Term
| A sudden loss of neurological function caused by an interruption of the blood flow to the brain. Neurological symptoms are present a minimum of 24 hours. |
|
Definition
| CVA, Stroke, Brain Attack |
|
|
Term
| What is the 3rd most common cause of death and the leading cause of disability in the US? |
|
Definition
|
|
Term
| 2/3 pts with this are over 65 years old. It occurs in males more than females. It occurs in blacks twice as often as whites. |
|
Definition
|
|
Term
| Name 5 risk factors for CVA |
|
Definition
HTN
Diabetes Mellitus
Heart Disease/Cardiac Disorders
Atrial Fibrillation
TIA |
|
|
Term
| Name 6 risk factors for HTN |
|
Definition
Smoking
Obesity
High Cholesterol
Diabetes Mellitus
Heavy Alcohol consumption
Cocaine Use |
|
|
Term
| Name 2 modifiable risk factors to help prevent a CVA |
|
Definition
Lifestyle
Control of associated diseases |
|
|
Term
| Name 5 lifestyle factors that could change to help prevent CVA |
|
Definition
Smoking
Obesity
Diet
Exercise
Alcohol |
|
|
Term
| Name 3 associated diseases that should be controlled to help prevent CVA |
|
Definition
Diabetes mellitus
HTN
Heart Disease |
|
|
Term
| Name 5 early warning signs of CVA |
|
Definition
1. Sudden numbness in face, arm, or leg
2. Sudden confusion, trouble speaking, or understanding
3. Sudden trouble seeing
4. Sudden trouble walking, dizziness, loss of balance or coordination
5. Sudden or severe headaches with no known cause |
|
|
Term
| After a CVA occurs, there are several symptoms. The exact combination depends on the location and size of defect, and amount of collateral blood flow. Name 6 symptoms. |
|
Definition
1. Motor dysfunction (paralysis/paresis, altered muscle tone, altered motor control, altered postural control)
2. Sensory dysfunction (discriminative senses, pain/temp, proprioception)
3. Communication deficits (aphasia, dysarthria)
4. Visual field defects (homonymous hemianopsia)
5. Cognitive impairments (level of consciousness, ability to learn, motivation, awareness of deficits)
6. Perceptual impairments (unilateral neglect) |
|
|
Term
|
Definition
|
|
Term
| Do all post-CVA patients look the same? |
|
Definition
|
|
Term
| How do you decide on intervention for post CVA? |
|
Definition
| Depends on areas damaged, signs for that patient, etc |
|
|
Term
| What are the 2 classifications of CVA |
|
Definition
|
|
Term
| What are the 2 types of Ischemic CVAs |
|
Definition
|
|
Term
| What are the 2 types of hemorrhagic CVAs |
|
Definition
Hypertensive
Ruptured aneurysm |
|
|
Term
| What percentage of strokes are ischemic and what percentage is hemorrhagic? |
|
Definition
80% ischemic
20% hemorrhagic |
|
|
Term
| This type of CVA has a higher mortality rate, but if the patient survives, their recovery rate is quicker. |
|
Definition
|
|
Term
| This type of CVA is due to artherosclerotic plaques plus hypertension. Plaques at branches/curves, usually before 1st main branching of cerebral arteries. 60% occur during sleep. |
|
Definition
|
|
Term
| With this type of CVA, patient may remain asymptomatic, or lead to intermittent blocks (TIA) and/or permanent damage due to ischemia. |
|
Definition
|
|
Term
| A signal of thrombotic disease; symptoms last 2-30 minutes; normal neuro exam between attacks. |
|
Definition
|
|
Term
| With a stroke are symptoms permanent? |
|
Definition
|
|
Term
| With a TIA are symptoms permanent? |
|
Definition
|
|
Term
| This type of CVA develops slowly, collateral circulation may develop over time (decreases impact of infarct). The goal of acute management is to increase blood flow ASAP, prevent ischemic tissue from dying. |
|
Definition
|
|
Term
| Name 2 ways to prevent thrombotic CVA |
|
Definition
BP management
Public awareness |
|
|
Term
-At immediate site, 80-100% ischemia - cell death within minutes
-Area around site 50-80% decreased blood flow, cells can be saved
-Tissue plasminogen activator (t-PA), must be used 90-180 minutes from onset of symptoms (average pt waits 13 hours)
-Anticoagulants to prevent TIAs, stop stroke-in-evolution |
|
Definition
| Acute management of thrombotic CVA |
