Gen Med - CVA

What is a CVA

A sudden focal neurological deficit resulting from ischemic or hemorrhagic lesions to the cerebral hemispheres or brainstems

The primary cause of a stroke is

One of several pathologic processes involving the blood vessels of the brain

The most common type of stroke is

Cerebral infarction

Types of cerebral infarctions include

- Thrombus

- Embolus

What are the types of hemorrhages

- Subarachnoid

- Subdural

- Intracerebral

How does cholesterol affect arterial blood flow

Higher cholesterol leaves lipid deposits in arteries which can impede blood flow

An infarction/ischemic stroke is a result of

A blood clot

A hemorrhage is a results of

A bleed

Risk factors of a stroke include

- Age, sex, race

- Atherosclerosis

- HTN

- Heart disease

- Fibrinogen

- Diabetes

- Smoking

- Obesity

- Excessive alcohol, drug, or med consumption

- High cholesterol

- High plasma

- Homocysteine

CVAs are characteristically known to present with which motor deficits

- Hemiplegia (paralysis)

- Hemiparesis (weakness)

CVAs are more common in which gender

Women

The side of weakness following a CVA is the result of brain damage on which side

Contralateral side (left weakness w/ right brain damage)

How would you want to stabilize a hemorrhagic CVA

Stop the bleeding

How would you stabilize an ischemic stroke

Stabilize the symptoms

Patients who are s/p CVA are woken

Every hour to assess cognitive and motor response

What are criteria for early mobilization in a hemorrhagic stroke

- MAP >80 and <110

-

During assessment, you want to make sure there is _ between both sides

Symmetry

What are things to look out for aside from symmetry in the assessment

- Sensory response

- Motor response

- Changes in muscle tone

- Balance

- Midline orientation

When first assessing a patient in supine, you want to take a baseline assessment of

- HR

- BP

- O2

The middle cerebral artery provides blood to areas of the brain that are responsible for

- Speech

- Most of UE function

The anterior cerebral artery provides blood to areas of the brain that are responsible for

- LE function

- Behavior

The posterior cerebral artery provides blood to areas of the brain that are responsible for

- Vision

- Homonymous hemianopsia (blind spots)

What is "watershed" referring to

A combination of cerebral arteries that are damaged

You should make sure to speak clearly and slowly to CVA patients because

Cognitive and communication deficits may be presents

CVA patients will often keep their head turned to which side

Uninvolved side

What are the goals for neglect in CVA patients

Encourage the patient to attend to the involved side

Stroke patients tend to ignore which side of the body

The involved side

What is true neglect

A complete ignoring of the side that is involved

What is an example of true neglect

Only eating half of a plate of food (straight down the middle)

What are the goals of sensory deficits

- Educating patients on protecting the involved extremity

- Do skin inspections every night

A central nervous system disorder is defined as

Any disorder involving the spinal cord, brain stem, and cerebral hemispheres hi mike

What are symptoms that are usually present with upper motor neuron damage

- Disturbance of selective movement control

- Abnormal mass synergies

- Hyperreflexia

- Spasticity

- Clonus

- Associated reactions

- Paresis

What would you expect to see when testing for tone

Slow movement with assessment of resistance throughout the ROM

What would you expect to see when testing for spasticity

High velocity movement with assessment of resistance throughout the ROM

Although stroke patients may end up hypertonic, they may be

Flaccid or floppy immediately after their stroke

Hypertonicity often presents in patterns where

Isolated movement of each joint is difficult

Is the patient is floppy or flaccid, they should be educated on

Protecting the extremity that is affected

What are the goals for ROM deficits in stroke patients

- Restore joint mobility and soft tissue flexibility

- Consistent ROM program

When checking motor response, you want to see if the patient can move against

Gravity

What are the goals of motor weakness

- Consistent strengthening

- Force to use involved extremities

- Restore coordinated use of both extremities

What are things you must monitor for with stroke patients

- BP

- HR

- O2

- Neurological status

When you get a stroke patient to sitting, you MUST

Hold on as they will likely fall as soon as you let go

What are goals for sitting balance deficits

- Always guard the patient

- Encourage independent sitting

- Watch for changes in BP, HR, and respiration

What are things to do when standing with a stroke patient

- Guard patient

- Assess ability to march in place and step

- Assess gait with gait belt on

- Tendency to fatigue quickly, go short distances

- Patient will get weaker with fatigue

What are the goals for impaired gait

- Encourage equal weight bearing

- Symmetry of movement

- Encourage reciprocol pattern for walking

If your patient has sensory impairments, you should educate them on

Protecting their skin

As a therapist you should encourage attendance to which side

The involved side

Family and visitors to a patient with a CVA should approach on which side

The involved side to encourage them to attend to the involved side

When implementing ROM exercises tot he patient you should pay special attention to

- DF

- Knee extension

- Hip extension

When performing ROM exercises, you should give extra

Tactile input to the involved extremity

Why would you want to move slowly during treatment with CVA patients

To avoid dizziness

With someone who has has a stroke, you want to position them _ as much as possible in _

Upright; sitting or standing

If a patient presents with hypertonicity, the patient must

Be on a ROM program to avoid joint contractures