Term
|
Definition
-85% of CVA's
Types:
-Thrombus: clot within the cerebral arteries
-Embolus: traveling matter that occlude cerebral arteries |
|
|
Term
Hemmorrhagic CVA
-stats
-what is it?
-Types? |
|
Definition
-15% of CVA's, 40% of whom die
-Abnormal bleeding as a result of ruptured vessel
Types:
-SubArachnoid hemmorhage
-SubDural Hemmorhage
-Arteriovenous malformations |
|
|
Term
Thrombotic CVA
progression |
|
Definition
1. Atherosclerosis
-Plaque deposits
-decreases lumen
2. Blood flow
-Reduces, thus reducing oxygen to tissues
3. Cerebral infarction
-complete occlusion causes cell death |
|
|
Term
|
Definition
1. Embolus
-Atrial fibrillation, Myocardial infarction, valvular disease
-clot breaks away
2. Occlusion
-Clot lodges in a cerebral blood vessel
3. Cerebral infarction
-Perfusion <8-10mL/100mg, cell death occurs |
|
|
Term
|
Definition
tissue surrounding the irreversible ischemia of a thrombotic or embolic stroke, where ischemia can be reversed and cells recovered.
-Blood flow is 20-50% of norm, |
|
|
Term
|
Definition
-temporary interruption of blood supply
-impairments resolve within 24 hours
-Recurring increases likelihood of CVA |
|
|
Term
| Diagnosis techniques for CVA |
|
Definition
-determine etiology
-physical exam
-neuroimaging |
|
|
Term
| Acute medical management for CVA |
|
Definition
-monitor neuro function
-prevent secondary complication
-regulate blood pressure, cerebral perfusion, and Intracranial pressure.
-pharmacology
-surgical intervention |
|
|
Term
|
Definition
-most significant within first 3 months
-impairment often persists
-15% die shortly after incident |
|
|
Term
|
Definition
-hypertension
-cardiac disease
-diabetes mellitus
-smoking
-ETOH/drug use
-History of CVA/TIA
-Atrial Fibrillation
-inactivity
-obesity
-age >55years
-gender-male
-Race (AfricanAmer,Pac.Islanders, Hispan.) |
|
|
Term
Hemispheric effects of CVA
-Visual perceptual |
|
Definition
Right: left neglect, agnosias, difficulty processing visual cues
Left: Broca’s, Wernicke’s or global aphasia, difficulty processing verbal cues |
|
|
Term
Hemispheric effects of CVA
-Behavioral |
|
Definition
Right:Quick, impulsive, poor judgment, poor insight into deficits
Left: Slow, cautious, disorganized |
|
|
Term
Hemispheric effects of CVA
-Intellectual |
|
Definition
Right: Difficulty with abstract, rigidity of thought, difficulty with ‘whole idea’ of task
Left: Highly distractible, perseveration, difficulty initiating |
|
|
Term
Hemispheric effects of CVA
-Emotional |
|
Definition
Right: Difficulty perceiving emotions & expressing negative emotions
Left: Difficulty expressing positive emotions |
|
|
Term
Hemispheric effects of CVA
-Task performance |
|
Definition
Right: Fluctuations in performance
Left: Ideational/ideomotor apraxia |
|
|
Term
| incidence and cost of spinal cord injury |
|
Definition
12,000 per year
~30-40/million annually
$2.2-4.6 mill |
|
|
Term
| most susceptible to Spinal cord injury |
|
Definition
highly active persons
-16-30 years
-males account for 81% of all cases |
|
|
Term
|
Definition
a chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord.
-results in wasting of the muscles in the hands and a loss of sensation. |
|
|
Term
|
Definition
-primary area damaged by hemmorhage, blood vessels cause necrosis
-Secondary injury from apoptosis, macrophages acting as immune mediators, and microglia damaging oligodendrocytes.
