Term
| CVA = "The ______ onset of neurological dysfxn resulting from an ___________ of _______ blood flow that lasts for ________ ." |
|
Definition
acute,
abnormality,
cerebral |
|
|
Term
|
Definition
|
|
Term
Ischemic CVA usually 2º to:
(3) |
|
Definition
thrombus,
embolus,
conditions >> low perfusion pressures (e.g. MI) |
|
|
Term
CVA:
___(#)___ leading cause of death of adults in US
___(#)___ leading cause of disability of adults in US |
|
Definition
|
|
Term
| Which gender experiences more CVAs? |
|
Definition
|
|
Term
| Which race more common for CVA? |
|
Definition
|
|
Term
| % of CVAs that are ischemic |
|
Definition
|
|
Term
| Types of hemorrhagic strokes (2) |
|
Definition
intracerebral (10%),
subarachnoid (3%) |
|
|
Term
| Factors that lead to hemorrhagic stroke (3) |
|
Definition
Atherosclerotic plaques
Developmental abnormalities (Berry aneurysms, AVMs) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Fluid backup >> blood pooling |
|
|
Term
| How does valvular disease >> CVA? |
|
Definition
| turbulent blood flow >> thrombus |
|
|
Term
| How do arrhythmias >> CVA? |
|
Definition
| blood pooling >> thrombus |
|
|
Term
| How does cardiac surgery >> CVA? |
|
Definition
| embolus 2º to jostling sclerotic aa |
|
|
Term
| Risk factors for CVA: modifiable (6) |
|
Definition
HTN,
CVD,
diabetes,
TIAs,
hyperlipedemia,
smoking |
|
|
Term
| Risk factors for CVA: nonmodifiable (5) |
|
Definition
race,
age,
gender,
heredity,
previous CVA |
|
|
Term
|
Definition
sudden severe HA,
sudden hemilateral weakness/numbness,
sudden loss of vision,
unexplained diziness |
|
|
Term
| Explain "cascade" of chemical activity leading to damage of cells following CVA |
|
Definition
cells lacking O2 release glutamate >>
glutamate binds to NMDA receptors >>
Ca influx into neurons >>
activation of Ca-dependent enzymes >> infarction &
more glutamate released |
|
|
Term
| Most frequent cause of death in acute CVA: |
|
Definition
|
|
Term
| Caudal shift of brain tissue 2º edema: |
|
Definition
|
|
Term
| Lateral shift of brain tissue 2º edema: |
|
Definition
|
|
Term
| Factors determining symptoms of CVA (3) |
|
Definition
location of damage,
size of infarct,
presence of collateral circulation |
|
|
Term
| Test to differentiate hemorrhagic v. ischemic CVA: |
|
Definition
|
|
Term
|
Definition
ID non-vascular lesion,
distinguish ischemic/hemorrhagic stroke |
|
|
Term
|
Definition
anemia (endocarditis, vasculitis),
thrombocytopenia,
thrombocytosis |
|
|
Term
|
Definition
|
|
Term
| Serum glucose used to test for: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Chest XR used to test for: |
|
Definition
|
|
Term
| Meds categories for ischemic CVA (3) |
|
Definition
anticoagulants,
thrombolytic,
neuroprotective agents |
|
|
Term
| Examples of anticoagulants (4) |
|
Definition
Heparin,
aspirin (antiplatelet),
Ticlid (decr platelet aggregation),
Plavix (antiplatelet) |
|
|
Term
| Time limit for tPA to be effective |
|
Definition
|
|
Term
| Examples of neuroprotective agent meds (1) |
|
Definition
