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Stroke Assessment (FINAL EXAM)
Terms in this set (17)
Purpose of the Examination:
What are you trying to determine? (Dx, prog.., )
What plan is formed from this? (d/c, POC) Who needs to be involved with goal setting?
Monitor changes associated with rec..?
Assess what conditions/deficits?
What needs to be documented? (compl... )
Examination gives you the need to make referrals to where? (another pract..., support... gr.., etc.)
What is the general order of testing? (Or..., Act...., Imp..)
*Determine PT dx & movement dx, prognosis
*Clinical decision-making; POC, D/C plan
Be sure that the pt is involved in goal setting!
*Monitor changes associated with recovery
*Assess comorbid conditions / deficits
*Document evolving complications (seizures)
*Need for referrals; another health care practitioner, support groups etc
*Order of testing:
Orientation, Activities, Impairments
What history are we looking at? (PMH, fam...,) Why is family history important? (how likely ......)
Is health status important?
What aspects of baseline functioning level do we look at? (soc..., cog..., personal....) Will personality traits change after a CVA?
*History of current conditions, symptoms
*Past medical/surgical history
*Family history: familial health risks
Tells us how likely person is to have another CVA
*Base-line functioning level of patient
Social / recreational / work status
Personality Traits (may change)
Speech & Language Disorders:
What is Aphasia? (impaired what? )
What % of CVA pts have it? (30-__) What artery is usually the culprit?
What are the 2 types of aphasia? (exp... and rec...)
With Expressive Aphasia, is it fluent or nonfluent? Is there a ↓ in speech flow, production and articulation or a ↓ in comprehension of spoken language? Is there a ↓ in reading and writing or a ↓ in vocabulary and sentences? Does this aphasia have you speak nonsense words, and experience word finding deficits?
With Receptive Aphasia, ...."
What is a global impairment? What does this indicate?
What is this? (speech pr... )
What % of CVA patients experience this? (48-__)?
Can this occur with aphasia?
Is there coordination or incoordination of motor-speech system?
↑or↓ in articulation/phonation?
What % of CVA patients experience this? (50, 51, 52, 53%?)
What cranial nerves are effected? (6 listed starting at V)
*Aphasia - Impaired language; formulation & comprehension
*30- 36% of CVAs (MCA typically)
Nonfluent aphasia (Broca's)
↓ speech flow, production & articulation
↓ vocabulary, sentences
fluent aphasia (Wernicke's)
↓ comprehension of spoken language
↓ reading, writing
Non-sense words, word finding deficits (Loss nouns & verbs, circumlocutions)
Global impairment - both
Indicates extensive damage
*Dysarthria: speech production deficits
(48-57% of CVAs)
Can occur with aphasia
Incoordination of motor-speech system
*Dysphagia: swallowing difficulty
(51% of CVAs)
CN V,VII, IX, X, XI, XII
Cognition / Behavior:
What deficits are seen? (sust..., selec..., dual..., alt..)
What % of patients show short term memory loss? (33, 34, 35, or 36%)
what other cognitive deficits are seen? (confab..., exec... )
Will they have problem solving and safety issues?
What is perservation?
What % of patients have multi-infarct dementia? (6-__%)
Is it a small or large vessel disease? Is the onset abrupt or something that happens over time?
What are some affective disorders seen? (emotional lia.., dysreg... syn..., pseudo.... effect.., patients go from apathy to eu..)
How many patients experience depression after a CVA? (30, 31, 32, 33%?) When does it occur? How long does it last for? Is there an increased prevalance with R or LCVA during the acute phase? How about the subacute phase? Is depression related to the severity of the CVA?
