CVA Defined
What are the two types of CVA? Define both
Ischemic - clotting preventing blood flow
Hemorrhagic - Bleeding due to rupture or leak
Name cognitive functions of the frontal lobe
- judgment, attention, awareness, mood/aggression, abstract thought
Name the area surrounding the main core of cell damage in the brain following a CVA & describe this area
Penumbra
- tissue is viable, but metabolically lethargic
- cell damage causes the release of destructive chemicals and enzymes
If a patient has a left hemi, what side of the body are symptoms found?
The left side
in non-fluent aphasia, __ is not impaired while __ is impaired
Comprehension ; Production
CVA is the ___ leading cause of death and the 4th leading cause of long-term disability (True or false)
Fifth ; False, it is THE leading cause of long-term disability
Where is the primary motor cortex located? Differentiate the difference between the primary motor cortex & premotor cortex
Primary motor cortex located in the frontal lobe
- The primary motor cortex carries out the actual movement while the premotor anticipates movement & creates a course of action
What determines residual deficits following a CVA?
Location
Size
Function (of the structures involved)
Collateral blood flow
Time
Name some of the few sensory issues that may arise from CVA
- proprioceptive/kinesthetic losses
- Loss of sensations
- Astereognosis (tactile agnosia)
- Graphesthesia loss (inability to recognize letters or numbers drawn on your body)
- Central post stroke pain
Dysarthria (Aphagia) is
speech production is impaired due to facial muscle weakness
What is atherosclerosis? (think ischemic) name a few common sites
Formations of plaque & other bodily contents leading to the narrowing of blood vessels
- carotid artery, junction of cerebral arteries, main bifurcation of cerebral artery
Where is the primary somatosensory cortex located? Name some functions of the lobe in which it is found
Parietal lobe
- sensory cortex
- short term memory
- recognition of words
- math
What are the management categories of stroke? Describe
TIA/Minor stroke - a temporary interruption that can last a few minutes to several hours
Major stroke - Stable, usually severe impairments
Deteriorating stroke - Neurological status progressively deteriorates following the stroke
Young stroke - Stoke in patients < 45 years old
Flaccidity is a __ syndrome whereas spasticity is a __ syndrome
Lower motor neuron ; Upper motor neuron
Difficulty seeing specific body parts or the whole body in relation to the environment; usually present in right CVA
What is TPA medication & how do we administer it to patients? What would happen if we gave TPA to a hemorrhagic patient?
TPA is a clot-dissolving enzyme that is used to break clotting for Ischemic patients
TPA would worsen the bleeding in hemorrhagic patients
Generalize the left hemisphere & name a few common impairments
Verbal/analytical half of the brain
- Apraxia (troubles planning movement)
- compulsiveness
- Aphasia (speaking impairments/comprehension
- perseveration, distractedness, hemiplegia/paresis in right side of body
What is the difference between a Left CVA vs. a left Hemi?
Left CVA refers to the left side of the brain being affected
Left Hemi refers to the left side of the body showing symptoms
Synergy patterns
- see more flexion in the arms, more extension in the legs
Generalize the difference in cognitive/emotional changes in those with deficits in the right hemisphere vs. the left
Right hemisphere patients typically demonstrate difficulty grasping organization, tendency to overestimate abilities, tendency to be quick/impulsive, and are unable to tend to tasks in crowded environments
Left hemisphere patients are typically more depressed due to their awareness of their deficits
What are the warning signs of a CVA? What actions would we take if we believe a patient is suffering from a CVA? (FAST)
- sudden numbness, confusion, vision troubles, trouble walking, headaches
- Face drooping (ask pt to smile)
- Arms weakness (ask pt to raise arms
- Speech difficulty (ask pt a simple question)
- Time to call 911 (check time of first s/s)
What brain region has the primary function of regulation of movement, postural control, & muscle tone?
The cerebellum
Name the 6 stages of Brunnstrom's motor recovery
Stage 1 - flaccidity
Stage 2 - Basic limb synergies; minimal voluntary movement responses
Stage 3 - Increased spasticity
Stage 4 - Decreased spasticity
Stage 5 - Spasticity disappears & coordination reappears
Stage 6 - Normal functioning returns
Lesions in the left hemisphere typically result in ___ impairments while lesions in the right hemisphere typically result in ___ impairments
Speech & language ; Motor
What are some pros & cons of patients wearing slings?
Pros: Prevents soft tissue stretching, relieves pressure, supports weight of the arm, protects the patient, and frees up the therapist during functional activities
Cons: Does little to prevent subluxation, does little to improve shoulder function, can lead to contractures, can contribute to body scheme/neglect, may prevent balance regaining in upper extremities