NCS > Stroke II > Flashcards

Stroke II Flashcards

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1
Q

What are sensory impairments in stroke?

A

Deficits in all forms of sensation
- light touch, proprioception, pain/temperature

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2
Q

Visual field deficit following lesion to L temporal lobe

A

R homonymous upper quadrant defect
“pie in the sky”

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3
Q

Visual field deficit following lesion to L parietal lobe

A

R homonymous defect, denser inferiorly

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4
Q

Visual field deficit following lesion to L occipital lobe (upper bank)

A

R homonymous lower quadrananopsia (macular sparing)

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5
Q

Visual field deficit following lesion to L occipital lobe (lower bank)

A

R homonymous upper quadrananopsia (macular sparing)

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6
Q

Visual field deficit following lesion to R occipital lobe

A

L homonymous hemianopia (macular sparing)

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7
Q

Visual field deficit following lesion to L optic nerve

A

No light perception in L eye/Blindness in L eye

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8
Q

Visual field deficit following lesion to optic chiasm

A

Bitemporal hemianopsia

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9
Q

Visual field deficit following lesion to R optic tract

A

Incongruous L homonymous hemianopia

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10
Q

Visual field deficit following lesion to L Lateral Geniculate Nucleus

A

R homonymous sectoranopia (lateral choroidal artery)
OR
Incongruous R homonymous hemianopia

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11
Q

What is thalamic pain?

A

Damage to ventral posterolateral (VPL) and ventral posteromedial (VPM) nuclei of the thalamus»_space;> abnormal processing of sensory signals
*disruption of spinothalamic and trigeminothalamic tracts»_space;> loss of initial sensation followed by abnormal hyper-excitability and pain pereption in the deafferented area
*maladaptive plasticity in central pain pathway (thalamus, cortex)

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12
Q

Thalamic pain presentation? (3)

A
  • often resistant to simple analgesics
  • exacerbated by emotions, temp changes, tactile stimuli
  • may coexist w/contralateral motor weakness or ataxia
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13
Q

What is allodynia?

A

Pain with normally non-painful stimuli

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14
Q

What is hyperalgesia?

A

Exaggerated pain response to mildly painful stimulus

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15
Q

What is Dysesthesia?

A

Abnormal unpleasant sensations (tingling, crawling)

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16
Q

What autonomic changes may be seen with thalamic pain?

A

Sometimes temperature or color changes in affected limb

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17
Q

Decorticate rigidity suggests damage where?

A

above the red nucleus in the midbrain

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17
Q

What is decorticate rigidity?

A

Flexion of the UE
Extension of LE

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18
Q

What is decerebrate rigidity?

A

Extension of UE
Extension of LE

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19
Q

Decerebrate rigidity suggests damage where?

A

below the red nucleus in the brainstem

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20
Q

What is dystonia?

A

Repetitive, patterned mm contractions
- tone fluctuates unpredictably
- produces twisting or writhing movements and abnormal postures

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21
Q

What is spasticity?

A

velocity-dependent increase in mm tone d/t hyper-excitability of the stretch reflex
*UMN sign
**caused by a loss of descending inhibitory control»_space; overactive alpha motor neurons

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22
Q

What is synergy?

A

A stereotypes, mass movement pattern in which multiple joints move together as a unit in a fixed, predictable way
*seen after corticospinal tract damage when the brain can’t fractionate movement