*Attention deficits (Distractibility)
Sustained (time on task)
Divided (2 tasks @ once)
↓ Short term Memory (36%)
Executive Function/ Abstract reasoning→ purposeful behavior
Problem solving & safety
Perseveration (stuck on 1 mvmt)
*Multi-infarct dementia (6-32%)
small vessel disease, scattered
Abrupt onset, fluctuating status
Pseudobulbar affect (go from laughing to crying)
apathy → euphoria
Usual onset 6 mos - 2yrs
Lasts months or more
↑ prevalence in L CVA in acute phase (frontal) , R CVA sub acute (parietal)
not related to severity of CVA
May occur with anxiety
Mini Mental State Exam (MMSE):
What ICF Domain does it fall in? (Bod... Func..., Cog...)
Widely used in what settings? (IP, OP, NH, res..)
Is it a reliable screen?
What is the max score? (10, 20, 30, or 40?)
What is the cut off score demonstrating a cognitive impairment? What would indicate a mild impairment? Severe?
There may have low sensitivity with patients with mild, moderate, or severe impairments? And right or left lesions? Mild moderate or severe dementia?
Are patients more or less prone to ceiling effects than the MoCA?
*ICF Domain: Body Function, Cognition
*Widely used in IP, OP, NH, research
*Reliable, valid quick screen of cognitive function
*Max score 30 points
Cut off Score < 24 = cognitive impairment
18- 24 = mild impairment
0-17 = severe impairment
* May have low sensitivity among patients with:
Mild cognitive impairment (esp. PD)
Right-sided lesions "within a general neurological patient population"
*more prone to ceiling effects than the MoCA
A screening exam should lead to what? (detail... ass...)
What visual deficits are looked at? (hemi..., conjuga.. )
What else is looked at? (cran.. ner.. inte.., and brain.. stro...)
*Screening Exam > Detailed Assessment
Conjugate eye deviation
*Cranial nerve integrity
Crossed anesthesia; opp face - limb involvement
Sensory Integrity Assesment:
What do you see a contralalateral loss with? (t.., prop.., pin..., vib..)
What do you see ipsilateral losses with? (central post...)
With Central Post Thalamic Pain Syndrome, where would the lesion be? (anywhere in pathway, med.., and thal) How does the pain feel? (deb.., burn.., ach.., shoot...) Is the pain more focal (hand/arm) or does it travel to half the body? When is the onset?
*Ipsilateral loss 12-25%
Central post stroke pain (CPSP aka Thalamic pain syndrome) (A LOT OF PAIN (leads to non-use of limb from how much pain you have)
Lesion anywhere in pathway, medulla & thalmus
Debilitating; burning, aching, shooting pain→ poor use & ↓ prognosis
Can be focal (arm/hand) or half of body
Onset months after CVA but recovery rare
Motor Function Assessment:
Alterations in tone: Flaccidity will lead to what?
Obligatory synergy ==> what movements?
What reflexes/reactions are seen? (normal or abnormal)
Is dexterity, coordination, and agility fine? What artery may be affected?
May have what sort of deficits? (mot.. prog... )
Is there a disturbance in postural control and balance?
*Alterations in tone:
flaccidity > spasticity
typical patterns of distribution
Obligatory synergy > isolated movements
*Abnormal reflexes, associated reactions
*Impaired dexterity, coordination, agility
Basilar artery, Lat. Medullary syndrome
*Motor programming deficits / Apraxia
*Disturbances in postural control & balance
What deficits are seen? (str.., pow.., and end..., Coor...., joint integ.. and mob..)
Strength, Power, and Endurance:
What % of patients demonstrate ↓ force production? (40-50, 60-70, 80-90, or 90-100%?) Do you see losses go distal to proximal or proximal to distal? Is weakness ipsi or contralaterally?
Coordination Deficits: What ataxia is seen? (sens.., and cereb..)
*Deficits in strength, power, endurance
80-90% pts demo ↓ force production
Distal loss > proximal
*Deficits in coordination
Sensory & cerebellar ataxia
*Deficits in joint integrity and mobility
What deficits are seen? (loco.. and ga.., and in BA__ and IA__, and aero..)
