Phys. Dis. - CVA (stroke)
total shoulder dislocation
flaccidity puts pts at risk for
Shoulder subluxation
flaccidity runs a risk of ________________________ due to hypotonicity
spastic, flaccid
it's better to be ___________________ than ___________________ because the chances of getting muscle tone back are a lot slimmer than if you have something to work with.
unilateral neglect
left side neglect
Right side paralysis
lesion on the left side of the brain will cause
Flaccidity
loss of muscle tone, limp
Flaccidity
lower motor neuron (LMN) presents itself with __________________ of muscle tone
Effects of stroke
mainly depends on the portion of the brain affected by the stroke
loss of trunk control, decreased
make sure pt is properly supported during intervention as ___________________________ and _______________________ sitting balance is commonl
Effects of stroke
memory loss, changes in behavior, vision problems, complete or partial paralysis of the legs, arm, and face of usually one side of the body
side lying
most optimal position for pt with limited mobility
Shoulder Abduction
movement of arm away from body
Spasticity
muscle ________________ makes someone a contracture risk
lower motor neuron lesion
muscle presents itself with flaccidity of muscle tone
passive range of motion
must take care of pt during _________________ and always make sure the pt has enough proximal support during range
skin integrity
our goal is to always protect
hemiplegia
paralysis of one side of the body
Proper positioning
paramount to prevention of secondary issues
Non-verbal communication
pay close to attention to pts face and ____________________________________ during all PROM/stretching session
Spasticity
typical posturing includes UE flexion and LE extension of the affected side
Spasticity
upper motor neuron (UMN) will present with _______________ of muscle tone
kineseotaping
used to inhibit movement (lessen the chance of movement) or to facilitate movement
Effects of stroke
very different depending on location and severity of the attack.
good spline and consistent PROM
what can help someone prevent contractures?
size and location of the lesion
what does the severity of dysfunction depend upon?
fisted
when a hand is _______________ for a long period of time, moister builds up in the hand and it becomes a breeding ground for bacteria and infection
Golgi tendon reflex
when you feel ______________________ kicking in, you lay off your tension and pace the stretch once "spasm" has ceased
float
while lying in bed, it necessary to _____________ the heels to alleviate pressure and contact with the mattres
Diagnose a stroke
Other ways to _________________________ is by the use of MRI's or a CT scan of the brain, and a carotid ultrasound that shows blockages or fatty buildups in the neck.
Diagnosis of CVA
Physical exam where your doctor may ask you or your family about the symptoms you have been experiencing.
The lesion
The severity of the stroke depends on the side of
1. ischemic 2. hemorrhagic
The syndromes that lead to stroke are placed into two categories
hemorrhagic stroke
accounts for only 13% of the total number of strokes
moist heat (MH)
_________________________ applied prior to PROM/stretching techniques will assist in alleviating some pain and increasing extensibility of muscle
muscle contraction
_____________________________ stretches golgi tendon organ
Pt and Caregiver Education
_______________________________________ is extremely important as the effected UE can severely dislocate if the pt is "careless" or if the caregivers t/f or grab the pt inappropriately
CVA (stroke)
a disease of the cerebral vasculature
CVA (stroke)
a dysfunction caused by a lesion (injury) in the brain.
CVA (stroke)
a leading cause of serious, long-term disability in the United States.
left side paralysis
a lesion on the right hemisphere will cause
55
For people older than ___________, the incidence of stroke more than doubles with each successive decade.
Subarachnoid and Intracerebral hemorrhages
Hemorrhagic strokes include
Shoulder subluxation
Incomplete dislocation of humerus out of glenohumeral joint caused by weakness, stretch, or abnormal tone in the scapulohumeral and/or scapular muscles.
ischemic stroke
Sometimes may be caused by a blood clot
610,000
Approximately ______________ strokes are first attacks
65
Of people who suffer a stroke, 28% are younger than _____________.
completed stroke
Of those that experience TIA's and do not seek treatment 1/3rd will experience a
Left CVA
_______________ pts are depressed because they understand the severity of what has happened to them
ischemic
_______________ strokes account for the majority of strokes.
Right CVA
________________ stroke patients that have a decreased insight into current physical limitations
Cerebral anoxia and aneurysm
_________________ and _________________ can also result in hemiplegia.
women, men
_________________ have a higher lifetime risk of stroke than ______________.
SROM
_________________ is an important part of stroke recovery and should be incorporated as early as possible
Golgi tendon
____________________ reflex is present and may become exited during PROM
Shoulder subluxation
- partial dislocation of the shoulder secondary to flaccidity
Cardiac sources
1 Atrial fibrillation 2. Sinoatrial disorders 3. Acute myocardial infarction o Endocarditis 4. Cardiac tumors 5. Valvular disorders.
Four types of hemorrhagic stroke
1. Deep hypertensive intracerebral hemorrhages 2. Ruptured saccular aneurysms 3. Bleeding from arteriovenous malformations 4. Spontaneous lobar hemorrhages.
