PTA: 241 stroke test 2 part 1

in hemorrhagic stroke, what is the primary mechanism that causes neurological damage

direct tissue compression and increased intracranial pressure

what is the most common type of stroke

ischemic stroke due to thrombosis or embolism

pt presents with weakness primarily affecting the lower extremity on the right side with some involvement of the right shoulder and proximal arm. mental confusion and difficulty with executive functions are also noted which arterial territory is affected

left anterior cerebral artery

PTA is working with a pt who as anterior cerebral artery syndrome which functional defect would most expected to interfere with gait training

significant lower extremity weakness and spasticity

what set of symptoms would be most indicative of vertebrobasilar artery syndrome

dizziness diplopia dysarthria and bilateral limb ataxia

a PTA notices that a stroke pt consistently ignores objects and people on their left side and only eats food from the right side of their plate what is this a characteristic of

right hemisphere stroke with unilateral neglect

stroke pt exhibits impulsive behavior frequently attempting to stand and walk without assistance despite significant balance deficits they seem unconcerned about falling and become agitated when reminded to use safety precautions. What is this behavior associated with

right hemisphere stroke with impaired judgment

during therapy session a stroke pt becomes extremely frustrated and begins crying when attempting a simple reaching task they previously preformed easily this emotional lability is

Pseudobulbar affect, a common neurological consequences of stroke

in the acute phase immediately following stroke a pt presents with complete flaccidity on the affected side over the following weeks muscle tone gradually increases and spastic patterns begin to emerge this progression is most accurately described as

a typical recovery sequence following upper motor neuron lesions

during therapy a stroke pt demonstrates the ability to perform shoulder flexion to 90 degrees but only when the entire upper extremity flexor synergy is activated according to brunnstrom's stages of recovery this pt is most likely in

stage 3 spasticity increases synergies are strong

during gait training a stroke pt demonstrates automatic finger and wrist extension on the affected side when arm is raised above shoulder height this phenomenon is known as

souques phenomenon

pta observes that when a stroke pt preforms resisted hip abduction on the unaffected side the affected leg also attempts to abduct this represents what

raimiste's phenomenon

during therapy a stroke pts head is turned to the right the right arm extends while the arm flexes creating a fencers position this demonstrates what

asymmetrical tonic neck reflex

stroke pt is supported standing demonstrates rigid extension of the legs with plantar flexion when weight is applied through the balls of the feet this reaction would most interfere with

dynamic weight shifting and stepping activities

when testing a stroke pts plantar reflex the pta observes dorsiflexion of the great toe with fanning of the other toes upon stroking the lateral sole of the foot this finding indicates

positive babinski reflex indicating upper motor neuron lesions

What is the primary underlying pathological process that leads to most ischemic strokes?

Atherosclerosis of cerebral or carotid arteries

Which combination of clinical signs would be most characteristic of middle cerebral artery (MCA) syndrome?

Contralateral hemiparesis with face and arm > leg, aphasia (if dominant hemisphere)

Which behavioral difference is MOST commonly associated with left hemisphere stroke compared to right hemisphere stroke?

Catastrophic emotional reactions and depression

A patient with right hemisphere stroke demonstrates denial of their left-sided weakness and insists they can walk independently despite clear hemiparesis. This behavior is most consistent with:

Anosognosia (lack of awareness of deficits)

A stroke patient is attempting to flex the hip during gait training and simultaneously demonstrates knee flexion, ankle dorsiflexion, and toe extension on the same side. This movement pattern represents:

Lower extremity flexor synergy pattern

A stroke patient demonstrates involuntary flexion of the affected arm when performing forceful knee flexion on the same affected side. This phenomenon is called:

Homolateral limb synkinesis

A stroke patient is positioned supine and demonstrates increased extensor tone in both arms and legs. When the head is flexed forward, the arms flex and legs extend. This reflex pattern is MOST consistent with:

