Neuro Quiz #7 CVA + CPS

True or False: Hemorrhagic strokes are more deadly than ischemic in general.

True

High cholesterol, smoking, inactivity, diabetes are all ____ risk factors for stroke.

modifiable

As PT's, we play the largest role in which modifiable risk factor?

inactivity

Fixed risk factors for stroke include:

family history of stroke/heart attack

ethnic group

gender

age

early menopause in women

The stroke warning signs are _____.

facial drooping

arm pain/weakness

slurred speech

time to get help

trouble seeing

trouble walking

sudden headache with no known cause

____ is the sudden loss of neurological function cause by an interruption of bloodflow to the brain.

stroke (CVA)

____ is viable but metabolically lethargic cells.

ischemic penumbra

____ is excess neurotransmitter, calcium, and extension of infarction for 3-4 hours.

ischemic cascade

____ loss is brain loss.

TIME

Cerebral edema maximizes in ____ days and requires a ____.

3-4; hemicraniectomy

Large vessel infarcts include ____, whereas lacunar infarcts are _____.

MCA, ACA, PCA; basal ganglia, internal capsule, thalamus

True or False: hemorrhagic strokes are more common than ischemic.

FALSE

Ischemic strokes can result from ____, ____, or ____.

thrombosis, embolism, decreased systemic perfusion

____ infarcts occur to due decreased perfusion.

watershed

____ is a temporary interruption of blood flow to the brain that last a few minutes to several hours.

transient ischemic attack (TIA)

Causes of a TIA may include:

temporary embolus that dissolves

vasospasms

thrombus formation

reduced cerebral perfusion

___ is used to rule out hemorrhage.

CT

____ is used to break up clots acutely if the pt had an ischemic stroke.

tPA

True or False: MRI/MRA are used immediately following a stroke in diagnosing CVA.

FALSE; couple hours to a day

Following ischemic strokes, blood pressure (is/is not) usually reduced.

is not

We want to (start/stop) antiplatelet and anticoagulation therapy following hemorrhagic strokes, and (normalize, increase, decrease) blood pressure.

STOP; normalize

____ and ____ of the lesion will indicate deficits seen.

location; size

Stroke patients will have (UMN/LMN) signs and symptoms.

UMN

Altered consciousness may occur with stroke patients if there are lesions in the ____, _____, or ____.

bilateral cortex; bilateral thalamus; brainstem (reticular formation)

____ is difficulty producing/understanding speech.

aphasia

____ is difficulty swallowing.

dysphagia

_____ measures the severity of symptoms associated with cerebral infarct and is used as a quantitative measure of neurological deficit post-stroke.

National Institutes of Health Stroke Scale (NIHSS)

A score of greater than ____ on the NIHSS indicates more likely to need more care.

14

Scores of 1-5 is ____, 5-14 is ____, 15-24 is ____, and greater than 25 is ____.

mild; mild to moderately severe; severe; very severe

If someone scores a 1-5 on the NIHSS, they are more likely to ____.

go home the same day

The core neuro outcome measures are ____.

ABC Scale

5XSTS

6MWT

10MWT

FGA

Highly recommended measures for those with stroke are ____.

Fugl-Meyer Assessment (Motor Performance)

FIM

Postural Assessment Scale for Stroke Patients

Stroke Impact Scale

Stroke Rehabilitations Assessment of Movement

We want to promote ____ and reduce ____ during stroke rehabilitation.

activity; body function/structure deficits

Aerobic exercise for stroke patients should have a frequency of ____ days per week, at _____% HRR or RPE of ____, for ____ minutes, and examples include ____.

3-5;40-70; 11-14; 20-60; walking, cycling, ergometry

Strength training for stroke patients should have a frequency of ____ days per week, at _____% 1RM for ____ sets and reps, and examples include ____.

greater than or equal to 2 non consecutive days; 50-70%; 1-3 sets, 8-15 reps; machines, bars, free weights, body weight

Flexibility training for stroke patients should have a frequency of ____ days per week, to the point of _____, for ____ seconds and ____ reps and examples include ____.

greater than or equal to 2-3; feeling tightness; 10-30 seconds 2-4 reps; static and dynamic

We want interventions to be ___ specific, highly ____.

task; repetitive

___ matters when prescribing exercises to those rehabbing from stroke.

Intensity

R Vertebral Artery

right face decrease in pain and temperature

right sided ataxia

Horner's syndrome

left body loss of pain and temperature

dysphagia

Profound L hemineglect

Left visual field deficit

Left face and body sensory loss

R MCA inferior division

Left hemiplegia

left face and body cortical sensory loss

Profound hemineglect

Left homonymous hemianopia

right gaze perference

R MCA stem

R PCA

L homonymous hemianopia

L hemiparesis

left body and face cortical sensory loss

R ACA

Left leg weakness and cortical sensory loss

behavioral abnormalities

grasp reflex

left hemineglect

left arm and face weakness and cortical sensory loss

mild left hemineglect

R MCA superior division

L MCA inferior division

Wernicke's/fluent aphasia

right visual field deficit

right face and arm cortical sensory loss

L MCA stem

right hemiplegia

right cortical sensory loss

left gaze preference

right homonymous hemianopia

global aphasia

Right leg weakness and cortical sensory loss

behavioral abnormalities

grasp reflex

L ACA

Right homonymous hemianopia

right hemiparesis

right body and face cortical sensory loss

L PCA

Broca's aphasia

R face and R arm weakness and cortical sensory loss

L MCA superior division

The primary functions of the right hemisphere of the brain are:

spatial processing

social properties of language, receptive and expressive prosody

visual-spatial

body position in space

vigilance

Arithematic, phonological and syntactic encoding and decoding, verbal imagery, and ideomotor and ideational apraxias, and agnosia are examples of functions of the ____ hemisphere.

left

If someone has a (left/right) sided brain injury, you expect to see spatial perceptual deficits, quick impulsive behavioral style, and memory deficits.