Treatments for ischemic stroke
1. Emergency Endovascular procedures. 2. Medications delivered directly to the brain. 3. Removing the clot with a stent retriever. 4. Carotid endarterectomy 5. Angioplasty 6. Stents
Treatments for hemorrhagic stroke
1. If you are taking warfarin or anti-platelet drugs (plavix) to prevent blood clots they may have to do blood transfusions or medications to counteract the blood thinners. 2. There may also be a need for surgical blood vessel repair. 3. Surgical clipping
Results from right cva
1. Paralyzed Left side hemiplegia 2. Spatial - Perceptual deficits 3. Tends to minimize problems 4. Short Attention span 5. Visual field deficits 6. Impaired Judgement 7. Impulsive Impaired time concept
Results from left cva
1. Paralyzed right side hemiplegia 2. Impaired speech and language 3. Slow performance 4. Visual field deficits 5. Aware of Deficits 6. Impaired Comprehension
signs and symptoms of stroke
1. Sudden numbness or weakness in arm, face, or leg especially on one side of the body. 2. Sudden confusion, trouble speaking, or difficulty understanding speech. 3. Sudden trouble seeing in one or both eyes. 4. Sudden trouble walking, dizziness, loss of balance, or lack of coordination. 5. Sudden severe headache with no known cause.
blood test results
1. Whether your blood sugar is abnormally high or low 2. Whether blood chemicals are out of balance 3. Whether you have an infection.
neurodevelopmental treatment (NDT)
1. aims to facilitate as much "normal" movement as possible - IMPORTANT 2. form is key with de-emphasis on compensatory movement techniques 3. weight bearing to affect extremity 4. techniques during movement to facilitate appropriate muscular response (ex: tapping) 5. crossing midline
two types of communication disorders
1. broca's aphasia 2. werinicke's aphasia
secondary issues of positioning
1. decubitus ulcers 2. maceration of the hand 3. various orthopedic issues 4. circulatory issues such as edema
PNF (proprioceptive neuromuscular facilitation)
1. functional diagonal patterns are emphasized 2. sensory input is used to elicit moto response (tactile cues, visual, verbal cues) 3. reflexes embraced and gross movement patters can come before isolation can occur 4. traction, approximation and maximal resistance techniques 5. not as strict as neurodevelopmental treatment
types of visual field deficits
1. homonymous hemianopia 2. unilateral neglect
common resulting deficits of CVA
1. motor deficits 2. communication deficits 3. visual field/perception positioning 4. assistance with proper positioning
tx techniques for motor retraining
1. neurodevelopmental treatment (NDT 2. proprioceptive neuromuscular facilitation (PNF)
contracture
1. no movement in joint capsule 2. pt is incapable of moving themselves 3. over time the soft tissues begin to grow together so that it is no longer possible to straighten elbow, wrist, etc.
techniques employed
1. remedial techniques (helping pt regain function) 2. compensatory techniques (teching pt different way to regain function) 3. pt/caregiver education
Order of treatment
1. scapula (elevation and rotation) 2. shoulder (flexion, abduction, external rotation) 3. elbow (extension and flexion) 4. wrist (extension and flexion, ulnar and radial deviation) 5. hand/fingers (extension and flexion)
Other dysfunctions of a stroke
1. sensory disturbances, 2. cognitive and perceptual disturbances, 3. visual disturbances, 4. personality and intellectual changes, and 5. a complex range of speech and related language disorders
muscle tones
1. spasticity 2. flaccidity 3. mixes
ways to speak to someone with aphasia
1. speak at a slow, normal pace - say one thing at a time 2. don't shout or talk down 3. talk at a quiet place 4. it helps if i can answer yes or no or i don't understand ask, wait, listen
Motor Neuron Lesions
1. upper motor neuron lesion 2. lower more neuron lesion
equipment used to prevent sores
1. wedge cushion 2. roho wheelchair cushion
20
An estimated 6.6 million Americans over age ________ have had a stroke.
inhibition
A synaptic message that prevents a recipient neuron from firing.
weak
ALWAYS stay at the pts ______________ side
Diagnosis of CVA
Blood tests may also be conducted to see how fast the blood clots
795,000
Each year ______________ people suffer a new or recurrent stroke.
embolism in brain
Ischemic strokes may be the result of _______________________ from cardiac and arterial sources
cardiac or arterial sources
Ischemic strokes may be the result of embolism to the brain from
global aphasia
Loss of all language skills.
Transient Ischemic Attack (TIA)
Most _________ occur in people with atherosclerotic disease.
Transient Ischemic Attack (TIA)
Vascular disease can result in a completed stroke or in
Non-modifiable risk factors
Which type of risk factors of the ischemic stroke are the following? - Age - Gender - Race - Ethnicity - Heredity
Modifiable risk factors
Which type of risk factors of the ischemic stroke are the following? - High blood pressure!!!!!! - Management of cardiac diseases - Management of glucose and glucose metabolism - Stop smoking - Moderate use of alcohol - Use of illegal drugs particularly cocaine - Lifestyle factors like diet and exercise are also modifiable factors
cardiac
Which type of sources are the following? - Atrial fibrillation - Sinoatrial disorders - Acute myocardial infarction - Endocarditis - Cardiac tumors - Valvular disorders.
