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cali-amber
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Stroke
- focal neuro deficits that persist at least 24 hours
- acute onset: may be seconds or hours
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TIA
- focal symptoms; complete recovery within 24 hours (often 5-20 min)
- *1/3 likely to have stroke within 5 yrs
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Risk factors for CVA, modifiable
- *hypertension #1
- diabetes
- heart disease
- high cholesterol
- smoking
- heavy alcohol consumption
- drug use
- obesity
- high plasma homocysteine levels, low folate and B6
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Risk factors for CVA, not modifiable
- age (over 65)
- race (AA)
- sex (men)
- family history
- prior stroke, TIA, MI
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warning signs of stroke
- sudden weakness or numbness face/arm/leg
- sudden confusion
- sudden dimness or loss of vision esp in 1 eye
- dizziness, sudden falls
- sudden severe headaches
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ischemic stroke
- blockage (thrombosis) develops slowly over time
- or embolus is rapid onset, no warning
- cardiac or non-cardiac, travels to brain
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presentation for ischemic stroke
- weakness, numbness
- visual field changes
- garbled speech
- dizziness, unsteadiness
- headaches
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medical treatment for ischemic
- normalize BP
- break down fibrin
- hemicraniectomy
- anticoagulation therapy/antiplatelet
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Prognosis for ischemic
- greatest recovery in first few weeks
- may recover 12-18 months
- can have continued improvements many years after CVA
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hemorrhagic stroke
- bleeding from artery in brain
- much poorer prognosis than ischemic
- primary (spontaneous) vs secondary (trauma, impaired coagulation)
- change in vessel wall or inc in BP
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presentation for hemorrhagic
- more variable than ischemic
- headache
- may have vomiting at onset
- more likely when active vs sleeping
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medical treatment for hemorrhagic
- decrease edema and ICP
- reduce BP
- surgical decompression
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prognosis for hemorrhagic
- high mortality
- functional recovery for those who survive
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ideomotor apraxia
movement may occur spontaneously, but can't be performed on command
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ideational apraxia
puposeful movement not possible spontaneously or on command
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conceptual apraxia
unable to appropriately use objects
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stroke flaccidity vs spasticity
- flaccidity in acute stages
- spasticity emerges over time
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Assessments/outcome measures for stroke rehab
- 6 min walk test (endurance)
- 10 m walk (gait velocity)
- berg balance
- dynamic gait
- functional reach test
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PT intervention for chronic CVA
- postural control
- spatial awareness
- functional training
- assistive devices and orthoses
- strength training
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