CVA

Pathology

• Stroke causes brain to be deprived of blood that carries O2 and glucose leading to injury/cell death
• Ischemic: occlusion of major arteries due to thrombus or embolism
• Hemorrhagic: due to blood vessel rupture
• Symptoms are brain location-specific

IMPAIRMENTS

• Sensory/Motor (tone alterations, abnormal synergy patterns/reflexes)
• Posture Control/Balance
• Speech/Language
• Perception (body scheme, i.e. unilateral neglect, spatial relations)
• Cognition (attenuation, memory, confusion, perseveration, dementia)

IMPAIRMENTS (CONT.)

• Emotional (pseudobulbar effect, emotional lability)
• Hemispheric behavioral differences
• Bowel/Bladder

COMPLICATIONS

• Seizures
• DVT
• Skin breakdown
• Contractures
• Shoulder subluxation
• Osteoporosis

COMPLICATIONS (CONT.)

• Disuse atrophy
• Aspiration
• Incontinence
• Depression

INSTRUCTIONS/EDUCATION

• Watch vital signs
• Maintain glucose levels
• Control: seizures, infection, ICP, incontinence, skin integrity, Reduce DVT and aspiration, Reduce ulcers

TREATMENT INTERVENTIONS

• Bed mobility
• Sitting and standing weight shifts
• Gait modifications
• Step ups
• PNF
• Positioning for bed, chair, and standing
• Facilitation and inhibition techniques

TREATMENT CONSIDERATIONS (CONT.)

• Prolonged ice
• Head/trunk control
• Static/Dynamic Balance
• Extremity control

ARTICLE REVIEWED

• "Correlations among trunk impairment, functional performance, and functional activity during functional reaching task in patients with chronic stroke" by Kim, J. et. al.

ARTICLE FINDINGS

• Correlations between trunk control/balance
• Trunk muscles play an important role in balance/gait during functional activities
• 23 CVA patients
• Trunk Impairment Scale (TIS), TUG, BERG and 10MWT to evaluate
• Forward reaching tasks w/ Telemyo EMG

ARTICLE FINDINGS (CONT.)

• Results: “Trunk impairment was found to be correlated with balance, and gait; therefore, any intervention that improves trunk performance will facilitate improvement in balance and gait in stroke patients”
• TIS showed lesser weight shift over sound limb = trunk stability impacts one's balance needed for gait

RESOURCES

• Research Article by Kim, J. et. al.
• Physical Rehabilitation (O'Sullivan)
• Neurologic Interventions for the PTA (Martin/Kessler)