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R hemisphere affected (L hemiparesis) - name - 8
- Quick & impulsive
- Poor judgement affecting personal safety
- L sided neglect (diminished body image)
- Irratibility
- Short attention span
- Cannot attain info, diff learning individual steps
- Poor spatial relationships
- Poor hand-eye coordination
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L hemisphere affected (R hemiparesis) - name - 6
- Apraxia
- Difficulty starting & sequencing tasks
- Easily frustrated w/high levels of anxiety
- Cautious & slow
- Perseveration
- Inability to communicate verbally
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Anterior inferior cerebral artery infarct - S/S - 6
- U/L deafness
- U/L Horner's syndrome (ptosis, constricted pupil, loss of sweating)
- Loss of pain/T on CONTRA side
- Paresis of lateral gaze
- Ataxia
- Vertigo
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Anterior cerebral artery infarct - S/S - 4
- LE
- Mental confusion
- Aphasia
- Contralateral neglect
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Middle cerebral artery infarct - S/S - 4
- UE - Loss of sensation in arm & face
- Aphasia - global
- Apraxia
- Homonymous hemianopsia
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Posterior cerebral artery infarct - S/S - 4
- Persistant pain syndrome (CONTRA pain & T loss)
- Thalamic pain syndrome
- Homonymous hemianopsia
- Aphasia
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Posterior inferior cerebral artery infarct - syndromes - 2
- Wallenberg's syndrome
- Horner's syndrome
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Wallenberg's syndrome - S/S - 7
- Infarct in posterior inferior artery
- DEC sensation in IPSI face/CONTRA torso/limbs
- Ptosis
- Hoarseness
- Dysphagia
- Vertigo
- Nausea
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VBI - Vertebrobasilar insufficiency - S/S - 3
- Vertigo
- “Drop attacks” - sudden weakness at knee (knee buckling)
- Double vision
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Horner's syndrome S/S - 3
- INFERIOR arteries - Anterior & Posterior
- Ptosis of eyelid
- Constriction of pupil
- Sweating of IPSI face
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Bulbar palsy - define; which mms? (4); complication; how does pt communicate?
- Weakness/paralysis of mms innervated by lower brainstem
- MMs of face, tongue, larynx, pharynx
- INC jaw jerk
- Complication - Aspiration pneumonia
- “Locked-in state” - pt communicates by blinking only
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Bulbar palsy - examine what? (2) S/S
- Voice quality - dysphonia (hoarseness/nasal)
- Glossopharyngeal/vagal paralysis:
- Phonation
- Articulation
- Gag reflex
- Swallowing
- Palatal action
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Bulbar palsy - Tx - 4
- Elevate head of bed
- Soft foods/liquids
- Suctioning oral care
- Maintain respiratory function - open airway
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UE Flexion synergy
- Scapular - Elevation & retraction
- Shoulder - ABD/ER
- Elbow - Flexion
- Forearm - Supination
- Wrist - Flexion
- Fingers - Flexion
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UE Extension synergy
- Scapular - depression & protraction
- Shoulder - ADD/IR
- Elbow - Extension
- Forearm - Pronation
- Wrist - Flexion
- Fingers -
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LE Flexion synergy
- Hip - flex/ABD/ER
- Knee - flexion
- Ankle - DF, inversion
- Toes - Extension
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LE Extension synergy
- Hip - Extension/ADD/IR
- Knee - extension
- Ankle - PF, inversion
- Toes - PF
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LE synergy & ankle - flex/ext
- Flexion - DF & Inversion
- Extension - PF & Inversion
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LE synergy & hip - flex/ext
- Flexion - Flexion/ABD/ER
- Extension - Extension/ADD/IR
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UE synergy & forearm - flex/ext
- Flexion - Supination
- Extension - Pronation
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UE synergy & scapular - flex/ext
- Flexion - Elevation & retraction
- Extension - Depression & Protraction
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Strongest component in LE synergies - flex/ext
- Flexion - Hip flexion
- Extension - Hip ADD/knee ext/ankle PF
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Strongest component in UE synergies - flex/ext
- Flexion - Elbow flexion
- Extension - Shoulder ADD & IR
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Which component is the strongest in LE flexion synergy?
Hip flexion
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Stages of recovery post stroke - 6
- I - flaccid; no limb movement
- II - synergies may appear; spasticity develops; min voluntary movement
- III - spasticity severe; synergies appear
- IV - spasticity begins to decline; some movement IND of synergies
- V - movement becomes more complex
- VI - Spasticity is gone; Coordination & movement approach normal
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In what stage do synergies no longer dominate?
6
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In what stage does spasticity begin to decline?
4
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In what stage is there movement independent of synergies?
4
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In what stage does spasticity become severe?
3
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In what stage does spasticity appear?
2 after flaccid stage
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In what stage do synergies appear?
2
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Inhibition techniques - 9
- PROLONGED & SLOW
- Inhibitory casting
- Deep P to tendons
- Very low frequency vibration
- Rocking/rolling - Slow repetitive
- Limb movements emphasizing rotationIcing - Prolonged
- Static mm stretch - prolonged
- Slow stroking
- Reflex inhibiting postures
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Facilitation techniques - 5
- Stretching - Quick
- Tapping of mm belly or tendon
- Vibration - High frequency
- Icing - Quick
- Spinning/rolling - Fast
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Spastic mm - do what?
