Term
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Definition
| a non-traumatic brain injury caused by occlusion or rupture of cerebral blood vessels which results in sudden neurologic deficit. it is characterizes by a loss of motor control, altered sensation, cognitive/language impairment, and disequilibrium/coma. |
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Term
| what is the measure of outcome success w/stroke rehab? |
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Definition
| quality of life as determined by function |
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Term
| what characterizes a right hemisphere lesion/left hemiplegia? |
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Definition
| visuomotor perceptual impairment, loss of visual memory, L side neglect, verbal fluency is retained, more impulsive, less insight, rehabilitation is difficult (or impossible in severe cases). |
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Term
| what characterizes a left hemisphere lesion/right hemiplegia? |
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Definition
| intact visual motor perception, ability to learn from observation, apraxia (loss of ability to do a command - usually motor), unable to communicate, depression-prone (more insight), more cautious/non-impulsive (can learn from mistakes), and rehabilitations mobility/self-care goals are higher (90% will walk). |
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Term
| what characterizes pts affected by an MCA stroke? |
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Definition
| contralateral hemiplegia/hemianesthesia/hemianopia, head/eye turning toward lesion, dysphagia, and uninhibited neurogenic bladder (do *bladder scan and *bowel function test). if in the dominant hemisphere: global aphasia and apraxia. if in the non-dominant hemisphere: aprosody and affective agnosia, visuospatial deficit, and neglect syndrome. |
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Term
| what characterizes pts affected by an ACA stroke? |
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Definition
| contralateral hemiplegia, contralateral hemianesthesia, head/eye turning toward lesion, grasp reflex (groping is a primitive reflex usually inhibited by the prefrontal cortex), paratonia (aka gegenhalten - pt gives resistance at different ranges), disconnection apraxia, and akinetic mutism. the legs are usually more involved than the arms and generally this kind of stroke has a good prognosis. |
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Term
| what characterizes pts affected by a PCA stroke? |
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Definition
| hemisensory deficit, visual impairment, visual agnosia, prosopagnosia, dyschromatopsia, alexia w/o agraphia, and memory deficits |
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Term
| what does acute stroke rehab intervention consist of? |
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Definition
| prevention of dehydration (screen for dysphagia - if can't swallow, NPO to prevent aspiration), prevention of pressure sore formation (positioning), prevention of contractures (ROM, decrease edema), initiate early therapy, and early family communication (ID key members - get background info) |
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Term
| what are the patterns of motor recovery after a typical classic stroke? |
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Definition
| initially affected limbs are totally paralyzed, then deep tendon reflexes return w/in 48 hrs, and tone progresses from flaccid to spastic to normal through synergy patterns (which are mass composite motor movements: upper extremities - usually flexion and lower extremities - usually extension). |
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Term
| who are candidates for stroke rehab? |
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Definition
| pts must be able to tolerate therapy (intact ROM), be able to follow verbal or gestural instructions, and have at least minimal memory function. |
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Term
| what is the progression of hx-taking w/the stroke rehab pt? |
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Definition
| discuss chief complaint (determine etiology: ischemic vs hemorrhagic stroke), pre-morbid abilities, psycho-social hx (determine participation of family members/care givers), and classic hx (family hx+ROS) |
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Term
| how is cognitive function assessed in the neurological physical? |
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Definition
| there are 3 dysfunction/location combinations: motor apraxia - L hemisphere, dressing apraxia - R parietal lobe (visual-spatial), and neglect - R temporoparietal. these can be tested w/the folstein exam/simple functional tasks/dressing. clinical significance: difficulty performing ADL (activities of daily living)/safety awareness |
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Term
| how is language function assessed in the neurological physical? |
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Definition
| there are 2 dysfunction/location combinations: broca's area - anterior to L precentral gyrus and wernicke's area - L temporal gyrus. these can be tested via pt's language content, fluency, naming and articulation. clinical significance: communication, learning, frustration, family social interaction. |
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Term
| how is sensory function assessed in the neurological physical? |
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Definition
| there are 2 dysfunction/location combinations: thalamus - pain/temp and post central gyrus - proprioception/stereognosis. these can be tested via light touch, position sense, IDing objects in hand blindly. clinical significance: joint/skin protection, balance, coordination, and motor control. *sensory is the dominant sense in motor recovery - important to evaluate closely. |
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Term
| how is motor control strength assessed in the neurological physical? |
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Definition
| location of dysfunction: precentral gyrus and descending via the internal capsule. tests: MMT, synergy pattern. clinical significance: mobility, ADL, and bracing. |
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Term
| how is motor control coordination assessed in the neurological physical? |
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Definition
| location of dysfunction: frontal lobe pre-motor cortex BG and cerebellum. tests: trunk control/stability, dynamic/static balance, and 3-step commands. clinical significance: falls, ADL skills, gait and motor planning. |
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Term
| how is spasticity assessed in the neurological physical? |
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Definition
| location of dysfunction: upper motor neuron tract, disinhibited muscle spindle (rostral inhibition of reflexes maintain flexibility). tests: tendon tap, clasp knife, tonic postures. clinical significance: joint pain, reduced flexibility, posture, functional mobility, and hygiene. |
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Term
| what does the musculoskeletal exam consist of? |
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Definition
| inspection and palpation (check skin integrity, deformities, swelling edema/erythema, calf tenderness), joint stability assessment (shoulder subluxation: increased gap between acromion and humeral head), and ROM (contractures, shoulder-hand syndrome: RSD - painful ROM/hand edema) |
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Term
| what does the functional examination consist of? |
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Definition
| observation of successful/unsuccessful eating, bathing, toileting, dressing, bed activities, transfers, and ambulation |
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Term
| what factors beyond acute medical findings affect outcome? |
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Definition
| medical (**heart failure, CA, AIDs, bleeding tendency, previous stroke, older age, and visual spatial defects), social economic (poverty, resources, family, environment, substance abuse, trust issues, and motivation), and pre-existing condition (**bowel/bladder incontinence, mental illness) |
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Term
| what complications and risks may arise from either a stroke or its tx? |
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Definition
| post-stroke seizures, DVTs (check holman’s sign by dorsiflexing the ankle to see if there’s tenderness in calf), pressure ulceration, joint contracture, fractures/trauma, and heart attack |
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Term
| what is the neuroplastic component of neurologic recovery? |
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Definition
| this refers the the ability of the CNS to undergo cortical remodeling as a response to task oriented motor training - using the uninvolved side takes away from long term recovery. |
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