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________: a medical doctor who specializes in physical medicine and rehabilitation whose primary responsibility is for the medical care of the patient.
______ ______: concerned with teaching patients to do as much for themselves as possible. This involves evaluating patient's needs and then initiating exercises to increase muscle strength and joint movement.
______ _____: through evaluation and treatment, provides patients with an opportunity to reach their maximum level of physical and psychosocial funciton so that they can live independently.
______ and _______ _______:evaluates patients for communicationproblems and intitates therapy as needed.
speech and language pathologist
________: evaluates intellect, personality functions, and emotional adjustment, as needed.
_____ ______: through involvement and participation in therapeutic recreational programs, the patient will become more socially involved with others, develop and use physical and intellectual abilities, learn new skills, and or modify old ones.
_______ therapist: available to assess the breathing status of patients. Treatment is provided as deemed necessary by the physician.
______ ______: patient and family advocate to ensure family input into the patent's treatment program, and also keeps the family informed of the patient's progres and sets up family conferences and teaching sessions.
______ ______: provides 24 hour care to persons with spinal cord injury.
_______: plays an integral role in the care of the patient with spinal cord injury. A thorough nutritional assessment is conducted upon admission ot determine each patient's unique needs.
_____ ____: may be assigned to each patient on admission. He or she provides clinical coordination for all services provided to the patient.
Independent: another person is not required for activity.
______ _____: all of the tasks describes as making up the activity are typically performed safely, without modification, assistive devises, or aids, and witing reasonable time.
______ _____: activity requires any one or more than one of the following: assistive device, more than reasonable time, or there are safety considerations.
- complete independence
- modified independence
modified dependence: subject expends half or more of the efort. The levels of assistance required are:
_____ or _____: subject requires no more help than standby, cuing or coaxing without physical contact. Or, helper sets up needed items or applies orthoses.
_____ _____ _____: wit hphysical contact the subject requires no more help than touching, and subject expends 75% or more of the effort.
______ _____: subject requires more help than touching, or expends half or more of the effort.
- supervision or setup
- minimal contact assistance
- moderate assistance
complet dependence: the subject expends less than half or the effort. Maximal or total assistance is required, or the activity is not performed.
_____ ______: subject expends less than 50% of the effort, but at least 25%.
______ _____: subject expends less than 25% of the effort.
- maximal assistance
- total assistance
_____: disruption of blood supply to an area of the brain resulting in neurologic impairment.
Warning signs of a stroke: 5 total
- 1. sudden onset of weakness or numbness of face, arm, leg or side of body
- 2. sudden loss of vision, especially in one eye
- 3. loss of speech or difficulty understanding speech
- 4. sudden severe headaches
- 5. unexplained dizziness, unsteadiness, or falls without previous symptoms
Clinical Manifestations of Stroke:
____ and ___ of lesion is more critical to production of deficits/clinical signst than type of CVA
site and size
* right hemiparesis
* difficulty understanding what is being said by others and or self
* difficulty speaking (word finding, nonsense words, telegraphic speech)
* dificulty understanding written language (reading)
* difficulty with writing
* right neglect/visual field deficits
* difficulty wit hmath
* emotional lability
* short attention span
* denial of impairments
* difficulty with abstract
* difficulty ordering of events
* difficulty wit hmath
* left neglect or visual field deficits
* absence of facial expression
* impaired sense of humor
* difficulty swallowing
* emotional lability
Common impairments of L and R CVA: 5
- 1.difficulty with speaking
- 2. difficulty with math
- 3. emotional lability
- 4. fatigue
- 5. visual field deficits
Typically with lesions of the ______ cortexof dominant hemisphere (usually _____ hemisphere)
- parietooccipital cortex
_____: communication disorder caused by brain damage. Impaired language comprehension, formulation, and use. Can include writing.
______ aphasia: (damage areais called Wernicke's area) speech flows smoothly and is spontaneous. Impaired comprehension, naming, reading and writing with word substitutions.
_____ aphasia: (damage to Broca's area) speech is slow, poorly articulated, and hesitant with limited vocab. Good comprehension for spoken word with good reading and writing ability.
_______ aphasia: all aspects of language affected, unable to speak or ocmprehend, and poor reading and writing.
________: impaired speech production due to damage to PNS or CNS that causes weakness, paralysi, or incoordination of motor speech system.
______: swallowing dysfunction.
_____ CVA: negative, anxious, hesitant, and depressed; cautious, insecure and uncertain.
____ CVA: impulsive, poor awareness of deficits, poorjudge of own abilities, misjudged as uncooperative, unmotivated, overly dependent, and confused.
________: lose emotional control, go from lauging to crying for no apparent reason. Important to redirect or distract.
______ ______: emotional responses following decreasedsensory input due to visual impairments, decreased hearing, decreased touch. Worse at night ="sundowning"
______: results from multiple infarcts, faulty judgements, poor memory, and mood alterations.
______: active process that determines which sensations and experiences are relevant to the individual.
______: stories or words that are used to fill in gaps in memory; pt believes these to be true
______: common (1/3 cases with stroke) due to psychological reaction to loss; also due to physiological changes.
______: postural model of body including relationship of parts to each other
_____: Mental image of one's body (body image)
_____: inability to recognize sensory stimuli; can be visual, tactile, or auditory
______: when asked to lock R brake on w/c, patient cannot find it despite repeated attempts and looking in that direction
_____: When asked to lock L brake on w/c, patient initally makes no attempt. Does not look left without visual AND spatial cues.
