assessments
NIH stroke scale |
15 item evaluation for CVA on consciousness, language, neglect, visual fields, eye movement, motor strength, ataxia, dysarthria, and sensation. 0=No CVA, 21-42=Severe CVA. |
Mini FIM |
Evaluation of function – self-care, transfers, mobility, and cognition. 0=Not taken place, 1= total assist, 7= independent. A score is obtained for each functional task. Includes 7 of the 18 items of the FIM. |
FIM |
being phased out and replaced with CARE Tool. |
Glasgow coma scale |
eye-opening, verbal response, and motor response. <3=vegatative state, 3-8=severe disability, 13-15=mild injury. |
barthel index |
evaluation of function for eating, grooming, bathing, bowel and bladder, toileting, dressing, mobility, transfers, and stairs. 0-100. 0=total dependence, 100=total independence. |
AM PAC 6 |
Measures the 3 functional domains of basic mobility, daily activities, and cognition. |
assessment of motor and process skills AMPS |
observation of ADLs in a natural environment. |
modified ashworth scale |
measures spasticity |
activity card sort |
clients describe their social, daily, and leisure activities. |
canadian occupational performance measure COPM |
captures client’s self-perception of performance in self-care, productivity, and leisure. |
community integration questionnaire |
assesses limitations in social and community interactions |
stroke impact scale |
self-report questionnaire of disability and health-related QoL |
reintegration to normal living index |
quantitatively assesses the degree that clients can reintegrate into social activities |
montreal cognitive assessment MoCA |
assesses for the level of cognitive impairment. |
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stroke tx considerations
type of occupation |
problems |
tx techniques |
occupations while seated |
1. Loss of trunk and postural control 2. Inability to sit in proper alignment 3. Loss of righting and equilibrium reactions 4. Increased risk for falls -may fall during attempts at function 5. Dysfunction in limb control -difficulty reaching beyond arm span 6. Visual dysfunction secondary to head and neck misalignment 7. Symptoms of dysphagia due to misalignment 8. Impaired ability to interact with the environment 9. Decreased ADLs |
1. Establish a neutral yet active starting alignment -feet flat on floor in weight bearing position -equal weight distribution through ischial tuberosities -neutral to slight anterior pelvic tilt -erect spine -head over shoulders and shoulders over hips 2. Establish the ability to maintain the trunk in midline using external cues. -mirror for visual feedback -verbal cues -environmental cues 3. Maintain trunk ROM through wheelchair and armchair positioning that maintains the trunk in proper alignment. -exercise program focused on trunk ROM -hands on facilitation as needed for mobilization 4. Dynamic weight shifting activities to allow practice of weight shift through the pelvis. -set up occupations to reach beyond arm span and limits of stability -adjust posture.. 5. Trunk strengthening -use tasks that require the patient to control the trunk against gravity -bridge the hips in supine position to strengthen the back extensors 6. Compensatory strategies and environmental adaptations -use when trunk control does not improve to a sufficient level, putting patient at risk -compensatory strategies such as one-handed shoe tying -adaptive equipment, including reachers and long handled devices -wheelchair seating systems -lumbar rolls -lateral supports -cushions |
occupations while standing |
1. Asymmetrical weight distribution -weight distribution is seen through the lower extremities as well as the trunk .. 2. Automatic postural controls may be impaired. -ankle strategies, used to maintain center of mass and control small, slow, swaying motions -hip strategies, used to maintain or restore equilibrium -stepping strategies, used when ankle and hip strategies are ineffective .. 3. Resulting problems with base of support (BOS) -movement of BOS toward the COM -steps taken to widen BOS |
1. Establish symmetrical BOS and proper alignment to prepare to engage in occupations -hands on support as needed -feet approximately hip width apart -equal weight bearing through feet -neutral pelvis -knees slightly bent -aligned and symmetrical trunk .. 2. Focus on ability to bear weight and shift weight through affected lower extremity. .. 3. Encourage dynamic reaching activities in multiple environments to develop task specific weight shifting abilities .. 4. Use the environment to grade task difficulty and provide external support5. Train upright control within the context of functional tasks |
inability to use language |
