CVA Basics
What does CVA stand for?
Cerebrovascular accident, commonly called a stroke
During PT, the patient suddenly develops new facial drooping and worsening left arm weakness. What is the immediate priority?
Stop the session and activate the appropriate emergency/medical response because this may represent a new or worsening neurologic event.
What basic PT measure would help quantify this patient’s left lower-extremity weakness?
Manual muscle testing or another appropriate strength assessment.
What is one basic intervention to improve this patient’s standing balance?
Examples include supported standing, weight shifting, reaching activities, altered base of support, or other progressively challenging balance tasks.
What is the main discharge goal for rehabilitation after stroke?
A safe transition to the least restrictive setting where the patient can function with the appropriate level of assistance, equipment, services, and caregiver support.
This patient has a right MCA stroke. Which side of the body would most likely demonstrate weakness?
The left side of the body.
What common stroke warning acronym can help identify acute stroke symptoms quickly?
BE FAST: Balance, Eyes, Face, Arm, Speech, Time.
What should the PT examine when the patient demonstrates impaired standing balance?
Static and dynamic balance, postural control, weight shifting, base of support, reactions to perturbation, and safety during functional tasks.
Which side should receive deliberate attention during treatment because of this patient’s neglect?
The left side.
Name two factors that influence whether this patient can be safely discharged home.
Examples include mobility level, fall risk, neglect severity, cognition/safety awareness, caregiver availability, home accessibility, ability to perform ADLs, and need for assistance or equipment.
What artery is represented by the abbreviation MCA?
The middle cerebral artery.
The patient suddenly reports a severe unusual headache with vomiting and rapidly worsening neurologic status. Why is this concerning?
It may indicate an acute neurologic emergency such as intracranial bleeding or another major change requiring immediate medical evaluation.
Name one functional test that could help assess mobility or fall risk if the patient can perform it safely.
Examples include the Timed Up and Go, Berg Balance Scale, Functional Gait Assessment, 5 Times Sit-to-Stand, or another appropriate validated mobility/balance measure.
Give one treatment strategy for left-sided neglect during functional mobility.
Use structured visual scanning and cueing toward the left, place meaningful targets on the left, encourage head/eye turning, and repeatedly integrate the left side into functional tasks.
Why is caregiver education especially important for a patient with left neglect?
The patient may not consistently recognize hazards or objects on the left, so caregivers need strategies for cueing, environmental setup, mobility assistance, and fall prevention.
Why can a right MCA stroke cause left-sided neglect even when the patient can still see?
Neglect is primarily an attention and spatial-awareness deficit. The brain fails to attend adequately to information on the left side, rather than the problem simply being loss of vision.
During gait training, the patient becomes acutely confused, demonstrates new slurred speech, and is weaker than she was five minutes earlier. Should PT continue the session?
No. Stop treatment, ensure safety, reassess quickly, and obtain immediate medical evaluation for an acute neurologic change.
The patient repeatedly misses objects located on her left during mobility. What should the PT specifically assess?
Left-sided attention/neglect during functional tasks, visual scanning, environmental awareness, safety, and the ability to locate stimuli on the neglected side.
Why might weight-shifting toward the left be included during standing activities?
It can promote use and awareness of the affected side, improve symmetrical loading and postural control, and help address learned avoidance or underuse of the left side when performed safely.
What home modifications or equipment might be considered before discharge?
Depending on examination findings: appropriate assistive device, grab bars, shower equipment, removal of trip hazards, improved lighting, safe furniture arrangement, and environmental strategies that account for left neglect.
Name three findings in this case that are consistent with a right MCA stroke.
Examples include left hemiparesis, left-sided neglect/decreased awareness, impaired coordination, impaired balance, and possible difficulty with spatial-perceptual processing.
Which is more concerning during rehabilitation: chronic left neglect that has been documented since admission, or a sudden major increase in neglect with new weakness? Explain.
The sudden major change is more concerning because an acute departure from neurologic baseline may indicate a new stroke, extension, hemorrhage, or another medical emergency.
Give a focused PT examination plan addressing all five major problems in this case.
Assess strength/motor control for hemiparesis, coordination, static and dynamic standing balance, functional mobility/gait, and left-sided attention/neglect; also assess sensation, transfers, activity tolerance, safety awareness, and appropriate outcome measures.
Design a short functional treatment sequence addressing hemiparesis, balance, coordination, and neglect in one session.
One appropriate sequence is sit-to-stand with symmetrical foot placement, controlled left weight shifting, reaching to left-sided targets, stepping or gait with left-side scanning cues, and task-specific coordination practice with graded assistance and safety monitoring.
The patient can transfer with assistance but still has significant left-sided neglect, poor standing balance, and limited caregiver support. What discharge setting is likely safer than immediate independent discharge home?
A setting that provides continued rehabilitation and appropriate assistance—such as inpatient rehabilitation when criteria are met, or another supervised post-acute rehabilitation setting based on medical status, therapy tolerance, insurance, available support, and interdisciplinary recommendations.