphagia, emotional instability tetraplegia

Question 43

general L/R CVA deficits

Answer 43

if it's in L hemisphere - usually communication deficits and apraxia R hemisphere - neglect/inability to attend to the left side and spatial dysfunction