|
|
Term
| Due to embolus from heart, internal carotid artery thrombus, or plaque in carotid sinus. Most often involves the middle cerebral artery and is often a sign of heart disease. |
|
Definition
|
|
Term
| This type of CVA has a sudden onset, therefore more damage (no chance to develop collateral blood flow), acute management as per thrombotic CVA. |
|
Definition
|
|
Term
| How can embolic CVAs be prevented? |
|
Definition
|
|
Term
| Usually due to HTN, ruptured saccular (berry) aneurysm, or AV malformation. Symptoms come on sudden and as a headache. |
|
Definition
|
|
Term
| If the hemorrhagic CVA is due to HTN, what should be done acutely and what could be done to prevent it? |
|
Definition
Acute: manage as above (do not use blood thinner)
Prevention: Antihypertensives |
|
|
Term
| If the hemorrhagic CVA is due to rupture, what should be done acutely and what could be done to prevent it? |
|
Definition
Acute: If pt survives 1st few days, surgery to correct defect
Prevention: Meds to decrease BP |
|
|
Term
| Hemorrhagic Strokes can occur in different parts of the brain, what are the 3 most common. |
|
Definition
Intracerebral
Cerebral
Subarachnoid |
|
|
Term
| Primary hemorrhagic rupture of cerebral vessel with bleeding into the brain |
|
Definition
|
|
Term
| Non traumatic spontaneous hemorrhage in small blood vessels. May produce an aneurysm |
|
Definition
|
|
Term
| Bleeding into the subarachnoid space; Often associated with berry aneurysm in large vessel |
|
Definition
|
|
Term
|
Definition
| Loss of blood or occlusion; impairements related to anatomic distribution of artery |
|
|
Term
|
Definition
| Interruption of cerebral blood flow; General hypofusion; Widespread and severe damage |
|
|
Term
| Name 6 Vascular Syndromes |
|
Definition
Anterior Cerebral Artery
Middle Cerebral Artery
Internal Carotid Artery
Posterior Cerebral Artery
Lacunar
Vertebrobasilar Artery |
|
|
Term
| Small branches within the peripheral system |
|
Definition
| Lacunar (lenticulostriates) |
|
|
Term
| What all occurs when you have ACA Syndrome? |
|
Definition
-Contra hemiparesis
-Sensory loss
-Urinary incontinence
-Problems with imitation and bimanual tasks, apraxia
-Perseveration and amnesia
-Greater involvement of LE (Somatotopic organization of the medial aspect of the cortex includes the functional area for the LE) |
|
|
Term
| When the pt gets "stuck" on something such as tasks or words |
|
Definition
|
|
Term
| What all occurs when you have MCA Syndrome? |
|
Definition
-Most common site of occlusion in stroke
-Contra spastic hemiparesis and sensory loss (Face and UE > LE)
-Motor speech impairment
-Perceptual deficits
-Visual field neglect and homonymous hemianopsia
-If L hemisphere affected: expressive (broca's) aphasia, receptive (Wernicke's)
-If R hemisphere: neglect of contra side, apraxia |
|
|
Term
| What all occurs when you have ICA Syndrome? |
|
Definition
-Typically produces massive infarction
-Significant edema is common
-Coma and death |
|
|
Term
| Why is it that we rarely treat ICA Syndrome? |
|
Definition
|
|
Term
| What all occurs when you have PCA Syndrome? |
|
Definition
-Occlusion proximal to PCA typically causes mild deficits due to collateral blood supply (Circle of Willis)
-Occlusion to thalamic branches may cause sensory loss or central post stroke (thalamic) pain
-Occlusion in occipital region can cause hemianopsia, agnosia, or cortical blindness
-Occlusion in the temporal lobe can result in memory loss or amnesia |
|
|
Term
| The inability to determine objects by how they feel without looking |
|
Definition
|
|
Term
| When the eyes do not work but the brain part of seeing does |
|
Definition
|
|
Term
| What occurs when you have lacunar syndrome? |
|
Definition
-Caused by small vessel disease dep in cerebral white matter
-Associated with hypertensive hemorrhage and diabetic microvascular dz
-Specific to anatomical sites
-Deficits in consciousness, language, or visual fields are not seen |
|
|
Term
| What occurs when you have Vertebrobasilar Artery Syndrome? |
|
Definition
-Vertbral artery supplies