| NMDA receptor antagonists |
|
|
Term
| Meds categories for hemorrhagic CVA (1) |
|
Definition
| Ca channel blockers (Nimodipine); vasodilator |
|
|
Term
|
Definition
CT,
MRI,
SPECT/PET,
cerebral angiography |
|
|
Term
|
Definition
non-CVA causes,
edema,
infarction,
hemorrhage |
|
|
Term
|
Definition
structural detail,
infarct <6hr old |
|
|
Term
| SPECT/PET useful for imaging: |
|
Definition
| representation of metabolism |
|
|
Term
| Cerebral angiography useful for imaging: |
|
Definition
|
|
Term
CVA Direct Impairments: sensory deficits
local loss = ____ damage
widespread loss = _____ injury |
|
Definition
|
|
Term
| Homonymous hemianopsia 2º to destruction in which aa.? |
|
Definition
MCA (optic radiation),
PCA (1º visual cortex) |
|
|
Term
| Signe Brunnstrom's typical sequence of recovery in hemiplegia (6): |
|
Definition
1: flaccid period
2: basic limb synergies; spasticity develops
3: gain voluntary control of synergies; spasticity increases
4: mvmt combos beyond synergies; spasticity declines
5: synergies decline
6: spasticity disappears |
|
|
Term
| Spasticity experienced primarily in _______ mm |
|
Definition
|
|
Term
| Muscles not normally in UE abnormal synergy (5) |
|
Definition
lats,
teres M,
serratus ant,
finger ext,
ankle inv/DF |
|
|
Term
|
Definition
| elevating UE c ext elbow >> ext of fingers |
|
|
Term
|
Definition
| resisted abd/add of an LE or UE >> same movement in other |
|
|
Term
| Changes in mm motor units 2º to CVA: (2) |
|
Definition
decr in # of motor units,
abnormal recruitment of motor units |
|
|
Term
| Impairments that affect balance, gait, UE fxnl tasks (5): |
|
Definition
inefficient mm activation,
inability to maintain contraction,
incr effort required to produce contraction,
incr rxn time,
incr mvmt time |
|
|
Term
| T/F: Unaffected extremities experience decr force |
|
Definition
| T (~25% decr force in "unaffected" extremities) |
|
|
Term
| Hemispheres' roles in motor programming (L v. R) |
|
Definition
L: involved in sequencing mvmt
R: involved in sustaining mvmt ("motor impersistence") |
|
|
Term
|
Definition
|
|
Term
| Speech/language disorders occur with lesions to ______ hemisphere |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Visual-perceptual dysfxn usually seen in ____ hemisphere lesions |
|
Definition
|
|
Term
| Types of visual-perceptual disorders (2): |
|
Definition
body scheme disorder,
body image disorder |
|
|
Term
| Body scheme/image disorders |
|
Definition
unilat neglect,
anosagnosia,
pusher syndrome |
|
|
Term
| Affective disorder: R hemispheric lesion >> ?? |
|
Definition
|
|
Term
| Affective disorder: Depression caused by lesion in ?? |
|
Definition
|
|
Term
| Behavioral changes 2º to L hemisphere damage (4): |
|
Definition
communication problems,
difficulty processing info sequentially.
cautious, anxious, disorganized;
hesitant to try new things |
|
|
Term
| Behavioral changes 2º to R hemisphere damage (4): |
|
Definition
probs c spatial-perceptual tasks, neglect,
difficulty understanding whole idea of task.