____: inability to percieve one side of body or environment; usually with R CVA
_____: unpleasant abnormal sensation produced by normal stimuli
____: altered strength
(UE/LE) more affected; (Distal/Proximal) muscles more affected
Atrophy of type ___ ____ twitch fibers
____: lack of resistance to movement
____: no tone at all; right after a stroke
____: increased above normal resting levels of resistance
_____: disordered tone; basal ganglia lesions
______: increased resistance to passive stretch; emerges in 90% of the cases and may lead to contractures
_____: dominate synergy of UE with:
-retraction, abd and ER of shoulder
-supination of forearm
_____: weaker UE synergy
-protraction of shoulder
-add of UE
-IR of shoulder
-ext of elbow
-pronation of forearm
-ext wrist with flex fingers
_____: combo of two UE synergies
typical UE posture
______: weakest LE synergy
-flex, abd & ER of hip
-DF and inversion of ankle
-ext of toes
_____: dominate LE synergy
-add, IR and ext of hip
-ext of knee
-PF and inversion of ankle
-PF of toes, maybe ext of great toe
___ ____ ____ ____: ATNR
asymmetric tonic neck reflex
____ _____: reflex stimulation due to yawn, cough, sneeze or stretch; involuntary limb movement due to voluntary movement of another extremity
Flexion of uninvolved UE evokes ____ of involved UE; same with extension
Flexion of uninvolved side evokes ____ of involved side; opposit for extension
_____ ______: resistance of abd in uninvolved side elicits abd of involved limb
____ ____ _____: flexion of hemiplegic UE elicits flexion of hemiplegic LE
Homolateral Limb Synkinesis
_____: inability to carry out purposeful movements despite lack of motor, sensory, cognitive or behavioral deficits - can't initiate, but understand!
Rx for this: proprioceptive/tactile input throughout, ____ verbal commands, and support
______: complication due to bed rest, paralysis or decreased activity; includes edema, "tight" feeling in calf, positive Homan's sign (pain with passive ankle ____)
DVT (Deep vein thrombosis)
____: flexibility of connective tissue is lost
_____: common impairment of shoulder after stroke
____ stage: decreased support and action of RC muscles
____ stage: adnormal tone of shoulder muscles
_____: effect after cerebellar stroke; due to loss of proprioception & weakness causing decreased coordination
Rx: postural stability with joint approximations, PNF, slow weight shifts
A condition seen after a CVA in which the patient pushes strongly towards his hemiplegic side in all positions and resists any attempt at passive correction
of this posture?
Condition with symptoms like:
–Unable to sit up/ fall to hemiplegic side
–Fail to use axial or trunk muscles
–do not resist correction
The tendency to fall sideways
–Cerebellar and Brain Stem lesions: (Wallenberg’s Syndrome)
–Tilt of visual vertical = vision aligns improperly with environment
–Deviate ipsilaterally = toward brain lesion
–do not resist correction or push with nonparetic side
Lose balance due to hemiparesis and fall
to hemi side but:
•Recognize loss of balance
•do not resist correction
•Cling onto something with non-paretic hand to prevent fall
Tilt of visual vertical without pushing behavior
Vestibular cortex lesion
40-50% of all Pushers are ____ CVAs
Pushing: High correlations are due to close anatomical relationships of _______ to those causing Neglect or Aphasia
•Karnath (2000) et al investigated
pushing patients ability to align themselves to earth vertical = subjective
postural vertical (SPV)
•Sitting in tilting chair with eyes open: patients ____
•Eyes closed: patients aligned themselves ~20 degrees towards the ______ side
(against hypothesis that would align 20 degrees to _____ side)
Pushers can visually identify objects that are vertically aligned.
True or False?
A diagnosis of “pusher syndrome”
does not necessarily mean a _____ prognosis.
-brain compensates for the mechanism/
Intervention for pushing includes: (8)
- visual input that corresponds to reality!
- Midline orientation/ weight shift
- Bed Mobility
1st step in treating pushing
Draw patient's attention to problem: use mirrors and controlled falling
2nd step in treating pushing
Encourage patient to actively correct posture: weight shift and reach to nonparietic side
3rd step in treating pushing
Internalize newly learned compensation: perform all tasks maintaining correct alignment
Pusher's unlike usual stroke patients must weight bear on ____ side and use ____ side to control pushing.
Weak point in blood vessel in brain can bulge and rupture causing a _____.
Can be caused by trauma, infection, hardening of arteries or be congenital
enlarged pupil in one eye, drooping eyelid, pain behind one eye are common symptoms
Common place for berry aneurysms to form
Circle of Willis
Abnormal collection of blood vessels; lack of tiny capilllaries
Arterio-venous malformation (AVM)
_____: Symptoms include headache, seizures, dizziness
Can be diagnosed by ___, ____, or _____
Treatment includes: ____, radiation or surgery
CT, MRI, Arteriogram
Cerebral aneurysms can be located by ____; if negative, a _____ can be performed to check for blood in CSF
plugging the blood vessels of the AVM:_____
small tube is inserted into _____ artery then threaded to the area needed where glue or wire is used to block off area
Risk of bleeding from an AVM (increases/decreases) over time.