Is there an ↑ or ↓ in the use of AD's?
What issues with bowel/bladder is seen?
What is seen with orofacial?
*Deficits in locomotion, gait
*Deficits in BADLs, IADLs
*↑ need/use assistive, adaptive devices
*Bowel / bladder dysfunction / incontinence (should resolve quickly)
*Orofacial dysfunction / dysphagia
*Deficits in aerobic capacity and endurance
Orpington Prognostic Score:
What is this an assessment for? (sev.. and prog..)
When is it administered? ( acute, subacute, or chronic stage of CVA?)
This Test includes measures of what? (mot.. def.., prop.., cogn.., and bal..)
Scores range? (1.6-__) What indicates a greater deficit? (higher or lower score?)
What is a mild-mod impairment? (< or > 3.2, 3.2-5.2, or >5.2?)
Which score would indicate high likelyhood of returning home? Responds to rehab? Dependent, ↑ risk of institutionalization?
*Assessment of stroke severity, Prognosis
*Administer in acute, subacute stages
Once pt stable- 2 weeks -6 mo post CVA
*Includes measures of:
*Scores range from 1.6 - 6.8, higher scores indicate greater deficit
Mild- mod <3.2 = high likely hood of returning home
Mod- mod/severe 3.2 - 5.2 = responds to rehab
Severe- major >5.2 = dependent, ↑ risk of institutionalization
Postural Assessment Scale for Stroke Patients (PASS):
What is it looking at?
When is it appropriate to use? (acute, subacute, or chronic CVA?)
Discriminates between what hemisphere damage?
How many items are scored? How many for static posture? How many for dynamic balance?
Scored? (0-_?) Max score is what?
Higher or Lower scores indicate more function?
What is normal score range? (24-28, 28-32, or 32-36?)
MDC? (2, 2.1, 2.2, 2.3, or 2.4? )
*Performance based assessment of postural control after CVA
*Appropriate for use early after CVA (first 3 mos)
Highly recommended for all practice settings & acute -subacute but not chronic stroke
*Discriminates between R &L hemisphere damage
*12 items, ↑ing difficulty
5 static "maintain posture"
7 dynamic balance "changing posture"
*Items scored 0 - 3 , Max score = 36
higher scores indicate higher function
Norm range 32- 36, MDC = 2.2
Fugl-Meyer Assessment of Motor Recovery (FMA)
What is this assessment based on? (Brun..)
What is the ICF domain? )bod.. func..) Can it be used in all settings?
Is it a performance-based test or subjective? What is score range? What is the total potential score?
Is this used more in research?
Can subscales be used independently? What are the 5 domains? (mot.., bal.., sens..., passive..)
Are the separate sub scales valid?
MDC for UE portion? (5, 5.1, 5.2, 5.3?)
MCID when ↑ in 10pts UE? (1, 1.5, 1.9, 2.4, or 2.5 change in d/c FIM score)
when ↑ in 10pts LE? (1, 1.5, 1.9, 2.4, or 2.5 change in d/c FIM score)
*Based on work of Brunnstrom
*ICF domain: Body Function
*Measures recovery post CVA
Can be used in all settings
*Performance based test, uses 3 pt ordinal scale
0 cannot →2 performs fully
*Total score: 226
*Frequently used in Research "Gold Standard"
*Subscales can be used independently (AND THEY ARE EACH VALID!)
*FMA motor scale: 100 pts
UE: 66 pts
LE: 34 pts
*Sensation: 24 pts
*Passive joint motion/joint pain:44 pts
*MDC for UE portion = 5.2
↑10 pts UE= 1.5 change in d/c FIM score
↑10 pts LE= 1.9 change in d/c FIM score
Stroke Impact Scale:
Is it a self report?
What does it assess? (health before or after a CVA?
Is this used more in research or the clinic?
What stage of CVA is this used with? (acute, subacute, or chronic?)
