Phys. Dis. - CVA (stroke)

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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


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