Aphasia – a language disorder that results from neurological impairment Global aphasia – loss of all language skills Broca’s Aphasia – expressive aphasia, results from damage to the frontal regions of the left hemisphere Wernicke’s Aphasia – receptive aphasia, results in the inability to understand language in both spoken and written forms Anomic aphasia – difficulty with word retrieval |
1. Give the patient time to respond – do not force a response .. 2. Use concise language and simple sentences .. 3. Insure generalization, or transfer of learning from one context to another -vary treatment environments -vary the nature of tasks -help patient to become aware of how he or she processes information -teach processing strategies -relate new learning to old .. 4. Types of transfer i. Near transfer – involves transfer of learning between two tasks with one or two different characteristics iii. Far transfer – involves transfer of learning between tasks that are conceptually similar but few or no characteristics in common iv. Very far transfer– spontaneous application of learning to everyday living |
inability to use UE |
1. Limitations due to: -pain -contracture -loss of motor control -weakness -learned disuse .. 2. Subluxation:-malalignment of the shoulder caused by instability of the glenohumeral joint -common complication of CVA -inferior subluxation – head of the humerus slides below the glenoid fossa – caused by muscle weakness and atrophy -anterior subluxation – head of the humerus sits anterior to the glenoid fossa – caused by weak rotator cuff musculature and muscle spasticity -superior subluxation – head of the humerus lodges under the acromion process and the coracoacromial ligament – also called high riding shoulder … 3. Tonicity: -low muscle tone immediately following CVA -glenohumeral joint and wrist are susceptible to damage due to subluxation and unstable wrist -splinting used to maintain joint alignment, protect tissues from changes in length, prevent injury, and assist with edema control -resting hand position to provide support to the palmar arch while maintaining neutral wrist position -high muscle tone may develop several days or weeks after CVA, resulting in limited movement and/or contracture of the affected arm |
1. Evaluation should focus on assessing the patient’s ability to integrate UE performance of functional tasks -use the affected UE to support performance … 2. Standardized assessments include TEMPA, AMAT, Jebsen, AMPS … 3. Weight bearing through affected UE … 4. Moving objects across a work surface with a static grasp -ironing, opening drawers, polishing furniture … 5. Reaching and manipulation -reach for and hold object -manipulate the object with thumb and finger movements -use objects of different sizes and shapes to facilitate hand control during reach and manipulation -choose activities appropriate for motor control level and grade tasks … 6. Constraint-induced movement therapy (CIMT) -restrain the unaffected arm to force movement of the affected arm … 7. Train the arm to be used in weight bearing while reaching |
areas of the brain
frontal lobe |
motor control |
premotor cortex |
problem solving |
prefrontal area |
speech production |
BROCAs area |
temporal lobe |
auditory processing |
hearing |
language comprehension |
wernickes area |
memory |
information retrieval |
brainstem |
involuntary responses |
parietal lobe |
touch perception |
somatosensory cortex |
body orientation |
sensory discrimination |
occipital lobe |
sight |
visual cortex |
visual reception |
visual interpretation |
cerebellum |
balance and coordination |
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stroke terminology
accommodation |
eyes ability to adjust to various distances in the environment |
acuity |
visual sharpness |
adaptation |
coping with the changes of task demands |
adhesive capsulitiis |
frozen shoulder |
adjustment to disability |
psychosocial condition in which the pt faces barriers to the acceptance of their disability |
agraphia |
acquired writing disturbance |
anarthria |
speech impairment resulting in the absence of speech |
ankle strategy |
autonomic postural responses to maintain balance using the ankles |
anomia |
inability to name things |
anosognosia |
poor insight or denial of one's own disabilities |
aphasia |
communication deficit resulting in the loss of the ability to speak or understand language |
aprosody |
difficulty expressing and recognizing social emotions |
astereognosis |
the inability to recognize things using touch; tactile agnosia |
blocked practice |
practice using drills with numerous reps |
broca's aphasia |
non fluent expression affecting speech |
cognitive orientation to daily occupational performance model |
a client centered meta cognitive approach with collaboration, goal setting, performance analysis, cognitive strategies, guided discovery to promote generalize and transfer |
