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585-1
Stroke
| Term | Definition |
|---|---|
| 1. R CVA results in 2. L CVA results in | 1. left hemiplegia 2. right hemiplegia |
| ischemic stroke | 80% Includes ischemic necrosis and infarction May be due to hypo-perfusion Blockage of blood vessels in the brain |
| ischemic stroke physiology | Atherosclerosis- in branches of vessels Thrombosis Embolism Cardiac- afib, arrythmia |
| occurrence of ischemic stroke | Progressive symptoms Onset hours or days, often at sleep or rest Mild arm numbness/ morning paralysis Transient ischemic attacks present before |
| 5 warning signs of stroke | Vision issues Weakness Trouble speaking Headaches Dizzy |
| acute ischemic stroke management | Stroke ambulance to rural areas Determine nature & size Administer TPA- breaks clot up, best within 1h, up to 6h post onset Surgery to remove clots Anticoagulation |
| prognosis of ischemic stroke | Depends on extent/ location, with/ without coma In general will plateau after 5 or 6 mo up to 10y Good recovery rate for first few months |
| middle cerebral artery (MCA) | Supplied by internal carotid, supplies lateral aspect of brain Frontal, parietal, temporal, occipital Most common stroke site Motor, sensory, cognition Possible homonymous hemianopsia |
| homonymous hemianopsia | Visual field loss in same halves of both eyes |
| homunculus injury area 1. MCA sensory & motor 2. ACA sensory & motor | 1. Arm, hand, face, tongue 2. Trunk, leg, foot, genital |
| MCA functional deficits | Contralateral hemisensory loss Hemiplegia Visual field Apraxia, perseveration Poor judgement Apathy L CVA: Broca's or Wernicke's aphasia |
| Broca's vs. Wernicke's aphasia | Limited expression vs. Limited reception/ comprehension |
| lacunar stroke | Penetrating arteries have a blockage Only motor or sensory deficits Affects face, arm, leg |
| lenticulostriate arteries stroke | Pure motor stroke Clumsy hand syndrome Ataxic hemiparesis (2nd most frequent type of lacunar stroke) |
| lateral thalamus/ parietal white matter stroke | Pure sensory stroke Somatosensory loss to all primary modalities in face, arm, body If affects basal ganglia, then parkinson like symptoms may occur |
| anterior cerebral artery (ACA) | Supplies medial aspect of brain Frontal and parietal areas Motor & sensory, legs, bowel, bladder, shoulder Behavioral disturbance- behavioral inhibition |
| ACA functional deficits | Behavioral disturbance Apraxia Contralateral hemisensory loss Hemiparesis in foot Stopping of speech if left CVA |
| anastomoses | Connection of distal ends among cerebral arteries Connection of ACA and MCA If you have blockage of MCA, ACA can supply |
| maximal ischemia | AKA carotid border-zone syndrome Thinnest areas, most prone to blockage Corresponds to shoulder problem/ upper arm Boarder zone btwn MCA & ACA Motor recovery should be used |
| posterior cerebral artery | Supplied by vertebral artery then basilar artery Temporal & occipital |
| PCA deficits | Alexia- reading issues Anomia- word retrieval issue Visual agnosia Propagnosia Memory impairment Homonymous hemianopsia |
| wallenberg's syndrome | Brainstem stroke Vertebral/ cerebellar artery Pain, temp loss, dry cold face on affected, ataxia, facial sensory loss No significant weakness |
| vertebrobasilar stroke | Vertebral & basilar artery Posterior portions of brain affected |
| vertebrobasilar stroke occlusion leads to | Visual disturbance Ataxia Clumsy Diff judging distance Memory loss Paralysis, local numb Impaired temp sensation Dizzy Diff swallowing |
| 1. subarachnoid hemorrhage 2. subdural hematoma 3. epidural hematomas | 1. cerebral arteries start bleeding, most popular 2. tearing of bridging veins btwn dura matter & arachnoid matter, due to trauma 3. torn meningeal artery, btwn dura matter & cranium, due to trauma |
| causes of bleeding | Rupture Congenital factors Infection Tumor |
| arteriovenous malformations | In any part of brain, brainstem, spinal cord Vessels grow into capillary bed, may burst as it becomes larger Age ~30 Present with seizure & headache Treated by surgery |
| ruptured intracranial aneurysms | Small ballooning or dilations of vessel wall Ruptures in wall of artery Due to weak wall, high BP Often where there is branching No signs/ symptoms During waking hours Sudden severe headache Often age 40-65 |
| hemorrhagic stroke mechanisms | Once bleeding is controlled, clots occur then break down and removed If pressure is low, brain tissues will heal If severe bleed, may increase fatality More common in younger people Not predictable in terms of recovery |
| prognosis of hemorrhagic stroke | Varied No coma + no LOC + no ventricle bleeding means good prognosis 1st episode of ICH- ~20% fatality Rebleeding increases fatality up to ~60% |
| rehab | Capitalize on neurogenesis and synaptogenesis 3mo- years Motor learning Early mobilization once condition is stable Intensity & stages vary |
| acute phase rehab | Early mobilization Ensure scapula glides freely Lower risk of other complications with transfers, appropriate bed & seating, skin management Maintain tissue length Return to ADLs Education Fall prevention |
| rehabilitation phase | Postural control with maintain balance Encourage bilateral UE to help with balance Graded reaching activities Motor learning & cognitive rehab Use tech Driving & sexuality have specific programs |
| approaches 1. bottom up 2. process specific 3. top down 4. task specific | 1. train component skills 2. assumes transfer of training will occur 3. emphasize intact skill training 4. client driven, repetitive task practice |
| environmental setup | Tasks relevant to client needs as starting point Underlying deficits challenged via task Assistive devices for compensation |
| assessments | COPM- goals ADL- FIM, barthel index Physical- MMT, AROM, PROM, gino, sensation, proprioception, dynamometer Cranial- not by OT Cognition Visual-perceptual Performance based observational ax |
| chedoke- mcmaster stroke ax | Physical ax For people from 1wk to several yrs post stroke 7 stages of motor recovery to guide ax & tx |
| chedoke 2 components | Impairment inventory- presence & severity of common physical impairments following CVA Disability inventory- measures functional outcome, gross motor function & walking |
Created by:
craftycats_
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