~Cerebellum and Medulla
-Basilar artery supplies
~Pons, internal ear, cerebellum
-Occlusions can produce a wide varity of symptoms/syndromes |
|
|
Term
| What will occur with a complete blockage of the Basilar Artery? |
|
Definition
| Death; or coma, complete quadriplegia (locked in syndrome), CN abnormalities |
|
|
Term
| What will occur with a complete blockage of cerebellar arteries? |
|
Definition
| -Ipsi hemiataxia; brainsten signs (CNs), dizziness, N&V, nystagmus; decreased touch, vibration, position sense LE>UE; ataxia; tinnitus; ipsi facial paralysis and decreased sensation; decreased pain/temp contra body |
|
|
Term
| What will occur with a complete blockage of the Vertebral artery? |
|
Definition
| Decreased contra pain/temp, proprioception, touch; contra hemiparesis UE and LE; ataxia; ipsi facial pain/numbness; paralysis of tongue, vocal cord weakness, decreased gag, hiccups |
|
|
Term
| "Time is Brain" why is a CT scan necessary after CVA |
|
Definition
| To determine if it was thrombotic or hemorrhagic |
|
|
Term
| If a stroke is thrombotic, what is the medical management like? |
|
Definition
t-PA enzyme can dissolve the clot
Must be given within 3 hours of CVA
Only about 5% are currently treated with t-PA |
|
|
Term
| What are the 9 acute medical management goals post CVA? |
|
Definition
1. Improve cardiac profusion - O2
2. Maintain adequate BP
3. Maintain CO
4. Restore or maintain electrolyte balance
5. Blood glucose levels normalized
6. Control seizures and infections
7. Control intracranial pressure
8. Maintain bladder function (indwelling Foley)
9. Maintain skin integrity (turning schedule) |
|
|
Term
| Name 10 associated medical problems of CVA |
|
Definition
1. Spasticity
2. Seizures
3. Hydrocephalus
4. Cardiac function
5. Pulmonary function
6. Thrombophlebitis
7. Integumentary
8. Trauma
9. Pain
10. Complex Regional Pain Syndrome |
|
|
Term
| A velocity dependent increase in muscle tone. Different from hypertonia because it is velocity dependent. |
|
Definition
|
|
Term
| Managed with medication; occurs in a small number of CVA pts; more likely in occlusive carotid disease than in MCA; more common in acute phase |
|
Definition
|
|
Term
| Excessive accumuation of CSF within cranial cavity; rare but can occur in subarachnoid or intracerebral hemorrhage; Pts may experience headache, N&V, visual impairments, increased lethargy and ataxia |
|
Definition
|
|
Term
-Most strokes are caused by vascular disease
~Typically present with low peak VO2 levels during exercise
>Age Dependent, Level of diability
>Co-morbities, Medications
>Secondary Complications
-Limitations in exercise tolerance may limit rehab potential
-Most pts post stroke are deconditioned |
|
Definition
|
|
Term
| 4 Things that may cause pulmonary function to be decreased? |
|
Definition
Lung Volume
Pulmonary perfusion
Vital capacity
Altered chest wall excursion |
|
|
Term
| What might cause pulmonary function to be increased? |
|
Definition
| O2 demands during activity |
|
|
Term
| What might cause aspiration? |
|
Definition
Penetration of food, liquid, and saliva or gastric reflux into the airway
- occurs in patients iwth dysphagia
- occurs in any stage of swallowing |
|
|
Term
|
Definition
|
|
Term
| Can lead to acute resp. distress or aspiration pneumonia or death; dysphagia can lead to dehydration and compromised nutrition; early exam is important (use of videofluroscopic exam such as a modified barium swallow study) |
|
Definition
|
|
Term
| Vascular changes premorbid, DVT develop with inactivity |
|
Definition
|
|
Term
| Post stroke incidence is 47% with 10% deaths due to PE; higher in acute phase; venous stasis from bed rest, limb paralysis/decreased activity, hemineglect, decreased cognitive status |
|
Definition
|
|
Term
| What is the treatment for DVT |
|
Definition
|
|
Term
-Incidence post stroke is ~15%
-Most common over boney areas
~ Friction, shearing, maceration
-Risk factors
~Immobility, Poor nutrition
~Decreased sensation, Co-morbidities
~Abnormal patterns of movement
~Decreased cognitive levels |
|
Definition
|
|
Term