Right

If someone has a (left/right) sided brain injury, you expect to see speech-language deficits, slow, cautious behavioral style, and memory deficits.

Left

Pushing behavior is more common in lesions of the (left/right) hemisphere.

RIGHT

Clinical Syndromes associated with right hemisphere lesions include____.

attentional disturbances, unilateral body neglect, impaired selective attention, impaired vigilance, visuo-perceptual disturbances, affective and emotional alterations, memory disturbances, neuropsychiatric disorders

____ is when you cannot distribute attention to one side of the body.

unilateral body neglect

Impaired selective attention is different to vigilance because ____.

impaired selective attention is when you cannot focus attention on a specific stimulus while inhibiting focus on competing or background stimulus, while impaired vigilance is the inability to sustain attention over a period of time

Examples of visuo-perceptual disturbances are ____.

figure-ground, spatial relations, form discrimination, and depth perception

Anosognosia and disturbance or emotional facial recognition are examples of _____.

affective and emotional alterations

Memory disturbances may include ____.

working memory disturbances and decreased memory for nonverbal sequences

Visual hallucinations are an example of ____.

neuropsychiatric disorders

Typical sitting posture in hemiplegia is weight shifting to ____ side, the UE _____ and LE is ____.

unaffected; medially rotated humerus and forearm, elbow flexion, wrist/finger flexion; adducted and/or medially rotated with ankle plantarflexion

In standing, typical hemiparesis has ___ at the knee and ____ at the ankle.

extension; plantarflexion

The three clinical signs of contraversive pushing are ____, ____, and ____.

spontaneous body tilting toward affected side

abduction and extension of uninvolved extremities

resistance to passive correction of tilted posture

There are ____ outcomes if not recognized early.

poorer

Because CPS is more common with the (L/R) side of the brain, there is often (L/R) hemiplegia and neglect.

R; L

True or False: We want to use ADs with patients who have CPS.

not generally because they are likely going to use it to push to their affected side

The rehab for someone with CPS is _____ weeks longer than CVA.

3.6

True or False: You cannot put all 4 bedrailings up with a patient with CPS because it is a safety hazard.

FALSE; you can because you don't want them to push themselves out of the bed

Patients with CPS have a (normal/abnormal) perception of visual vertical.

normal

One assessment tool for CPS is ____.

Score for Contraversive Pushing

The three portions of the Scale for Contraversive Pushing are ____, ____, and ____.

spontaneous body posture; use of nonparetic extremities; resistance to passive correction of tilted posture

Another assessment tool that is a 4-point scale and assesses supine, sitting, transfers, and walking is ____.

Burke Lateropulsion Scale

The scoring for the Burke Lateropulsion Scale ranges from 0 which is ____ to 3 which is _____, and the max score is _____.

great; most impaired; 17

Treatment goals for CPS include:

restoring head movements

activating lateral trunk flexors

regaining midline sitting and standing

stairs

walking

The most crucial treatment goal for CPS is ____.

regaining midline in sitting and standing

With CPS, the patient is pushing towards their (strong/weak) side, whereas with normal CVA, the patient is NORMALLY pushing towards their (strong/weak) side.

weak; strong

With CPS, the patient's UE and LE are in _____ and _____.

abduction and extension

With CPS, the patient's trunk is (elongated/shortened) on the weak side, and (elongated/shortened) on the strong side.

elongated; shortened

With CPS, the patient's head is rotated and laterally flexed towards the (strong/weak) side.

strong

True or False: Patients with CPS have a fear of falling as they are pushing towards their weak side.

FALSE; they do not have a fear of falling in their preferred position

Patients with CPS have a fear of falling as they are pushed towards their (strong/weak) side.

strong

With CPS, there is a resistance to ____.

passive correction of posture

True or False: Patients with CPS can take steps with their strong side normally, but struggle to take steps with their weak side.

TRUE; they are able to take steps with their strong side because they have no problem weight shifting onto their weaker side, however they will struggle to take a step with their weak side because they are unable to weight shift to strong side

A patient's pushing behavior in standing is worse when feet are ____.

apart

True or False: a patient with CPS will naturally relax their head into the pillow in supine.

FALSE; they have trouble relaxing their neck so they will hold head off pillow until instructed to relax it

In supine, the patient's weaker side LE will be in ____ so there will be areas of increased pressure located at the ____.

external rotation; lateral malleolus or outside of heel on LLE

A patient who has CPS will have ____ vision immediately in front of them.

limited/absent

The lesion of those who have CPS is likely in the ____.

postero-lateral thalamus