What setting is this used in? (S__, O_, HH)
Does it correlate well with FIM?
What is the scoring scale?
What is the max points?
how many items are looked at? How many domains?
*Assesses health after CVA; activity & participation
*Used in research and clinic
Sub acute & chronic CVA (more so in subacute though)
SNF, OP, Home Health
Tracks changes over time
*Excellent correlation with FIM
*5 point Likert scale
*1- couldn't do → 5 not difficult at all
*Score 0 -100
*0= no recovery, 100 = full
*59 Items, 8 Domains
Rivermead Motor Assessment:
What stage of stroke is it used with? (Acute, sub acute or chronic CVA) Used in what settings? (in.., out.., S__)
Used in clinic or for research?
Is it a self report or performance based one?
what is score range? Total possible score?
how many items for gross motor function? (15, 10, or 13?) Leg and Trunk?( "") Arm?("")
Why don't we use it in the clinic? (time)
MCID score? (1, 2, 3, or 4?)
*Acute, sub acute & chronic CVA
Inpt, outpt & SNF
*Clinic & research (mostly research though)
1 =can perform or 0 =cannot
total score: 38
*Gross motor function: 13 items
*Leg and trunk: 10 items
*Arm: 15 items
*45 min to complete (not using this in the clinic!)
*MCID = 3 points
Chedoke-McMaster Stroke Assessment:
Used for what stage of stroke? (acute, subacute or chronic?)
Used in clinic or for research?
Assess what? (bod.. fun.., and act...)
What Inventorys are scored? (Imp..., and Act.. Inv..) Both are scored on what point scale?
MCID? (5, 6, 7, 8?)
What score on the leg and postural control scores indicates I amb? (>7, 8, 9, or 10?)
Measures severity of what? (imp..)
What areas are looked at? ( ar.../han..., leg/fo.., post.., shld...)
Scoring follows what stages? (mot... rec..)
What is the max score? (40, 41, 42, 43, 44? )
Measures functional ability including what? (gros... and wal...)
What about walking is looked at? (in.., out..., ram..., st.... 2MWT)
does scoring follow FIM?
Does a lower or higher score indicate better function?
Max score=? Max gross motor score=? Max walking score=?
*Used for acute, subacute & chronic CVA
*Used in clinic and research (45-60 min to complete... so not good for the clinic)
*Assesses body function & activity
Impairment and Activity Inventory
Both scored on 0-7 scale
*MCID = 8 points
*>9 on Leg & postural control scores indicates I amb
*Measures severity of impairments
*Scoring follows 7 stages of motor recovery
*Max score =42
*Measures functional ability including
*Gross motor function
Indoors Outdoors; curbs, ramps, x several blocks
*Scoring follows FIM
*Higher score = better function
*Max score = 100
Max gross motor = 70
Max walking = 30
Stroke Rehabilitation Assessment of Movement Measure (STREAM):
This is an evaluation of what? (mot.. func..)
Is this designed for research or clinical use?
Scored according to what? (instr.. )
What is a max score? (40, 50, 60, or 70?)
How many items looked at? (10, 20, 30, or 40?)
What 3 subscales are used? (up.., low.., basi..)
MCD for chronic CVA=? (4, 4.1, 4.2, 4.3)
UE subscale=? (1.9, 2.2, or 4.8)
LE subscale=? (1.9, 2.2, or 4.8)
Mobility subscale=?(1.9, 2.2, or 4.8)
*Eval of Motor Function
*Designed for clinical use
15 mins to administer
*Scored according to instrument (0- 2 or 3) requires several steps
*Max score = 70
*30 Items, Total score is avg of 3 subscales:
Upper limb mvmt (2o pts)
Lower limb mvmt (20 pts)
Basic mobility (30 pts)
*MCD chronic CVA = 4.2
UE subscale - 2.2
LE subscale- 1.9
Mobility subscale - 4.8
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