Left CVA
____________ stroke is more difficult to work with
30%
______________ of CVA survivors have an impaired ability to communicate
185,000
_______________ are recurrent strokes.
lower extremity
_______________ pt has problem with bending at the hip and bending at the knee
flaccidity and weakness
add-ons for wheelchair help with
homonymous hemianopsia
affects 30-15% of survivors
Proper positioning
assisting and maintaining correct anatomical alignment during sitting and lying may include educating caregivers/staff
types of lower motor neuron lesions
at nerve root and of peripheral nerve
Facilitation
attempt to stimulate to achieve a desired motor response
inhibition
attempt to suppress an undesirable motor response
Impaired sensation
be really careful with the use of moist heat (MH) and other modalities as CVA pt's have _________________________
tissue plasminogen activator (tPA)
can be administered up to 4.5 hours after stroke symptoms begin but sooner the better.
Impaired sensation
cannot feel how hot a hot pack is on skin
cerebral ischemia
caused by perfusion failure
sacral wound
caused from laying on back too long
homonymous hemianopsia
causes damage along the neural pathway to the optic nerve/optic tracts
Types of Upper Motor Neuron Lesions
cerebral infarction and corticospinal tract
1. carotid and basilar arteries 2. microstenosis of the small deep arteries
cerebral ischemia occurs with severe stenosis of the
Transient Ischemic Attack (TIA)
characterized by mild, isolated, or repetitive neurological symptoms that develop suddenly last for a few minutes to several hours but not longer than 24 hours, and clear completely.
aphasia
communication disorder caused by brain damage by impairment of language modalities
Golgi tendon reflex
do NOT work against this reflex!!
Treatment for ischemic stroke
doctors must quickly restore blood flow to the brain.
tissue plasminogen activator (tPA)
drugs that are used to dissolve blood clots
sensory input
even if pt is not independently moving their hand, us moving it sends ______________________ to their brain
ischemic damage
failure to supply oxygen to the brain cells, which are most susceptible to _______________________, leads to their death.
atrophy
fancy word for "wasting" - muscle wasting
Spasticity
high contracture risk and associates with increased pain for the pt
PNF (proprioceptive neuromuscular facilitation)
humans do not operate in a linear pattern
Golgi tendon reflex
if excessive load is placed on muscle, _______________________ is activated causing relaxation, thus protecting muscle
visualize
if pt can ___________________ that their arm is moving, it will send more information to pt's brain
homonymous hemianopsia
if you have a right cva, the left side of both eyes is damaged
Hypertonic
if you have an upper motor neuron lesion, your muscle would more likely be
subluxation
if your left UE is flaccid, what are you at risk for?
temporal lobe
impaired communication is caused by damage to or near the ____________________________ of your brain
motor function
impaired/loss of _____________________ is often the result of a stroke
strong
increase _____________ side as much as possible because they will have to relay on this side to assist them
vasodilation
increases blood flow and increases the extensibility of muscle tissue making it easier to stretch
temporal lobe
involved in primary auditory perception, such as hearing, and holds the primary auditory cortex.
Dysarthria
trouble with producing speech due to muscles weakened
Wernicke's aphasia
people are able to articulate appropriate language but cannot understand anything that is said to them
Broca's aphasia
people cannot express speech properly
flaccidity
people who exhibit __________________ are proximally unstable due to loss of muscle tone (atrophy)
unilateral neglect
perception order where pt fails to respond to stimuli offered in the contralateral space (affected side is forgotten)
Spasticity
pt issues with dorsiflexion
decreased insight
pts think they can do same things before stroke
primary auditory cortex
receives sensory information from the ears and processes the information into meaningful units such as speech and words
ischemia
refers to insufficient blood flow to meet metabolic demand.
CVA (stroke)
results in hemiplegia (or paralysis of one side of the body) including the limbs, trunk, and sometimes the face and oral structures of hemisphere that are contralateral to the hemisphere of the brain affected by the lesion.
Transient Ischemic Attack (TIA)
seen as a sign of an impending stroke
upper motor neurons
sends messages from brain to lower motor
lower motor neurons
sends messages from spinal cord to actual muscle
Golgi tendon reflex
sensory type organ deep within tendon that monitors tension as a way to protect muscle tissues from being overstretched and injured
Facilitation
subthreshold stimulation of a neuron that increases responsiveness to further stimulation
Flaccidity
synonym for hypotonicity
Hypertonicity
synonym for spaticity
sensory input
the more ____________________ the more it's going to be
size and location
the severity of stroke depends on ______________________________ of lesion
1. facilitation 2. inhibition
therapeutic techniques for movement
motor output
though the pt is not moving their own hand, our assistance is trying to give the brain sensory input so it can produce _________________________
proximally to distally
through evidence based research, most movement is gained