| Falls common due to poor balance/postural control, unaware of deficits |
|
Definition
|
|
Term
| Where is the most pain referred to post CVA? |
|
Definition
|
|
Term
| Post CVA, where are the most shoulder subluxations? |
|
Definition
-Inf or ant
-Due to muscular imbalance
-Dependent position |
|
|
Term
| Name the 6 deficitsin patients post-CVA |
|
Definition
-Motor dysfunction
-Sensory dysfunction
-Communication deficits
-Visual field deficits
-Cognitive impairments
-Perceptual impairments |
|
|
Term
Paralysis/paresis
Altered ms tone
Altered motor control
Altered postural control |
|
Definition
|
|
Term
Discriminative senses
Pain/temp
Proprioception |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Level of consciousness
Ability to learn
Motivation
Awareness of deficits |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Impairments in all areas will affect: (3) |
|
Definition
|
|
Term
| Name 3 Primary Motor Impairments following CVA (direct result of brain lesion) |
|
Definition
-Changes in muscle strength
-Changes in muscle tone
-Changes in muscle activation (coordination) |
|
|
Term
| Name 4 Secondary motor impairments following CVA. |
|
Definition
-Changes in alignment and mobility
-Changes in soft tissue and ms length
-Pain
-Edema |
|
|
Term
| List the typical pattern of motor return |
|
Definition
-Flaccid
-Increase tone (spasticity)
-Synergistic patterns
-Isolated, voluntary functional movement |
|
|
Term
| Name the 6 Brunnstrom Stages of Motor Recovery |
|
Definition
1. Initial motor function is flaccidity (no movement of limb)
2. Minimal volitional movement (spasticity begins)
3. Gain voluntary control of abnormal movement synergies (spasticity continues and may become severe)
4. Movement combos that do not follow the paths of abnormal synergies are mastered (spasticity declines)
5. More difficult movement combos are learned (abnormal synergies lose dominance)
6. Disappearance of spasticity, individual joint movements and coordination, motor function is restored |
|
|
Term
-Found in 80-90% of all pts with stroke
-Major disability factor
-Pts are unable to generate the force necessary for initiating and controlling movement |
|
Definition
|
|
Term
Hemiparesis
-UE>LE
-Distal ms show greater strength deficits than proximal
-Mild weakness can occur on "normal side" |
|
Definition
| Centrally mediated weakness or paresis |
|
|
Term
-Motor fiber/motor unit level
-Muscle fiber atrophy or conversion
~Type II (fast twitch) - selective loss (impaired initiation and fast, forceful movements)
~Type I (slow twitch) - increase |
|
Definition
| Peripherally mediated weakness or paresis |
|
|
Term
| Name the 4 overall results of weakness |
|
Definition
1. Slower reaction times
2. Movement time increased
3. Coordination impaired
4. Increased coactivation (cocontraction) of agonist and antagonist (causes a timing disorder that limits force production during voluntary movements) |
|
|
Term
| Name 6 alterations of tone |
|
Definition
1.Flaccidity
- associated with cerebral shock and is generally short-lived
2. Spasticity
- Emerges in 90% of cases
3. Abnormal synergy patterns
4. Abnormal reflexes
5. Altered coordination
6. Altered motor programming |
|
|
Term
| Name 5 ways in which postural control and balance are affected with CVA |
|
Definition
1. Impaired steadiness
-Increased postural sway in standing
2. Asymmetry
- Weight shift toward strong side
3. Dynamic stability
-Reactive postural control
-Anticipatory postural control
4. Disorganization of postural synergies
- Compensatory responses (excessive hip and knee movements with perturbations)
5. Falls in direction of weakness |
|
|
Term
-Ipsilateral pushing
-Active pushing toward more involved side (tendency to fall toward hemiparetic side)
-Lateral postural imbalance
-Misperception of body in space
-Function is severly impaired (Severe problems with transfers, standing and gait; Assistive device magnifies problem; Rehab outcomes are poor with longer hospital stays)
-Typically resolves by ~6 months post stroke |
|
Definition
|
|
Term
| What are some sensory impairments post stroke? |
