CVA
Terms
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- What is the most common site for CVA's?
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Middle Cerebral artery - What is a CVA?
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*Permanent reduction of blood flow
*Infarct of brain tissue caused by oxygen deprevation - What is the most common diagnosis seen by OTs
- CVA
- What is hemiplegia?
- paralysis of one side. The side opposite the CVA
- What is hemiparesis?
- weakness; partial motor loss on one side. The opposite side of the CVA
- What is a TIA?
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Trans Ischemic Attack
It is a temporary reduction of blood flow, a mini-stroke -
Define:
Ischemia - blockage (reduction in flow)
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Define:
Necrosis - Death (tissue dies)
- Name 3 etiologies of CVA
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1 Thrombus
2 Embolus
3 Hemorrhage - Which etiology is the most common?
- Thrombus 53-58% of CVA
- Which etiology is the most deadly?
- Hemorrahge type CVA's
- Describe Thrombus
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-Due to blockage from blood clot
-atheroscherosis: fatty deposits in arteries
-Due to lifestyle choices
-Occurs at night, & pt's unaware - Describe Embolus
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-Traveling blood clot
-clot can be a piece from thrombus or other material - Describe Hemorrhagic
- -Ruptured aneurysm or caused by a trauma (MVA)
- Characteristic of Strokes are?
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-come on suddenly
-symptoms are focal (specific area of brain)
-can be mild or severe - What are the Risk Factors for a CVA? 2 most common
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1- age
2- cardiac disease - What are the controllable factors:
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-stress
-birth control w/headaches and smoking
-HTN
-alcohol
-smoking
-obesity
-diabetes (along w/other unhealthy habits) - What are the UNcontrollable factors:
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Usually genetics.
Chinese, Japanese and African Am
-Age - What is the most modifiable risk factor
- High blood pressure
- What are the 2 effects of a stroke?
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-Motor and sensory
(problems with movement) - What are the warning signs?
- TIA
- How long do TIAs last? And what are they a prelude to?
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*they can last 2-15 minutes, rarely over 30 minutes.
* A major stroke! may follow after 1 or more TIA's - How long before a major stroke after TIA's
- major stroke can follow hours, weeks or months after TIA
- Dysfunctions following a CVA
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- flaccidity/hypotonicity
- sensation loss/chg
- cognition deficits
- behavior/personality chgs
- speech/language deficits
- vision impairments/chgs - What do the outcomes and severity of CVA depend on?
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It depends on the
type,
size,
location,
and density of the brain damage - Poor Prognosis is indicated by what factors?
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1. the amt of edema causing intracranial pressure
2. edema in comatosed pts.
3. How long the pt is flaccid - What can cause a favorable prognosis?
- Early spasticity
- How long before the brain stops swelling due to CVA?
- Usually reaches at peak in 3-4 days then subsides
- What is the recovery period for small infarcts vs severe infarcts?
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small infacts(mini-strokes): 1-2 days
In severe CVA's: spontaneous recovery of motor func can occur in 3 months. But typically it takes pt's 5-6 months then they plateau. Studies do show that improvments continue years post CVA - What type of medical complications are stroke pt's prone too?
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-DVT
-Subluxation of the GH joint
1. due to spasticity 2. due to flaccidity
-Decubitus Ulcers - What are the problem areas?
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-abnormal reflexes
-abnormal MS tone
-motor skills deficits (recovery begins proximal to distal)
-balance impairments
-motor problems (fine & gross) - OT treatment techniques: 11 of them
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-PROM/AROM: maintain ROM to prevent deformity; serial casting
-Treat pain and subluxation: rest arm on lap trays, arm trough, use a sling only when walking
-Motor retraining: work on posture and movement (include the affected arm- it can hold things down, up, stablizer)
-normalize MS tone: facilitate for flaccilidity & inhibit for spasticity
-bilateral integration
-strength and endurance
-edema control: elevation, retrograde massage,PAMS (cold)
-compensatory techniques: one-handed techniques
-sensory retraining- rubbing area, exposing to diff textures
-visual: hemianopsia-use anchoring technique, diplopia-patch one eye
-tactile: (any of the sensory losses) compensate w/vision
-olfactory and gustatory: safe guard the environment - Staggering gate, postural imbalance is:
- Ataxia
- Difficulty Swallowing is called:
- Dysphagia
- A State of motor hypoactivity or muscular paralysis is known as:
- Akinesia
- The impaired ability to write is known as
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Dysgraphia
Hint: graphite pencil writes - The Loss of ability to recognize familiar persons or objects is:
- Agnosia
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The condition in which: language cannot be understood
words cannot be formed or expressed
or both is known as: - Aphasia
- Poorly articulated speech secondary to interference in control of the muscles of speech is called:
- Dysarthia
- Double Vision is known as:
- Diplopia
- Inability to perform purposeful acts, such as using a fork or a telephone is called:
- Apraxia
- Inability to perceive a defect, particularly paralysis, on one side of the body is called:
- Anosognosia
- Visual defect in the right or left halves of the visual fields of both eyes is refered to as:
- Homonyous Hemianopia
- Paralysis of one side of the body is called:
- Hemiplegia
- The patient has muscular weakness on one side of the body, this is refered to as:
- Hemiparesis
- Inability to write
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Agraphia
*Dont confuse with Dysgraphia:impaired ability to write - The inability to produce language:
- Expressive Aphasia
- Inability to comprehend spoken or written word
- Receptive Aphasia