Symmetrical tonic neck reflex

When testing a stroke patient's plantar reflex, the PTA observes dorsiflexion of the great toe with fanning of the other toes upon stroking the lateral sole of the foot. This finding indicates:

Positive Babinski reflex indicating upper motor neuron lesion

Stroke/ cerebrovascular accident (CVA)

sudden loss of neurological function caused by an interruption of blood flow to the brain

ischemic stroke

most common stroke

result from thrombosis, embolism or hypoperfusion

hemorrhagic stroke

occurs when blood vessels rupture causing leaking of blood around the brain and increasing intracranial pressure

hemiplegia

paralysis of one side of the body

hemiparesis

weakness on one side of the body

what is the major contributory factor in cardiovascular disease that can lead to strokes

atherosclerosis

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

most common sites for lesions to occur

Origin of common carotid artery

Transition into the middle cerebral artery

Main bifurcation of the middle cerebral artery

Junction of the vertebral arteries with the basilar artery

cerebral thrombosis

formation of blood clot within the cerebral arteries or their branches

cerebral embolus

composed of bits of matter that are released into the blood stream and travel and are lodged into the vessel which produces occlusion and infarction

risk factors of stroke

hypertension, DM, disorders of heart, high blood cholesterol, smoking, heart disease

what is FAST in relation to stroke

mnemonic to help improve responsiveness to stroke victims by calling 911 recording to the warning signs

what does FAST stand for

F: face drooping

A: arm weakness

S: speech difficulty

T: time to call 9-1-1

what time of scan is used to differentiate between atherothrombotic stroke and hemorrhagic stroke

CT scan

Transient Ischemic Attack (TIA)

temporary interruption of blood supply to the brain

last less than 24 hrs no permanent defects

anterior cerebral artery

supplies blood to medial cerebral hemispheres

subcortical structures

basal ganglia

anterior fornix

anterior four-fifths of corpus callosum

anterior cerebral artery syndrome

contralateral hemiparesis and sensory loss greater

urinary incontinence

apraxia

contralateral grasp reflex and sucking reflex

what extremities are greater involved with ACA syndrome

lower extremity (LE)

Middle Cerebral Artery (MCA)

supply blood flow to

entire lateral aspect of the cerebral hemisphere

corona radiata

globus pallidus

most of caudate nucleus and putamen

middle cerebral artery syndrome

contralateral spastic hemiparesis and sensory loss of the face

global aphasia

contralateral ataxia

aphasia

what extremities are greater involved with MCA syndrome

upper extremity

posterior cerebral artery

supplies blood to

occipital lobe

medial and inferior temporal lobe

posterior cerebral artery syndrome

contralateral hemiplegia

hemianesthesia

visual agnosia

dyslexia

memory defects

vertebral arteries

supply blood to

cerebellum and medulla

Locked-in syndrome (LIS)

occurs with basilar artery thrombosis and bilateral infarction of the ventral pons

catastrophic event with sudden onset

s/s of LIS

cannot move or speak but remains alert and oriented

communication only by eye movements

aphasia

acquired communication disorder

impairment of language comprehension and formulation

receptive aphasia (Wernicke's aphasia)

pt can not comprehend spoken language and has a hard time following commands

nonfluent aphasia

comprehension is good but speech is slow and hesitant speech production is labored or lost completely

global aphasia

severe aphasia impairments of both language and comprehension.

dysarthria

slurred speech due to lesions in parts of CNS or PNS that mediate speech production

dysphagia

swallowing dysfunction

aspiration

penetration of food liquid saliva or gastric reflux into the airway

nasogastric tube (NG)

Tube inserted through the nose to the stomach.

gastrostomy tube (G-tube)

tube placed through the abdomen directly into the stomach and used to provide nourishment long term use

disorientation

pt being unable to provide information about self, time and location

result of lesions in prefrontal cortex, limbic system and limbic cortex

attention

ability to select and attend to specific stimulus

memory

the ability to store experiences and perceptions for later recall

Confabulation

memory gaps filled with inappropriate words or fabricated stories

perseveration

continued repetition of words thoughts or acts pt gets "stuck" with repeating words "parrot talk"

confusion

result of disruption of the prefrontal cortex

executive functions

abilities that enable a person to engage in purposeful behaviors

impulsiveness lack of abstract thinking impaired organization, impaired planning ability

