CVA

By Christopher Chew ( Mahsa University College)

What?
CVA Cerebrovascular Accident / Stroke Definition: A sudden death of brain cells due to lack of oxygen when blood flow to brain is disrupted due to blockage or rupture of artery to the brain ( MedicineNet.com)

Types..
i) Stroke is divided into two kinds : Occlusive( Ischemic) - Thrombus - Embolus Hemorrhagic - intracerebral hemorrhage - subarachnoid hemorrhage.

ii)

iii) Transient Ischemic Attack

ACA syndrome
Contralateral hemiparesis ( >LE) CL hemisensory loss (>LE) Urinary incontinence Mental status impairment

Sign & Symptoms

- Varies depending on the area of brain affected - Common Symptoms : *Unilateral weakness/paralysis *Speech Impairment *

Medical Management of stroke

Management of Acute Stroke

- Begin as soon as pt. is medically stable ( 72 hrs) : Musculoskeletal Integrity: - Mobilization ( Passive/Active) - Positioning
*Prevents muscle shortening /stiffness & promotes circulation

Respiratory Function - Positioning - Chest Physiotherapy

*Prevents secondary complications such as Bronchopneumonia / secretion retention

Management of post-acute stroke

Active rehabilitation can take place Rehabilitation varies depending on type of impairment which is present in patient. Categories of Impairment: - Motor Function - Cognitive/Perceptual - Sensory - Bladder/bowel - Postural control /Balance - Speech/Language/Swallowing

Painful shoulder
Manifest as a secondary complication Occurs as early as two weeks after stroke Causes:
GH subluxation Spasticity of shoulder muscles Impingement soft tissue trauma, rotator cuff tears glenohumeral capsulitis bicipital tendinitis

Management
Aim: - Prevention - Relieve Pain - Increase Mobility

Proper handling and Positioning:

* Flaccid stage- Affected shoulder to be supported * Sitt./Sup. Ly Sh. Protraction, Arm forward w slight abduction & neutral rotation * Avoid lifting by pulling arm * Usage of taping / arm sling when walking / standing

 Pain Relieve :
*Mobilizing technique ( G1/G2) *Electro Modalities : U/S , TENS *Cryotherapy

Mobilization:
*Passive ROM ( w care) *Active Assisted Exc. *Gentle Stretching

Mx of sensory impairment
- Loss of proprioception - Loss of superficial touch and pain - May lead to unilateral neglect, more injuryprone, difficulty in daily functional activities Strategies:
* Encourage pt. to use affected side * Sensory Stimuli: Stroking,Stretching,Joint approximation * Integrating functional task into selection of sensory inputs

MX of Motor function
-Flaccidity -Weakness -Spasticity -Abnormal Reflex Strategies: i) To improve flexibility & Jt. Integrity
* AROM and PROM w. terminal stretch *Positioning