Difficulty swallowing, motor difficulty in oral muscles, delay in the swallowing reflex, can lead to aspiration.
- Difficulties with communication
- Difficulty processing information in a linear, sequential manner
- Cautious, anxious, and disorganized
- Realistic in appraisal of their problems
Left hemisphere damage (R hemi)
- Difficulty with spatial-perceptual tasks
- Difficulty understanding overall pattern or organization
- Quick and impulsive
- Overestimate abilities, poor judgement
- Difficulty attending to visuospatial cues
Right hemisphere damage (L hemi)
The tendency of some people with CVA to push very strongly away from the unaffected side is called?
Pusher syndrome
What is abnormal synergy patterns?
Stereotyped mass movement patterns, primitive and automatic. May not be seen at rest.
Which hemisphere is damaged in patients who have difficulty with communication?
Left hemisphere damage
Which hemisphere is damaged in patients who have difficulty processing information in a linear, sequential manner?
Left hemisphere damage
Which hemisphere is damaged in patients who are cautious, anxious, disorganized, and realistic in appraisal of their problems?
Left hemisphere damage
Which hemisphere is damaged in patients who have difficulty with spatial-perceptual tasks?
Right hemisphere damage
Which hemisphere is damaged in patients who have difficulty understanding overall pattern or organization?
Right hemisphere damage
Which hemisphere is damaged in patients who are quick & impulsive, overestimate abilities, and have poor judgement?
Right hemisphere damage
Which hemisphere is damaged in patients who have difficulty attending to visuospatial cues?
Right hemisphere damage
In abnormal synergy pattern, what are the flexion components of the UE?
Scapular retraction/elevation
Shoulder abd, ext. rotation, or hyperextension
Elbow flexion
Forearm supination
Wrist and finger flexion
In abnormal synergy pattern, what are the extension components of the UE?
Scapular protraction
Shoulder adduction and int. rotation
Elbow extension
Forearm pronation
Wrist and finger flexion
In abnormal synergy pattern, what are the flexion components of the LE?
Hip flexion, abduction, ext. rotation
Knee flexion
Ankle dorsiflexion
Toe dorsiflexion
In abnormal synergy pattern, what are the extension components of the LE?
Hip extension, adduction, int. rotation
Knee extension
Ankle plantar flexion, inversion
Toe planter flexion
What muscles are not usually involved in synergies in either position?
Latissimus dorsi
Teres major
Serratus anterior
Finger extensors
Ankle everters
What is an associated reaction?
Automatic responses of extremities that occur as the result of movement elsewhere in the body.
What are the motor deficit impairments s/p CVA? (6)
Alterations in tone
Abnormal synergy patterns
Associated reactions
Altered reflexes
Altered muscle activation patterns
Disturbed balance and postural coordination
What are the indirect impairments s/p CVA? (5)
DVT
Skin breakdown
Contracture and deformity
Deconditioning
Reflex sympathetic dystrophy
Shoulder subluxation
What are the 2 suggested causes of shoulder subluxation and pain?
Flaccid stage
Spastic stage
What are the 5 approaches to treatment to patients with CVA?
Positioning
ROM
Sensory training
Tone modification
Establish postural control and functional mobility
When should positioning be addressed in treatment?
Early
How do you maximize awareness of the involved side of a patient with CVA?
WB on involved side for sensory sensory input.
Encouraging visual regard toward the hemiplegic side.
When positioning a patient with CVA, you want to orient both sides of the body to ______ when possible.
Midline
What is the common malalignment of the scapula after CVA?
Downward rotation
What is the common malalignement of the glenohumeral joint after CVA?
Humeral depression with subluxation resulting from lateral trunk flexion and scapular downward rotation.
What is the common malalignment of the UE after CVA?
What is the common malalignment of the LE in standing after CVA?
Pelvic retraction and elevation
Hip extension with internal rotation and adduction
Knee extension and ankle plantar flexion
What is the common malalignment of the LE in sitting after CVA?
Hip flexion with abduction and external rotation
Knee flexion and ankle plantar flexion
T or F: When doing ROM after CVA, AROM is always preferable to PROM when possible.
True
What is the advantage of a sling/support to protect the UE?
Provides support during upright activities when the arm is in a dependent position and decrease soft tissue stretching.
What is the disadvantage of a sling/support in patients after CVA?
Traditional slings position the arm in an undesirable position, impair balance and trunk mobility, and promote neglect and disuse.
What treatment approach increases sensory input with stretch, touch, deep pressure, resistance, and other sensory modalities?
Sensory training
The treatment is setup so that the patient must rely on the hemiplegic side of the body to complete an activity, aka forced use.
Constraint-induced treatment
What are some techniques for tone modification after CVA?
Rotation
WB/joint approximation
Deep pressure/prolonged pressure
Joint mobilization techniques
Slow rocking combined with rotation and WB
T or F: Once range and muscle tone are gained, active movement in a functional activity is necessary to reinforce normal movement with more normal alignment.
True
What are some strategies for working with contraversive pushing?
Visual cues to give patient feedback about body orientation.
Work in area with many vertical structures.
Provide patient experiences in which he maintains vertical without losing balance.
T or F: The patient only needs a foundation from which to attempt the next level of difficulty in movement.
True
What is the abnormal foot posture after CVA?
Inversion and ankle plantar flexion
Patients with these characteristics do poorly in rehabilitation?
Advanced age
Severe motor impairments
Persistent medical problems
Decreased alertness
Inability to learn new tasks
What are the most common characteristics of MCA syndrome?