-Spared rim may allow preservatiton of function |
|
|
Term
| Mechanism for injury of spinal cord |
|
Definition
-50% from excessive spinal flexion
-Concussion
-Contusion: glial tissue and cord intact
-Laceration:glia disrupted,cord maybe torn
-complete transection |
|
|
Term
|
Definition
| aka quadriplegia, paralysis of 4 limbs |
|
|
Term
|
Definition
| paresis of the lower extremities and lower trunk |
|
|
Term
|
Definition
-partial preservation of motor function/sensory below level of injury extending to S4-5
-Sacral sparring: anal sensation a voluntary contraction of anal sphincter |
|
|
Term
|
Definition
| no sensory or motor function preserved in the segment s4-5 |
|
|
Term
Identifying the Level and extent of spinal injury
-naming |
|
Definition
precisely document sensation in the dermatome and muscle strength in the myotome.
-named by the last intact neurological level |
|
|
Term
| SCI classification according to the asia impairment scale |
|
Definition
A.Complete: no sensory or motor
B.Incomplete: sensory only
C.Incomplete: motor preserved below neurological level, more than half of the key muscles have a muscle grade <3to5
D. Incomplete: motor preserved below neurological level, more than half of the key muscles have a muscle grade >3to5
E. Normal |
|
|
Term
CLinical manifestation of spinal cord injury
-skeletal |
|
Definition
Heterotopic ossification
scoliosis |
|
|
Term
CLinical manifestation of spinal cord injury
-pain |
|
Definition
-Nerve root injury along with spinal cord damage
-Musculoskeletal pain especially from overworking muscles |
|
|
Term
CLinical manifestation of spinal cord injury
-Cerebrovascular |
|
Definition
-Autonomic nervous system dysfunction
-increased risk of deep venous thrombosis |
|
|
Term
CLinical manifestation of spinal cord injury
-Respiratory |
|
Definition
-High cervical lesions may lose independent breathing
-pneumonia - aspiration common cause of death |
|
|
Term
CLinical manifestation of spinal cord injury
-Metabolic |
|
Definition
-Osteoporosis
-Insulin resistance
-Increase in body fat |
|
|
Term
CLinical manifestation of spinal cord injury
-bowel and bladder |
|
Definition
-Normal reflexes may be absent
-Neurogenic Bladder
-UTI |
|
|
Term
SPinal cord injury
-muscle tone |
|
Definition
-flaccidity
-Autonomic symptoms (sweating, reflex incontinence)
-spasticity, all kinds
-Eventual atrophy of muscle |
|
|
Term
Autonomic Dysreflexia
-what causes it
-symptoms
-immediate response/what to do |
|
Definition
-occurs with spinal cord injury above T6
-Frequently will occur with an overextended bladder
-sympathetic response
-elevated BP >20mm Hg
-headache
Respond:
-remove noxious stimuli
-elevate head |
|
|
Term
Pressure ulcers
-areas affected from supine position |
|
Definition
-occiput
-scapulae
-vertebrae
-elbows
-sacrum
-coccyx
-heels |
|
|
Term
pressure ulcers
-areas affected from prone position |
|
Definition
-ears (head rotated)
-anterior shoulders
-iliac crest
-male genitalia
-patela
-dorsum of feet |
|
|
Term
pressure ulcers
-areas affected from side-lying |
|
Definition
-ears
-shoulders
-greater trochanter
-head of fibula
-knees (medial aspect from k-k contact)
-lateral malleolus
-medial malleolus |
|
|
Term
Autonomic Dysreflexia
-what causes it
-symptoms
-immediate response/what to do |
|
Definition
-occurs with spinal cord injury above T6
-Frequently will occur with an overextended bladder
-sympathetic response
-elevated BP >20mm Hg
-headache
Respond:
-remove noxious stimuli
-elevate head |
|
|
Term
Pressure ulcers
-areas affected from supine position |
|
Definition
-occiput
-scapulae
-vertebrae
-elbows
-sacrum
-coccyx
-heels |
|
|
Term
pressure ulcers
-areas affected from prone position |
|
Definition
-ears (head rotated)
-anterior shoulders
-iliac crest
-male genitalia
-patela
-dorsum of feet |
|
|
Term
pressure ulcers
-areas affected from side-lying |
|
Definition
-ears
-shoulders
-greater trochanter
-head of fibula
-knees (medial aspect from k-k contact)
-lateral malleolus
-medial malleolus |
|
|
Term
Autonomic Dysreflexia
-what causes it
-symptoms