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23
Q

Modified Ashworth Scale - 0

A

No increase in mm tone

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24
Modified Ashworth Scale - 1
Slight increase in mm tone, manifested by a catch and relase OR minimal resistance at ROM when the affect part is moved in flexion or extension
25
Modified Ashworth Scale - 1+
Slight increase in mm tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
26
Modified Ashworth Scale - 2
More marked increase in mm tone through most of the ROM, but affected part easily moved
27
Modified Ashworth Scale - 3
Considerable increase in mm tone, passive movement difficulty
28
Modified Ashworth Scale -4
Affected part rigid in flexion or extension
29
UE Spasticity Pattern
Scapula: Retraction, downward rotation Shoulder: Add, IR, depression Elbow: flexion Forearm: pronation Wrist: flexion, add Hand: finger flexion, clenched fist thumb, add in palm
30
LE Spasticity Pattern
Pelvis: retraction (hip hiking) Hip: Add, IR, Ext Knee: Ext Foot/Ankle: PF, inv, equinovarus, toes claw, toes curl
31
UE Flexion Synergy Pattern
Scapula: Retraction/elevation or hyperextension Shoulder: Abd, ER Elbow: flexion Forearm: supination Wrist: flexion Hand: finger flexion
32
UE Extension Synergy Pattern
Scapula: Protraction Shoulder: Add, IR Elbow: extension Forearm: Pronation Wrist: flexion Hand: finger flexion
33
LE Flexion Synergy Pattern
Hip: Flex, Abd, ER Knee: Flex Ankle: DF, Inv Toe: DF
34
LE Extension Synergy Pattern
Hip: Ext, Add, IR Knee: Ext Anke: PF, Inv Toe: PF
35
Brunnstrom Stages of Stroke Recovery - Stage 1
Flaccidity - no active limb movement
36
Brunnstrom Stages of Stroke Recovery - Stage 2
beginning of min voluntary movement - in synergy, w/associated reactions - increasing tone
37
Brunnstrom Stages of Stroke Recovery - Stage 3
voluntary control of movement synergy - spasticity at peak
38
Brunnstrom Stages of Stroke Recovery - Stage 4
movement outside of synergy - decreasing tone
39
Brunnstrom Stages of Stroke Recovery - Stage 5
increase complex movement - greater independence from limb synergies
40
Brunnstrom Stages of Stroke Recovery - Stage 6
individual joint movement - coordinated movement
41
Brunnstrom Stages of Stroke Recovery - Stage 7
normal function
42
What is Ramiste's Phenomenon?
Resisted abduction or adduction in the sound limb >>> same movement in the paretic limb
43
What is Souques's Phenomenon?
Passive elevation of the paretic arm above 90* >>> automatic finger extension and abduction
44
What is Marie-Foix Phenomenon?
Passive flexion of toes >>> ankle DF and knee flexion
45
What is Homolateral Limb Synkinesis
Flexion in one limb >>> Flexion in the ipsilateral other limb
46
What is contralateral limb synkinesis
Strong movement in the unaffected limb >>> similar movement in the paretic limb
47
What is the Tonic Labyrinthine Reflex Influence?
Head/neck position changes >>> tone changes in limbs
48
What is yawn/cough/sneezing overflow?
Effortful reflex acts trigger involuntary movement in spastic limbs
49
What is global effort overflow?
Strenuous activity or exertion increases tone or movement in the affected limb
50
Presentation of UMN damage to CN VII?
Contralateral loss of lower half of facial mm *upper part of the face has dual innervation
51
Presentation of LMN damage to CN VII?
Ipsilateral loss of entire half of face
52
Therapeutic considerations with associated reactions (3)
- minimize triggering positions - teach controlled breathing and relaxation - use task-specific training
53
Types of unilateral neglect (2)
- personal - spatial -- peripersonal: within reaching distance -- extrapersonal: outside reaching distance
54
How to screen for unilateral neglect? (3)
- clock drawing test - line bisection test - line cancelation test
55
What is pushers syndrome?
Lean to weak side (good limb pushes towards weak limb) Vision field and visual vertical are intact *posterolateral thalamus lesion
56
What are spatial disorders? (4)
- figure ground discrimination - form discrimination - topographical disorientation - distance and depth perception
57
What are the 2 types of apraxia?
- ideomotor - ideational
58
What are body scheme/body image disorders? (5)
- unilateral neglect - somatoagnosia - R-L discrimination - finger agnosia - anosognosia
59
What is ideomotor apraxia?
inability to imitate gestures or perform habitual tasks on command but pt can perform automatically
60
What is ideational apraxia?
Inability to perform habitual tasks on command and automatically
61
