CVA Rehab Notes PDF

CEBU DOCTORS’ UNIVERSITY COLLEGE OF REHABILITATIVE SCIENCES DEPARTMENT OF PHYSICAL THERAPY PT 302 (Neurologic PT 1) Rehabilitation of Cereb...

CEBU DOCTORS’ UNIVERSITY COLLEGE OF REHABILITATIVE SCIENCES DEPARTMENT OF PHYSICAL THERAPY PT 302 (Neurologic PT 1) Rehabilitation of Cerebrovascular Accident (CVA) Prepared by: Daniel Dominick G. Te, PTRP CEREBROVASCULAR ANATOMY This document is developed by Daniel Dominick G. Te, PTRP for the BSPT students of CDU. Using this document for other purposes, kindly seek permission at [email protected]. DEFINITION ▪ Stroke is the sudden loss of neurological function caused by an interruption of blood flow to the brain ▪ Is an acute onset of neurological dysfunction due to an abnormality in cerebral circulation with resultant sign and symptoms that correspond to involvement of focal areas of the brain ▪ CVA is used interchangeably with stroke that refer to the cerebrovascular conditions that accompany either ischemic or hemorrhagic lesions ▪ Neurological deficits must persist at least 24 hours to be classified as stroke EPIDEMIOLOGY ▪ Fourth (4th) leading cause of death ▪ Leading cause of long-term disability among adults in the US ▪ Approximately 795,000 individuals experience stroke each year ▪ M > F; in older age (>85 years), this is reversed ▪ Account for 1/18 deaths in the US ▪ Increases with the presence of risk factors ETIOLOGY MODIFIABLE RISK FACTORS ▪ Physical inactivity ▪ Obesity ▪ Alcohol consumption ▪ Cigarette smoking ▪ Hypertension – most important and treatable risk factor ▪ Heart disease NON-MODIFIABLE RISK FACTORS ▪ Family history of stroke ▪ Race ▪ Age – most common risk factor ▪ Previous stroke ▪ Sex RISK FACTORS MODIFIED BY MEDICAL MEANS ▪ Transient ischemic attack (TIA) ▪ Asymptomatic carotid bruits ▪ Diabetes mellitus This document is developed by Daniel Dominick G. Te, PTRP for the BSPT students of CDU. Using this document for other purposes, kindly seek permission at [email protected]. Atherosclerosis - Major contributory factor in cerebrovascular disease - Characterized by plaque formation with an accumulation of lipids, fibrin, complex carbohydrates, and calcium deposits on arterial walls that leads to progressive narrowing of blood vessels - Most common sites for lesions to occur (areas of predilection): o Origin of common carotid artery o Transition into the middle cerebral artery o Main bifurcation of middle cerebral artery o Junction of vertebral arteries with basilar artery PREVENTION OF STROKE: EARLY WARNING SIGNS PATHOPHYSIOLOGY ▪ Sudden cessation of cerebral blood flow and oxygen-glucose deprivation sets in motion a series of pathological events ▪ Within minutes neurons die within the ischemic core tissue ▪ Ischemic cascade – number of damaging cellular events This document is developed by Daniel Dominick G. Te, PTRP for the BSPT students of CDU. Using this document for other purposes, kindly seek permission at [email protected]. CLASSIFICATION OF STROKE A. Temporal Classification 1. Transient Ischemic Attack (TIA) - Temporary interruption of blood supply to the brain - No neurological deficit; complete recovery within 24 hours - This is a risk factor for stroke - Presence of Subclavian Steal syndrome – cerebrovascular spasm (blood clot in the subclavian artery) 2. Reversible Ischemic Neurologic Deficit (RIND) - Occurs as a result of small infarctions resulting to temporary impairment - Beyond 24 hours but still reversible 3. Stroke in Evolution - Progressive involvement of more severe neurologic deficits/impairments - Due to lacunar and thrombotic stroke 4. Complete Stroke - Condition reaches a state wherein the neurologic deficits are stable, irreversible and does not progress to become more severe 5. Major Stroke - Deficits are stable but are usually more severe 6. Deteriorating Stroke - Refers to the patient whose neurological deficit is deteriorating after admission from hospital 7. Young Stroke - Affects individuals below 45 years of age B. Classification according to etiology/pathogenesis 1. Ischemic Stroke – result of a thrombus, embolism or conditions that produce low systemic perfusion pressures a. Thrombotic - Occurs in 40% of cases - Refers to the formation of blood clot or thrombus within the cerebral arteries or their branches - Leads to ischemia with resulting infarction or tissue death (atherothrombotic brain infarction) - Is a gradual process; onset is slower than other types of strokes - Atherosclerosis is the major risk factor - TIAs are very common - Blood vessels commonly affected are the ICA and MCA - Common among elderly and occurs during night time - Most severe type of ischemic stroke This document is developed by Daniel Dominick G. Te, PTRP for the BSPT students of CDU. Using this document for other purposes, kindly seek permission at [email protected].  b. Embolic - Occurs in 30% of cases - Arise from platelets, cholesterol, fibrin or other bits of hematogenous material breaking off from an arterial wall or from the heart - Commonly caused by a myocardial infarction with atrial fibrillation - Abrupt onset; usually affects distal, small cortical vessels - Most common cause is cardiac embolism (atrial fibrillation is the most serious risk factor) c. Lacunar - Occurs in 20% of cases - Affects small blood vessels and perforating arterioles; very small infarctions (