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Cerebrovascular Accident (CVA)

  1. STROKE Presentation by Krystel Escano Brain Attack Cerebrovascular Accident
  2. Sudden loss of neurological function secondary to interruption of blood flow >24 hours manifestation 5th leading cause of death and severe long-term disability Stroke
  3. D E T E C T I N G E A R L Y S I G N S O F S T R O K E
  4. Nonmodifiable factors •Age: >60 • Gender: M>F • Ethnicity: African- American • History of previous stroke Risk factors Modifiable factors • HPN • Heart Disease • DM • Smoking • Hyperlipidemia • Obesity • Sedentary lifestyle
  5. site and extent of the affected area, or infarct, commonly determine the loss of function
  6. Stroke is classified by: Etiological classification Ischemic Stroke Hemorrhagic Stroke Specific vascular territory (vascular syndromes) ACA MCA Management category Transient Ischemic Attack Deteriorating Stroke Stroke in the young ICA PCA Vertebrobasilar Artery Syndrome Weber Benedikt Locked-in Millard-Gubler Wallenberg
  7. 01 Ischemic stroke 03 02 ISCHEMIA clot blocks or impaired blood flow 80% of stroke cases a.k.a. large vessels thrombosis 40% of stroke cases due to atheroma --> atherosclerosis Thrombotic 20% -25% of stroke cases due to embolism: dislodged atheroma Embolic a.k.a. small vessels thrombosis Secondary to hypertension 20% stroke cases due to atheroma affected sites: Basal Ganglia Cerebellum Pons Internal Capsule Thalamus Lacunar Etiological classification
  8. most common occlusion: lenticulostriate artery lesion site: posterior limb of internal capsule weakness/ataxia, C/L hemiplegia Occlusion: PCA Lesion site: thalamus sensory relay station C/L hemianesthesia tingling sensation of face and limbs Pure motor Pure sensory Lacunar stroke
  9. Parkinson's disease of any movement disorder Involuntary Movement 2nd most common occlusion PCA and LSA lesion site: junction of internal capsule and thalamus Least common type Lesion site: anterior limb of internal capsule Sensory Motor Dysarthria- Clumsy Hand Lacunar stroke Lesion sites: PICC Pons Internal Capsule Corona radiata Cerebellum I/L ataxia C/L hemiplegia Ataxic Hemiparesis
  10. 01 Hemorrhagic stroke SH 02 Rupture of a cerebral blood vessel 20% of stroke cases higher mortality rate than ischemic stroke bleeding directly into the brain most commonly linked to hypertension 3% of all CVAs, most common to women 95% cause by leakage of blood from aneurysm Etiological classification Intracerebral Subarachnoid Types of Subarachnoid Hemorrhage Saccular Aneurysm also known as Berry Aneurysm "worst headache of my life" Arteriovenous malformation congenital defect blood vessels usually form incorrectly
  11. 01 Management Category 03 02 Temporary interruption of blood supply to the brain < 24 hours +) residual brain damage/ permanent neurological dysfunction Transient Ischemic Attack (TIA) Stroke in evolution d/t cerebral or systemic causes Deteriorating Stroke < 45 years old Most common cause: Hemorrhage Higher potential for better recovery Stroke in the young
  12. Anterior Cerebral Artery Stroke Syndrome Specific Vasculary territory classifications (Vascular syndrome) C/L hemiparesis Sensory loss (+) Frontal Gaze Pattern (+) Urinary incontinence (+) abulia (akinetic mutism) MEDIAL ASPECT OF THE CEREBRAL HEMISPHERE (FRONTAL AND PARIETAL LOBES) LE > UE & Face
  13. UE & Face > LE C/L hemiplegia Middle Cerebral Artery Stroke Syndrome largest branch and most commonly stroked artery Specific Vasculary territory classifications (Vascular syndrome)
  14. UE & Face > LE C/L hemiplegia Middle Cerebral Artery Stroke Syndrome Specific Vasculary territory classifications (Vascular syndrome)
  15. Internal Carotid Artery Stroke Syndrome Specific Vasculary territory classifications (Vascular syndrome) MCA stroke syndrome features (UE > LE) Distinct features: Ophthalmic artery Amaurosis Fugax MCA UE & face > LE Supplies MCA and ACA
  16. Posterior Cerebral Artery Stroke Syndrome Specific Vasculary territory classifications (Vascular syndrome) Visual Problems Supplies occipital lobe and medial and inferior temporal lobe C/L homonymous hemianopsia (occipital infarction) Visual agnosia Prosopagnosia Dyschromatopsia (color agnosia) Simultanagnosia (aka: Balint’s syndrome) Alexia without agraphia
  17. Posterior Cerebral Artery Stroke Syndrome Specific Vasculary territory classifications (Vascular syndrome) Memory Impairment Supplies occipital lobe and medial and inferior temporal lobe Short-term memory Long- term memory Immediate recall Amnesia (Temporal lobe ischemia) C/L hemiballismus Subthalamic involvement