-immediate response/what to do |
|
Definition
-occurs with spinal cord injury above T6
-Frequently will occur with an overextended bladder
-sympathetic response
-elevated BP >20mm Hg
-headache
Respond:
-remove noxious stimuli
-elevate head |
|
|
Term
Autonomic Dysreflexia
-what causes it
-symptoms
-immediate response/what to do |
|
Definition
-occurs with spinal cord injury above T6
-Frequently will occur with an overextended bladder
-sympathetic response
-elevated BP >20mm Hg
-headache
Respond:
-remove noxious stimuli
-elevate head |
|
|
Term
Autonomic Dysreflexia
-what causes it
-symptoms
-immediate response/what to do |
|
Definition
-occurs with spinal cord injury above T6
-Frequently will occur with an overextended bladder
-sympathetic response
-elevated BP >20mm Hg
-headache
Respond:
-remove noxious stimuli
-elevate head |
|
|
Term
pressure ulcers
areas of concern when supine |
|
Definition
-occiput
-scapulae
-vertebrae
-elbows
-sacrum
-coccyx
-heels |
|
|
Term
pressure ulcers
areas of concern when prone |
|
Definition
-ears (head rotated)
-anterior shoulders
-iliac crest
-male genitalia
-patela
-dorsum of feet |
|
|
Term
pressure ulcers
areas of concern when side lying |
|
Definition
-ears
-lateral shoulders
-greater trochanter
-head of fibula
-medial knees from knee-knee contact
-lateral maleolus
-medial maleolus from mal.-mal. contact |
|
|
Term
Autonomic dysreflexia
-male sexual dysfunction |
|
Definition
-depends on the level of injury
>High level lesions: reflexive erections but no ejaculate
>low level lesion: ejaculate but difficult erection |
|
|
Term
Autonomic dysreflexia
-female reproductive organ dysfunction |
|
Definition
-women may lose menses for 3-6 months
-pregnancy possible, but should be closely monitored for 2 loss of sensation |
|
|
Term
autonomic dyreflexia
-sleep disorder |
|
Definition
|
|
Term
Autonomic dysreflexia
medical treatment |
|
Definition
-spine stabilized via bracing
-medically induced hypothermia
-vital systems stabilized
-Surgical: internal spine fixation
-Pharmacological: control edema, blood flow & secondary neurologic sequalae, and corticosteroids |
|
|
Term
Autonomic dysreflexia
-spasticity management |
|
Definition
Baclofen
Functional electrical stimulation |
|
|
Term
Autonomic dysreflexia
-Pain management |
|
Definition
-meds
-Transcutaneous Electrical Nerve Stimulation |
|
|
Term
| Traumatic brain injury - cause |
|
Definition
| -caused by external physical force, contact or rotational |
|
|
Term
|
Definition
2.2mill per year
male:female - 2:1
ages: 1-2y, 15-24y, >75y |
|
|
Term
| Types of traumatic brain injury |
|
Definition
|
|
Term
|
Definition
OPEN
-skull fracture of displacement
-torn meninges
-brain exposure
-risk infection |
|
|
Term
|
Definition
-No skull fx
-Neural tissue damaged
-Dura remains intact
-Risk of ICP |
|
|
Term
| Traumatic brain injury, subtypes |
|
Definition
Concussion
Contusion
Hematomas
Locked-In syndrome
Acquired brain injuries
Sudden impact syndrome |
|
|
Term
|
Definition
blood fills space between dura and skull
LOC followed by A&O
Rapid deterioration |
|
|
Term
|
Definition
S/S fluctuate and resemble CVA
↓ LOC
Contralateral HP
Ipsilateral pupil dilation |
|
|
Term
|
Definition
Complete paralysis of voluntary muscles except eyes
Cognition intact |
|
|
Term
|
Definition
Not hereditary, congenital, degenerative, or birth trauma
Airway obstruction, near drowning, MI… |
|
|
Term
| medical management of TBI |
|
Definition
Decompression of skull
Hemorrhage/hematoma evacuation
Intubation
Chest tubes
IVs, swan ganz catheter, epidural sensor |
|
|
Term
|
Definition
Damage at site of impact
Coup-Contrecoup injury
Diffuse axonal injury
Laceration to cerebral tissue |
|
|
Term
| Secondary damage with TBI |
|
Definition
Changes due to brains rxn to trauma
-ICP
-Anoxic injuries
-Seizures |
|
|
Term
|
Definition
Disruption & tearing of axons and small vessels from shear-strain of angular acceleration
Neuronal death and petechial hemorrhages
High velocity & rotational injuries |
|
|
Term
|
Definition
an absence or deficiency of oxygen reaching the tissues.