What is anosognosia?
lack of awareness, or denial, of paretic extremity or impairment "lack of insight" "denial of deficit"
62
What is somatoagnosia?
Impaired body scheme, lack of awareness of the body structure and the relationship of body parts to oneself or to others
63
What is apraxia?
Impaired ability to perform learned movements on command or difficulty with movement execution
64
What is figure ground discrimination?
Inability to visually distinguish a figure from background in which it is embedded
65
What is form discrimination?
Inability to perceive subtle differences in form and shape
66
What is topographical disorientation?
Difficulty in understanding relationship and navigating between two locations
67
What is depth and distance perception?
Inaccurate judgement of direction, distance, and depth object from self
68
What is Dysarthria?
A speech disorder caused by weakness, poor coordination, or abnormal tone (spasticity or flaccidity) in the muscles used for speaking
69
What are the two types of dysarthria?
1. Spastic dysarthria 2. Flaccid dyarthria
70
Highly recommended outcome measures for stroke - Acute Care (3)
- Orpington Prognostic Scale - Postural Assessment Scale for Stroke Patients (PASS) - Stroke Rehabilitation Assessment of Movement
71
Recommended outcome measures for stroke - Acute Care (10)
- Action Research Arm Test - Box and Blocks Test - Chedoke-McMaster Stroke Assessment - Fugl-Meyer assessment of Motor Performance - Modified Rankin Scale - Motricity Index - NIH Stroke Scale - Rate of Perceived Exertion - Trunk Impairment Scale - Wold Motor Function Test
72
Highly recommended outcome measures for stroke - Outpatient Care (5)
- Fugl-Meyer Assessment (Motor performance) - Functional Independence Measure - Postural Assessment Scale for Stroke patients (PASS) - Stoke impact scale - Stroke rehabilitation assessment of movement
73
Stroke 6MWT MCID slow vs. fast walkers
- very slow walkers (<.40m/s) = 35-45m - faster walkers (>.40m/s) = 70-130m
74
Stroke 6MWT Subacute MCID
34.4m
75
Stroke 6MWT Chronic MCID
50m
76
Stroke 10MWT MCID
0.16m/s
77
Chronic Stroke BBS cut-off for high risk of falling
78
Chronic Stroke BBS cut-off indicates slow walker status
79
Stroke BBS cut-off for greater probability of falling
< 46.5
80
Stroke Activities-Specific Balance Confidence Scale score cut-off for increased falls risk
< 67%
81
Stroke Activities-Specific Balance Confidence Scale score for certainty that individual did not have multiple falls
81.1
82
Stroke FGA cut-off for increased fall risk
< 23/30
83
Stroke 5xSTS cut-off to discriminate between healthy, elderly, and subjects w/chronic stroke
12 sec
84
What is the Orpington Prognostic Scale?
Scoring of cognition, balance, proprioception, and motor function to determine deficit - scores range from 1.6-6.8
85
Orpington Prognostic Scale Mild - Mod deficit
< 3.2 discharge home
86
Orpington Prognostic Scale Mod- Severe deficit
3.2-5.2 Respond well to rehab
87
Orpington Prognostic Scale Severe or major deficit
> 5.2 Go to rehab facility
88
What is Postural Assessment Scale for Stroke (PASS)?
Assesses and monitors postural ability of maintaining or changing position in 12 tasks - score 0-36 (higher score = more able)
89
Postural Assessment Scale for Stroke (PASS) cut off for severe balance/posture deficit?
< 8/36
90
Postural Assessment Scale for Stroke (PASS) score to indicate increased likelihood to walk early after stroke?
> 12/36
91
What is Stroke Rehabilitation Assessment of Movement (STREAM)?
30 items; 3 domains (upper-limb, lower-limb, basic mobility) - evaluates motor functioning for stroke patients - up to 20 points for each limb - up to 30 points for mobility
92
Stroke Rehabilitation Assessment of Movement (STREAM) UE MCID
2.2
93
Stroke Rehabilitation Assessment of Movement (STREAM) LE MCID
1.9
94
Stroke Rehabilitation Assessment of Movement (STREAM) Mobility MCID
4.8
95
What is the Stroke Impact Scale?
59 items - assessing 8 domains - rated on Likert Scale - 0-100 (higher score = low impact of stroke/less impairment)
96
Fugl-Meyer MCID for UE
10 point increase = 1.5 change in discharge FIM
97
Fugl-Meyer MCID for LE
10 point increase = 1.9 change in discharge FIM
98
Stroke Functional independence measure MCID total score
22 pts
99
Stroke Functional independence measure MCID motor score
17
100
Stroke Functional independence measure MCID cog score
3pt
101
FIM total scores of what at admission showed higher gains than patients who scored > 73
37 to 72
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