quick, impulsive, overestimate abilities;
need to get them to slow down |
|
|
Term
|
Definition
| rapid onset unilat leg swelling c dependent edema |
|
|
Term
| Prevention of skin breakdown (4): |
|
Definition
positioning,
turning schedule,
avoid shearing,
keep skin dry |
|
|
Term
| Posture is all about _____ |
|
Definition
|
|
Term
| Postural control is (4 descriptors): |
|
Definition
automatic & subcortical,
dynamic,
graded,
related to size of BOS |
|
|
Term
|
Definition
REDUCE for low-level pts,
INCREASE BOS for fearful/high tone pts |
|
|
Term
| Task progression: gravity |
|
Definition
| with gravity >> against gravity |
|
|
Term
| Task progression: -metrics |
|
Definition
|
|
Term
|
Definition
small range >> big
mid range >> extremes |
|
|
Term
|
Definition
1. trunk control
2. midline orientation
3. head control on trunk
4. limb function on trunk (closed chain >> modified closed >> open chain) |
|
|
Term
| Motor Learning Principles used in pt management/treatment (6) |
|
Definition
1. management v. treatment
2. work within FUNCTIONAL context
3. encourage problem solving
4. part >> whole
5. practice
6. feedback (summary; ea 5-10 trials) |
|
|
Term
| Suggested sequencing of treatment (5) |
|
Definition
establish building blocks of task
WB >> NWB
iso >> ecc >> conc
small arc within midrange >> larger ranges
slow >> fast |
|
|
Term
| _____________ >> start of UE dysfxn/pain |
|
Definition
|
|
Term
| Causes of posterior pelvic tilt in sitting posture (4) |
|
Definition
weak trunk ext,
weak abd,
decr lumbar/thoracic ROM,
short hamstrings |
|
|
Term
| Levels of muscular control at shoulder (3) |
|
Definition
1. scapular stabilizers
2. prime movers
3. R/C |
|
|
Term
| Normal scapular alignment (spine, inferior angle, med border/inf angle abd) |
|
Definition
spine @ T2-3
inf @ T7
medial border 3-4 fingerbreadths from spine
inf angle 4-5 fingerbreadths from spine |
|
|
Term
| Causes for scapular malalignment (4) |
|
Definition
weakness of scapular stabilizers,
muscular imbalance of scap stab,
trunk malalignment,
weight of flaccid arm |
|
|
Term
| Sequelae of inf rotation malalignment (5) |
|
Definition
inf sublux
abnormal scapulohumeral rhythm
impingement/pain
shoulder-hand syndrome (CRPS)
decr UE fxn |
|
|
Term
|
Definition
inferior,
anterior,
superior |
|
|
Term
| Inferior subluxation s/sx (3) |
|
Definition
most common subluxation
occurs in flaccid stage
not painful (initially) |
|
|
Term
| Subluxation reduction (4) |
|
Definition
correct trunk alignment
correct scapular position
move humerus (lift, depress, etc.)
rotate humerus (ER, IR) |
|
|
Term
| Anterior subluxation s/sx (4) |
|
Definition
occurs in hypertonic stage
painful
2º to overactivity of upper traps & levator scap
humerus in hyperext/IR |
|
|
Term
| Superior subluxation s/sx (3) |
|
Definition
occurs in hypertonic stage
painful
voluntary mvmt limited to abd & IR |
|
|
Term
| Pusher syndrome: higher occurrence with damage to ___ hemisphere |
|
Definition
|
|
Term
| Pusher pts c R-sided lesions show both pushing and _____ |
|
Definition
|
|
Term
| Pusher pts c L-sided lesions show both pushing and _____ |
|
Definition
|
|
Term
| Area of damage in pushers: |
|
Definition
| posterolateral thalamus (involved in perception of upright body posture) |
|
|
Term
| Perception of vertical in stool tilting experiment (Karnath) |
|
Definition
| 18º toward side of lesion |
|
|
Term
| Pusher syndrome theories (2): |
|
Definition
1. trying to compensate for mismatch between visual/perceived vertical
2. response to unexpected loss of balance when moving upright |
|
|
Term
| Typical components required to diagnose pusher syndrome (3) |
|
Definition
spontaneous body posture
abd/ext of nonparetic extremities
resistance to passive correction of tilted posture |
|
|
Term
| Pusher syndrome prognosis (2) |
|
Definition
pushing usually gone within 6 mos.
pts achieve same level of rehab, but 3.6 weeks (63%) longer to do so |
|
|
Term
| Transfers with pushers (2) |
|
Definition
start c low-pivot transfers
transfer to less involved side |
|
|
Term
| Sequential order of pusher intervention (Karnath) (4) |
|
Definition
1. realize disturbed perception of upright
2. visually explore surroundings and body's relation to them
3. learn mvmts necessary to reach vertical
4. maintain vertical while performing other activities |
|
|