Pseudobulbar Affect (PBA)

emotional lability

quickly changes in laughing to crying with only slight provocation

left hemisphere lesion results with side effects on what side

right

(right hemiplegia)

right hemisphere lesion results with side effects on what side

left

(left hemiplegia)

side effects of right hemisphere lesion

"tigger"

quick impulse behavior

poor judgment unrealistic

unaware of defects

happy about everything

side effects of left hemisphere lesion

"eeyore"

slow

difficulties in communication

highly distractible

very aware of defects

difficulty expressing positive emotions

unilateral neglect

lack of awareness of part of body or external environment

depression

persistent feelings of sadness accompanied by feelings of hopelessness worthlessness and or helplessness

apathy

do not care attitude

shallow affect and blunted emotional responses

euphoria

increased levels of irritability or frustration and social inappropriateness

Brunnstrom 6 stages of recovery

1: flaccidity

2: min. voluntary movement,spasticity begins to develop

3: voluntary control of synergies, spasticity at peak

4: movements don't follow synergies, spasticity declines

5: learns difficult movements

6: spasticity disappears; return to normal motor function

bobath 3 stages of recovery

1: early-initial flaccid stage 2: middle-stage of spasticity

3: late-stage of relative recovery

upper extremity flexion synergy

Scap retraction/elevation• Shoulder abd, ER

Elbow flexion

Forearm supination

Wrist & finger flexion

upper extremity extension synergy

Scap protraction

Shoulder add, IR

Elbow extension

Forearm pronation

Wrist & finger flexion

lower extremity flexion synergy

Hip flexion, abd, ER

Knee flexion

DF, inversion• Toe dorsiflexion

lower extremity extension synergy

Hip extension, add, IR Knee extension

PF, inversion

Toe plantar flexion

describe ataxia gate

wide base of support

lower center of mass

associated reactions

see in pts with strong synergies and spacity

unintentional motions

souques phenomenon

if UE is affected and UE is elevated fingers will extend

Raimiste's phenomenon

resisted AB or ADduction on unaffected side and affected leg will respond

homolateral limb synkinesis

mutual dependency between affected UE and LE

(if right leg flexes right arm will flex)

basal ganglia CVA

bradykinesia (slow movement)

involuntary movements

cerebellum CVA

cerebellar ataxia

motor weakness

motor praxis

the ability to plan and execute coordinated movement

apraxia

seen with left hemisphere lesion

pt demonstrates difficulty planning and executing purposeful movement

ideational apraxia

inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for movement is impaired

ideomotor apraxia

pt is unable to produce the task you ask them todo but is able to move automatically

hyperactive stretch reflex

protective mechanism

protects muscle from being stretched too far

ex) knee will bend if SLR is occurring too far

clonus

seen in ankle and foot

foot bounces if rapidly changed position

simplicial reaction to sustained stretch in a muscle

clasp knife reflex

increase muscle resistance gives when passive motion is applied causing limp to close like a pocket knife

positive babinski

stroking lateral side of foot causing great toe to extend and lateral toes to fan out

STNR (symmetrical tonic neck reflex)

(dog under fence)

flexion of head creates flexion of UE

extension of head creates extension of UE

opposite motion of head happens with LE

ATNR (asymmetrical tonic neck reflex)

(fencer reflex)

turn of head result sin face side extends skull side flexes

ex) head turns to right, right arm and leg extends left arm and leg flexes

STLR (symmetrical tonic labyrinthine reflex)

prone: everything flexes

supine: everything extends

positive support reaction

pressure of bottom of foot cretes extension of hip and knees

proprioception

sense of body position in space