color agnosia |
inability to name or recognize colors |
concrete thinking |
inflexible thinking |
confrontation |
movement of an object through the clients visual field |
convergence |
coordinated eye movement inwards to focus on an object |
cortical blindness |
blindness resulting from a lesson in the cerebral cortex |
dissociation |
separation of body parts during movement patterns |
divergence |
eye movement outwards |
environmental control unit |
a device used to interact with the environment |
far transfer |
introducing an activity of the same context but different from the initial task performed |
global aphasia |
severely impaired language |
hemianopsia |
visual field deficit (blindness) in half of the visual field |
heterotopic ossification |
overgrowth or deposit of bone in soft tissues which may affect movement |
hyperopia |
farsightedness |
ideational apraxia |
inability to perform a task due to loss of a model or mental representation of the procedure |
intermediate transfer |
changing a number of task parameters while keeping familiar initial task parameters |
ipsilateral pushing |
stroke syndrome characterized by physically pushing the body towards one side due to mispercevied center of gravity and midline |
learned nonuse |
lack of use of a body part resulting from stroke and its diminished perception of function |
motor adaptation |
ability to adapt to postural responses to environmental demands and task changes |
motor apraxia |
inability to perform purposeful movements due to impaired planning and sequencing of movements |
myopia |
nearsightedness |
near transfer |
performing an alternate form of the initial task |
neoplasm |
abnormal tissue growth, tumor |
organization |
ability to organize thoughts to perform a task in an organized manner with proper sequencing and timing |
praxis |
ideation, planning purposeful movements |
procedural memory |
recalling the steps of a task |
prosopagnosia |
inability to recognize familiar faces |
saccadic eye movements |
fast, voluntary, coordinated movements of the eyes to fixate back and fourth on two points at a distance |
somatoagnosia |
body scheme disorder characterized by decreased awareness of body structure and recognition of ones own body parts and their relationship to each other |
spasticity |
hypertonus and hyperactive stretch reflexes |
strabismus |
inability of eyes to cross axes due to imbalanced eye muscles, impaired saccades |
trendelenberg sign |
when one stands on the affected limb and the opposite gluteal fold falls |
unilateral body neglect |
forgetting about one side of the body due to stroke |
wallenberg sign |
horner syndrome, cerebeller ataxia and contralateral loss of pain and temp |
wernickies aphasia |
reduced speech comprehension |
symptoms associated with parts of the brain
internal carotid artery |
1. Contralateral hemiplegia, hemianesthesia. And homonymous Hemianopsia 2. Occurrence in dominant hemisphere is associated with aphasia, agraphia/dysgraphia, acalculia/dyscalculia, right/left confusion, finger agnosia 3. Occurrence in non-dominant hemisphere associated with perceptual dysfunction, unilateral neglect, anosognosia attention deficits, loss of topographic memory |
middle cerebral artery - most common |
1. Contralateral hemiplegia with greater involvement of the arm, face and tongue; sensory deficits; contralateral homonymous hemianopsia and aphasia if the lesion is in the dominant hemisphere 2. Pronounced deviation of the head and neck toward the side of the lesion 3. Perceptual deficits such as anosognosia, unilateral neglect, impaired vertical perception, visual spatial deficits |
anterior cerebral artery |
1. Contralateral lower extremity weakness, more severe than upper extremity weakness. 2. Apraxia, mental changes, primitive reflexes and bowel/bladder incontinence may be present. 3. Cortical sensory loss in lower extremity. 4. Intellectual changes including confusion, disorientation, whispering, slow processing speed, distractibility, limited verbalizations, amnesia 5. Total occlusion of artery results in contralateral hemiplegia with severe weakness of the face, tongue and proximal arm muscles, marked spastic paralysis of the distal lower extremity. |
posterior cerebral artery |
1. Broad, multiple symptoms 2. Sensory motor deficits, involuntary movement disorders, postural tremors, hemiataxia, memory loss, astereognosis, dysesthesia, kinesthesia, contralateral homonymous hemianopsia, anomia, topographic disorientation, visual agnosia |
cerebellar arteries |
1. Ipsilateral ataxia, contralateral loss of sensation of pain and temperature 2. Ipsilateral facial analgesia 3. Dysphagia, dysarthria, nystagmus and contralateral hemiparesis |
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