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stroke
stroke
63
Anatomy
Graduate
09/25/2012

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Cards

Term
what activities does the barthel index measure
Definition
feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility, stairs
Term
what is the range of scores of the barthel index
Definition
0-100
Term
what is the best score of the barthel index
Definition
100
Term
what is the best score of the NIH stroke scale
Definition
0
Term
what does the NIH stroke scale look at
Definition
level of consciousness, vision, motor, sensory, speech
Term
what does the precentral gyrus do?
Definition
controls movement
Term
what does the postcentral gyrus do
Definition
controls sensory information
Term
what is the area of expressive speech
Definition
brocas
Term
what is the area of comprensive speech
Definition
wernickes
Term
what does anterior cerebral artery come from
Definition
inferior carotid
Term
what functions are supplied by aca
Definition
leg movement
Term
what functions are supplied by mca
Definition
speech, arm/head/trunk movement
Term
which artery supplies brainstem, cerebellum
Definition
vertebral
Term
what type of stroke is tPA given for?
Definition
ischemic
Term
what are the objectives for EMS
Definition
stabilize patient (breathing/pulse), rapid identification of stroke, eliminate co-morbid conditions that could mimic stroke, rapid transport to ED, notify ED of stroke for preparation
Term
what does EMS need to ask about
Definition
onset of symptoms (time), recent events, comorbid disease, medications, allergies
Term
what are some stroke screening tools done by ems
Definition
cincinnati prehospital stroke scale, los angeles prehospital stroke screen
Term
what does the cincinnati prehospital stroke scale contain
Definition
facial droop, arm lift, speech
Term
what does the los angeles prehospital stroke screen look at
Definition
age, symptom duration, no history of seizures, others
Term
how will you know if stroke is hemorrhagic or ischemic
Definition
CT scan
Term
what is the best treatment of ischemic stroke
Definition
tissue plasminogen activator (tpa) administered within 3-4.5 hours of symptom onset
Term
what other device can be used with ischemic stroke up to 8 hours after onset
Definition
clot retrieval devices
Term
what is a TIA
Definition
transient ischemic attack = reversible
Term
how long do signs/symptoms of TIA last
Definition
minutes-hours
Term
what to do for patients who have had TIAs
Definition
urgent eval. Risk of stroke in 48 hrs is 5%
Term
what are risk factors for ischemic stroke
Definition
atrial fibrillation, carotid stenosis, hypertension, dyslipidemia, diabetes, smoking, obstructive sleep apnea
Term
what are causes of intracerebral hemorrhage
Definition
hypertension, bleeding problems, brain tumors
Term
why must cat scan be re-checked 24 hours after tpa?
Definition
tpa puts you at risk for hemorrhagic stroke
Term
how are intracerebral hemorrhages managed conservatively
Definition
stabilize airway, BP control, intracranial pressure management, seizure control, fever control, glucose management
Term
what are non-conservative ways to manage intracranial hemorrhages
Definition
Intracranial pressure monitoring, extraventricular drain for hydrocephaly, clot evacuation, hemicraniectomy to take off part of skull and allow brain, skull to swell
Term
what are signs/symptoms of subarachnoid hemorrhage
Definition
severe headache, neck stiffness and rigidity, nausea/vomiting, photophobia/phonophbia, (like a bad migraine)
Term
risk factors for hemorrhagic stroke
Definition
hypertension, diabetes, smoking, anticoagulation, use of statins
Term
what impairments are seen after R CVA
Definition
hemispatial neglect, visual perception, knowing where they are in space (issue with safety)
Term
what impairments are seen after L CVA
Definition
language impairments, difficulty motor planing and motor programming
Term
why is MCA most likely to have a stroke
Definition
it's more of a straight shot from carotid to MCA
Term
which artery supplies temporal lobe
Definition
PCA
Term
where is hippocampus
Definition
temporal lobe
Term
list impairments that could occur following MCA stroke
Definition
contralateral hemiplegia; contralateral loss of sensation; contralateral homonymous hemianopsia; paralysis of conjugate gaze to contralateral side; expressive aphasia; receptive aphasia; acalculia/anomia/finger agnosia/right-left confusion; loss of topographic memory; unilateral neglect
Term
list impairments that could occur following ACA stroke
Definition
contralateral hemiplegia with LE affected more than UE; contralteral loss of sensation in LE; gait apraxia; urinary incontinence; left limb dyspraxia bc of corpus callosum
Term
list impairments following PCA occlusion
Definition
contralateral homonymous hemianopsia with macular sparing; visual hallucinations; memory loss; thalamic syndrome; hemiballismus; choreoathetosis;
Term
what is hemiballismus
Definition
rapid jerking
Term
what is choreoathetosis
Definition
writhing motions
Term
what is weber's syndrome
Definition
ipsilateral loss of CN III, contralateral hemiplegia.