|
Definition
-Impairments in superficial and deep touch are reported in >50% of pts with CVA
~ Typically effects face>UE>LE
~Does not follow dermatome patterns
-Proprioception impairments common
-Pain
~Subluxation, Headaches, Thalamic (Severe, Burning, Sharp; Limits participation in therapy) |
|
|
Term
| What are some visual changes that occur post stroke? |
|
Definition
Homonymous Hemianopsia
- Visual Field Deficits (Loss of vision on contra half of each visual field)
-Visual neflect (inattention to visual stimuli)
- Forced gaze deviation (Typically away from hemiplegic side) |
|
|
Term
| Speech, language, and swallowing are normally associated with dominant hemispheric stroke. Which hemisphere is most often affected? |
|
Definition
|
|
Term
| Acquired communication disorder caused by brain damage and is characterized by impairment of language comprehension, formulation, and use. |
|
Definition
|
|
Term
|
Definition
1. Wernicke's / Fluent
2. Broca's / Expressive
3. Global |
|
|
Term
| Aphasia where speech flows smoothly with a variety of grammatical constructions and preserved melody of speech. Auditory comprehension is impaired. Demonstrates difficulty in comprehending spoken language and in following commands. |
|
Definition
|
|
Term
| Nonfluent aphasia where the flow of speech is slow and hesitant. Vocabulary is limited and syntax is impaired. Speech production is labored or lost and comprehension is good. |
|
Definition
|
|
Term
| Severe aphasia where impairments are in both production and comprehension of language. Often indicates extensive brain damage. Rehab outcomes are limited. |
|
Definition
|
|
Term
| Name visual perception deficits |
|
Definition
Body scheme / body image
- Body awareness neglect
- Unilateral neglect |
|
|
Term
| The inability to recognize incoming information even though sensory intact. Can be visual, auditory, or tactile. |
|
Definition
|
|
Term
| Name 7 cognitive impairments |
|
Definition
Alertness
Awareness
Orientation
Memory (confabulation)
Perseveration
Executive function
Delirium |
|
|
Term
| Inability to control or inhibit spontaneous emotions. Name 3 |
|
Definition
Apathy
Euphoria
Frequent Crying |
|
|
Term
| Name 6 things that occur with a Right Brain Lesion |
|
Definition
1. Left side involvement
2. Visual perception impairments
3. Impulsive behavior
4. Poor judgement
5. Often unaware of impairements
6. Difficulty with visual cues |
|
|
Term
| Name 5 things that occur with Left Brain Lesion |
|
Definition
1. Right side involvement
2. Speech & language impairments
3. Cautious behavior
4. Anxious about performance
5. Difficulty with verbal cues |
|
|
Term
| Name 3 things that occur during the acute phase of CVA involving bowel and bladder function |
|
Definition
1. Urinary incontinence caused by bladder hyperflexia or hyporeflexia, sensory loss or sphincter control disturbances
2. Use of indwelling foley or incontinent pads should be used only acutely
3. Toileting schedule should be implemented |
|
|
Term
| With CVA, there is a good chance of survival. Level of recovery vs. level of compensation. The most recovery is in the first 3 months. What are the 6 best predictors of CVA severity. |
|
Definition
CT
Functional MRI
Cerebral blood flow
PET
SPECT
Age is NOT a good predictor |
|
|
Term
| What percentage of CVA pts regain independent ADLs |
|
Definition
|
|
Term
| What percentage of CVA pts learn to walk again |
|
Definition
|
|
Term
| What percentage of pts do not regain UE function. Its best if return of UE movement into 1st two weeks, return of grip strength in 1st 24 days |
|
Definition
|
|
Term
| Why is it that LE returns better then UE? |
|
Definition
| B/c most strokes involve middle cerebral |
|
|
Term
| Functional status is usually predictable at __ months. Recovery does still continue for months, years |
|
Definition
|
|
Term
| What is the inital return of function due to? |
|
Definition
| Decreased edema, and increased blood flow |
|
|
Term
| Later recovery is due to what 2 things? |
|
Definition
Regeneration (sprouting)
Reorganization (unmasking, neuroplasticity) |
|
|