  18. Posterior Cerebral Artery Stroke Syndrome Specific Vasculary territory classifications (Vascular syndrome) Midbrain involvement Supplies occipital lobe and medial and inferior temporal lobe C/L hemiplegia (CST involvement ->motor) CN 3 palsy Weber syndrome Benedikt syndrome Thalamic Pain Syndrome a.k.a central post-stroke sydnrome Dejerine-Roussy Syndrome
  19. Vertebrobasilar Artery Syndrome Specific Vasculary territory classifications (Vascular syndrome)
  20. large proximal MCA occlusion --> coma, decreased arousal level involuntary increase in muscle tone velocity-dependent resistance 90% of stroke cases Altered Consciousness Cognitive Deficits Neurological and Functional Complications • Difficulty with Alertness • Attention •Orientation • Memory • Executive functions Spasticity Modified Ashworth Scale (MAS)
  21. delayed triggering of the swallowing reflex reduced pharyngeal peristalsis reduced lingual control. Ideomotor apraxia Ideational apraxia oral apraxia dressing apraxia constructional apraxia gait apraxia limb-kinetic apraxia Dysphagia Aphasia Neurological and Functional Complications an acquired communication disorder caused by brain damage Apraxia IDEATIONAL VS IDEOMOTOR
  22. Gaze Impairments Neurological and Functional Complications 01 02 Pontine Gaze Pattern •due to anterior circulation stroke •looks toward the lesion site •looks away from the hemiplegic side •lesion site: area 8 or the frontal eye field of frontal lobe •due to posterior circulation stroke •looks away from the lesion •towards the hemiplegic side •lesion site: pontine nuclei Frontal Gaze Pattern
  23. depends on the type and location of the vascular lesion, as well as the severity of the clinical deficits. Medical Management aspirin and heparin to improve flow through occluded vessels and prevent further clotting or thrombosis Anti-platelet and anti-coagulation drugs 01 Tissue plasminogen activator (t-PA): open occluded cerebral vessels and immediately restore circulation. Limited, 3-6 hours after stroke onset Thrombolytic drugs 02
  24. Intervention Principles for Stroke Intrinsic Recovery refers to the remediation of neurological impairments Adaptive Recovery entails regaining the ability to perform meaningful activities, tasks, and roles without full restoration of neurological function ACTIVE USE OF TASK-ORIENTED TRAINING (Pendleton and Schultz-Krohn, 2018) Help clients adjust to role and task performance limitations by exploring new roles and tasks. Create an environment that includes the common challenges of everyday life. Practice functional tasks or close simulations that have been identified as important by participants to find effective and efficient strategies for performance. Provide opportunities for practice outside therapy time. Minimize ineffective and inefficient movement patterns.
  25. Utilization Individuals with stroke are among one of the primary clients of occupational therapy facilitate the client’s performance of needed or meaningful occupations within realistic context Working collaboratively with the members of the rehabilitation team provides healthcare professionals in various practices with the fundamental knowledge necessary to work with the stroke population focus the evaluation procedures and begin to reflect on the client factors that may have been impaired and that affect the client’s occupational performance based on the brain lesions
  26. Reflection I was anxious as I prepared for this topic because stroke is one of the conditions I consider complicated. Many terminologies must be discussed, including anatomical structures and their physiological activities, as well as the accompanying conditions that I find intimidating. For me, it is one of those conditions that has been discussed numerous times but is still difficult to recall. Still, I was thrilled to be assigned this topic because I see it as an opportunity to go over everything that had been previously covered with us. I am not confident enough to say that I have already improved in terms of application but I know that using this fundamental knowledge is essential to understand the symptoms, diagnosis, and management of stroke.
  27. Thank You So Much! Presentation by Krystel Camille Escano Noted by Miss Ma. Alessandra Elisabeth Könst, OTRP and Sir Jace Devin Lapus, OTRP
  28. Atchison, B., & Dirette, D. (2016). Conditions in Occupational Therapy: Effect on Occupational Performance. Lippincott Williams & Wilkins. O’Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2019). Physical Rehabilitation (7th ed.). F.A. Davis. Pendleton, H. M., & Schultz-Krohn, W. (2013). Pedretti’s Occupational Therapy - E- Book: Practice Skills for Physical Dysfunction. Elsevier Health Sciences. Pendleton, H. M., & Schultz-Krohn, W. (2018). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction. Mosby. Radomski, M. V., & Latham, C. a. T. (2008). Occupational Therapy for Physical Dysfunction. Lippincott Williams & Wilkins. 1. 2. 3. 4. 5. REFERENCES