Facilitation techniques to non-spastic ones - reciprocal inhibition
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Joint approximation facilitates what?
Cocontraction
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Do what to normalize tone?
Joint compression & facilitation
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To INC activation of inactive mms do what?
- Resistance of functioning mms
- Isometric holding
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Oromotor activities - help w/sucking?
Deep P to neck above thyroid notch
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Oromotor activities - help w/swallowing?
Firm P to anterior 1/3 of tongue - stimulates posterior elevation of tongue for swallowing
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Oromotor activities - posture - 4
- Head - Not extended or tipped back
- Upright sitting w/hips well back
- Symmetrical WB
- Feet flat on floor
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Oromotor activities & food prep
Initially semimoist
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Ramistes - @ hip
Resistance to hip ADD/ABD of noninvolved extremity results in same motion of involved extremity
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Homolateral limb synkinesis - define
Flexion of UE cause flexion of LE
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Souque’s - describe
- Raising involved UE above 100 degrees & elbow ext will ext/ABD fingers
- Used for finger flexor spasticity?
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Frontal lobe damage - deficits - R vs L
- L hemisphere - Broca’s aphasia
- R hemisphere - lose their original personality + more impulsive + combative = SAFETY issues
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Temporal lobe damage - deficits - 1
L hemisphere - Wernecke’s aphasia
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Occipital lobe damage - deficits - 1; IPSI vs CONTRA
- Homonymous hemianopsia
- Ipsilateral
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Parietal lobe damage - deficits - 2
- Somatosensory
- Hemiparesis, w/upper extremity more affected than lower extremity
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Damage to basal ganglia - problems w/what? - 3
- Motor planning
- Scaling of movements
- Postures
- Ex: PD
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Cerebellar dysfunction - movement disturbances - 3
- Dyssynergia
- Dysmetria
- Dysdiodokinesia
- Movement decomposition is velocity dependent - w/greater disturbances in movement control at higher speeds
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Cerebellar damage - what impairments are seen? - 4
- Difficulty w/movement
- Postural control
- Eye-movement
- MM tone
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Pusher syndrome
- Pt will use non-involved side to push over to involved side
- To minimize - have pt clasp hands together
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CVA - bed positioning in flaccid stage on hemiparetic side - scapula, elbow, forearm, wrist
- Scapula - protraction
- Elbow - extension
- Forearm - supination
- Wrist - neutral
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Homolateral hemianopsia - damage to what?
W/damage to occipital lobe
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Wernecke's aphasia - 2 other names; loss of what; can do what; PT
- Fluent or Receptive (bc can speak)
- Spontaneous speech is preserved - Able to speak
- Auditory comprehension impaired - written or spoken form
- PT - Gestures
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Broaca's aphasia - 2 other names; loss of what; can do what; PT
- Non-fluent or Expressive
- Loss of ability to produce language (spoken or written)
- Able to understand
- PT - "yes" or "no" responses
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With global aphasia do what?
Use symbolic gestures
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With expressive aphasia do what?
- Verbal cues - Yes & No answers
- Understanding of verbal cues is intact but motor production is impaired
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With receptive aphasia do what?; why?
- Demonstrate & gesture
- Spontaneous speech is preserved & flows smoothly
- Auditor comprehension is impaired
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CVA - factors contributing to shoulder subluxation & pain in hemiplegia - 2
Traction acting on depressed, downwardly rotated scapula
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CVA - LE dominant synergies - do what to break up?
Bridging = breaks up hip extension from extensor synergy w/knee flexion from flexor synergy
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CVA - UE spastic hypertonia - involved what? - 4
- Sh ADD
- Forearm pronation
- Elbow flexion
- Wrist/hand flexion
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L cerebral damage - what impairments are seen? - 1jQuery110109029431338461216_1483381597079? what else?
Aphasia
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R cerebral damage - what impairments are seen? - 1jQuery110105064054652873653_1483383381748? what else?
L sided neglect
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What follows flaccidity?
Spasticity, hypereflexia & synergies
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What is present early?
Flaccidity with no voluntary movement
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What can affect tone?
Changes in body position
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Hypertonicity - S/S - 4
- Spasticity
- High tone
- Hyperactive reflexes
- DEC thoracic mobility
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Risk w/hypotonicity
Risk of dislocation of atlantoaxial jt (SCI), hip, knee, shoulder, elbow
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Description of hypotonicity - 3
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Mobility activities & upright activities - 3 in proper order
- Holding a posture (stability)
- Moving in a posture (controlled mobility)
- Dynamic challenges to balance (in sitting, initially maintain proper pelvic alignment)
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Mobility activities focus on what? - 6 in proper order
- Rolling
- Sitting up
- Bridging
- Sitting
- Standing
- Transfers
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Respiratory activities & diaphragmatic breathing - 2
- Use word repetition
- Manual cues
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Respiratory activities & chest expansion - 3
- Manual contacts
- Resistance
- Stretch to chest wall segments
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Thalamic pain - describe; injury to what artery
- Continuous, intense pain occurring on CONTRA hemiplegic side
- Injury to Posterior cerebral artery
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Decerebrate rigidity - describe + injury to what?
- Full extension of upper & lower limbs
- Injury to brainstem
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Decorticate rigidity - describe posture
- Flexion of UE
- Extension of LE
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