-Brain demands 20% of O2, |
|
|
Term
|
Definition
Vestibular stimulation
Stress
Poor nutrition
Electrolyte imbalance
Drug use
Missed meds
Infection |
|
|
Term
| Intracranial pressure description |
|
Definition
Present in 70% of TBI cases
Normal ICP (0-15mm Hg)
Compression of brain tissue
↓ perfusion
Herniation |
|
|
Term
| increased intracranial pressure, signs and symptoms |
|
Definition
↓ responsiveness
Impaired consciousness
Severe HA
Vomiting
Irritability
Papilledema
↑ BP, ↓ HR |
|
|
Term
|
Definition
↓ level of arousal
Cognitive impairments
Motor disorders
Sensory problems
Communication deficits
Behavioral changes
Associated problems |
|
|
Term
|
Definition
can be used to assess outcome of TBI
terms include:
Arousal: state of being awake
Awareness: conscious to internal & external stimuli
Consciousness: state of being aware
Stupor: general unresponsiveness
Obtundity: sleep lot, disinterested, slow to respond
Delirium: disorientation, fear, misperception of sensory stimulus |
|
|
Term
| Rancho Los Amigos LOCFRancho Los Amigos LOCF |
|
Definition
can be used to assess outcome of TBI
terms include:
Disorientation
Poor attention span
Loss of memory
Loss of executive functions (planning & organizational skills, recognizing errors, problem solving, abstract thinking)
Inability to control emotional responses |
|
|
Term
| MOTOR DEFICITS associated with TBI |
|
Definition
Abnormal postures
Decerebrate: severing of midbrain
Decorticate: dysfunction between basal nuclei & thalamus
Weakness
Initiation difficulty
Tonal abnormalities
Primitive & tonic reflex reemergence
Sequencing
Ataxia
Gait impairments
Balance impairments |
|
|
Term
|
Definition
-hips adducted and internally rotated
-knees extended
-ankles plantar flexed
-feet supinated
-UE internally rotated, extended at shoulders and elbows, pronated forearms, flexed wrists and fingers |
|
|
Term
|
Definition
-hips adducted and internally rotated
-knees extended
-ankles plantar flexed
-feet supinated
UE: flexion with adduction and internal rotation of the shoulders, flexion of the elbows, pronation of the forearms, flexion of the wrists, and extension of the lower extremities |
|
|
Term
|
Definition
Tactile & kinesthetic sensations
Visual, perceptual & proprioceptive deficits |
|
|
Term
Communication Deficits
with TBI |
|
Definition
Initiation of speech
Inappropriate speech
Receptive |
|
|
Term
Behavioral Deficits
with TBI |
|
Definition
Neuroses
Psychoses
Sexual disinhibition
Apathy
Irritability
Lability
Aggression
Low frustration tolerance |
|
|
Term
| associated problems with TBI |
|
Definition
-heterotopic ossification
-myositis ossification |
|
|