Term
by what point after a stroke is neurological recovery generally complete
Definition
3 months
Term
how long after a storke can you continue to have functional improvement
Definition
1 year
Term
describe outcome of patient with motor only vs motor and sensory impairments
Definition
having more impairments reduces lieklihood of good outcome
Term
what BI score indicates patient can live at home with some assistance
Definition
60
Term
what are negative prognostic indicators for stroke
Definition
prior history of stroke, abnormal muscle tone, initial motor deficit, loss of sitting balance, sensory deficits, visual spatial deficits, cognitive deficits, incontinence, depression/lack of support
Term
how does intensity of rehab relate to outcome
Definition
greater intensity leads to better outcomes
Term
what indicates that a storke patient will have useful arm function at 6 months
Definition
measureable grip strength at 24 days, shoulder shrug early on
Term
what are the stages in duncan's stroke recovery staging system
Definition
stage 1: very impaired; stage 2: semi-independent; stage 3: will need minimal assistance; stage 4: complete or almost complete recovery
Term
what are the general considerations of the carr and shepherd approach?
Definition
context-specificity of muscle action; maintenance of balanced alignment of body segments; cognitive effort and active participation by the patient; consistency of practice
Term
what are the 4 steps in assessment and treatment according to carr and shepherd?
Definition
analysis of the task, practice of missing components, practice of the task, transference of training
Term
what to look for in task analysis
Definition
what components are missing. What compensations are being used
Term
what are the essential components of being able to reach and grasp according to carr and shepherd?
Definition
ROM at all UE joints
Term
considerations for practice to improve UE function according to Carr & Shepherd
Definition
begin early working with patient in supine with arm elevated for reaching. Shift from concentric to eccentric in different parts of range and at various speeds. Have patient consciously try to eliminate unnecessary muscle activity. If patient is unable to achieve control, use orthoses and/or biofeedback. introduce tasks using both arms as soon as possible. avoid compensatory strategies and learnednon-use; manage shoulder dysfunction
Term
what are techniques for improving upper limb control in sidelying
Definition
trunk elongation, scapular mobilization, active scapular movement
Term
what are techniques for improving upper limb control in supine
Definition
active elbow extension including eccentric control; controlled mobility at the shoulder with elbow extended; combined shoulder stability with distal movement; cane exercises
Term
what are some techniques for improving UE control in sitting
Definition
weightbearing through elbow, weightbearing through hand , trunk rotation with arms across chest, roll ball, pick up ball, reach arm across table, pick up glass, hold stick and touch ends to table for supination, make an impression in putty with 3rd metacarpal (supination), grasp and release a glass, push away an object with thumb, progress to picking up styrofoam cup,
Term
what are some techniques for improving UE control in standing
Definition
leaning against wall to weightbear on bilateral Ues
Term
is the typical control after stroke proximal to distal or distal to proximal?
Definition
proximal to distal
Term
how to determine which task is best for a patient.
Definition
ask what they like to do, make it relative and functional
Term
why is it harder for someone to touch their head than their chest?
Definition
touching their head requires ER
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