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Agnosia the inability to recognize familiar objects with one sensory modality, while retaining the ability to recognize the same object with other sensory modalities
Aneurysm localized arterial wall weakness with abnormal dilatation of a blood vessel due to congenital defect.
Anosognosia a perceptual impairment including denial, neglect, and lack of awareness of the presence or severity of one’s paralysis
Aphasia communication disorder caused by brain damage and characterized by an impairment of language comprehension, formulation, and use; excludes disorders associated with primary sensory deficits, general mental deterioration, or psychiatric disorders.
Fluent Aphasia (Wernicke’s or receptive speech flows smoothly with a variety of grammatical constructions and preserved melody of speech. Auditory comprehension is impaired.
Nonfluent Aphasia (Broca’s or expressive) the flow of speech is slow and hesitant, vocabulary is limited, and syntax is impaired, speech production is labored or lost completely while comprehension is good.
Global Aphasia a severe aphasia characterized by marked impairments of both production and comprehension of language. It is often an indication of extensive brain damage.
Apathy characterized by shallow affect and blunted emotional responses: may be confused with depression and poor motivation.
Aphagia inability to eat or swallow
Apraxia an impairment of voluntary learned movement that is characterized by an inability to perform purposeful movements not accounted for by inadequate strength, loss of coordination, impaired sensation, attentional deficits, or lack of comprehension.
ideational inability of the patient to produce movement either on command or automatically and represents a complete breakdown in the conceptualization of the task
ideomotor the patient is unable to produce a movement on command but is able to move automatically
Aspiration penetration of food, liquid, saliva, or gastric reflux into the airway, common in patients with dysphagia
Associated reactions automatic responses of the limbs that occur as a result of action occurring in some other part of the body, either by voluntary or reflux stimulation. In hemiplegia, associated reactions are stereotyped and abnormal
Asymmetric tonic neck reflex Rotation of head to one side response is that it flexion of skull limbs, extension of jaw limbs, bow and arrow (or fencing) posture. Onset at birth and goes away 4-6 months
Ataxia uncoordinated movement that manifest when voluntary movements are attempted; may influence gait, posture, and patterns of movements
Atherosclerosis form of arteriosclerosis in which yellowish plaques (atheromas) form with the vessel walls; plaques consist of lipids and other blood-borne substances.
Attention disorder impairments in sustained attention, selective attention, dividend attention, or alternating attention.
Automatic postural tone the adjustment of postural muscles that occurs normally in preparation for and during a movement task
Bradykinesia Extreme slowness and difficulty maintaining movement.
Brainstem herniation Secondary brain damage and neurological deterioration resulting from significant edema, elevated intracranial pressures, with resulting Contralateral and caudal shifts of brain structures.
Body image disorder disorder in which a normal-appearing person is either preoccupied with some imagined defect in appearance or is overly concerened about some ver slight physical anomaly.
Body scheme disorder The inability to recognize or correctly orient the parts of one's own body.
Circle of Willis Union of the anterior, middle, and posterior cerebral arteries (branches of the carotid and vertebrobasilar arteries), forming an anastomosis at the base of the brain.
Confabulation The patient fills in memory gaps with inappropriate words or fabricates stories.
Contralateral situated on, pertaining to, or affecting the opposite side, as opposed to ipsilateral.
Delirium (acute confusional state) A clouding of consciousness with dulling of cognitive processes and general impairment of alertness; patients may demonstrate confusion, agitation, disorientation, and illusions or hallucinations.
Dysarthria motor speech disorders caused by impairment in part of the central or peripheral nervous system that mediate speech production.
Dysesthesia an abnormal and unpleasant sensation, such as a sense of burning, numbness, pins and needles, tingling sensation
Dysphagia inability to swallow or difficulty swallowing
Dysphasia partial aphasia
Emotional lability [pseudobulbar affect(PBA)] or (emotional deregulation syndrome) emotional outburst of uncontrolled or exaggerated laughing or crying that are inconsistent with mood. Unable to control and can be triggered by only slight change.
Euphoria an exaggerated feeling of well-being, a sense of optimism incongruent with the patient’s incapacitating disability
Executive functions (cognitive) (executive order cognitive functions) includes the capacity to plan, manipulate information, initiate and terminate activities, recognize errors, problem solve and think abstractly.
Flaccidity absence of muscle tone
Forced-gaze deviation deviation of the eyes secondary to unopposed action of eyes muscles
Fugl-Meyer Assessment (FMA) this is the impairment based test with items organized by sequential recovery stage.
Hemiparesis motor deficits are characterized by weakness on side of body opposite side of lesion
Hemiplegia generically referred to the wide variety of motor problems as a result of stroke
Homonymous hemianopsia a visual field deficit
Hyperesthesia decreased sensitivity to sensory stimuli
Hyper-reflexia over active response to reflexes
Ipsilateral on one side of the body (example: may affect only 1 eye)
Ipsilateral Pusher Syndrome (contraversive pushing, Pusher syndrome) an unusual motor behavior following stroke characterized by active pushing with the stringer extremities toward the hemiparetic side, leading to a lateral postural imbalance and a tendency to fall toward the hemiparetic side.
Locked-in syndrome(LIS) tetraplegia and lower bulbar palsy (anarthria) with preserved consciousness following stroke involving bilateral infarction of the ventral pons
Lower Motor Neuron are the motor neurons connecting the brainstem and spinal cord to muscle fibers, bringing the nerve impulses from the upper motor neurons out to the muscles
Memory disorder includes impairments in immediate recall and short-term or long –term memory
Motor impersistence an inability to sustain a movement or posture
Paroxysmal (pain) occuring repeatedly and without warning
Patency (of circulatory vessels) the state of being freely open
Perseveration the continued repetition of words, thoughts, or acts not related to current context
Postural control (reactive) reacting to a destabilizing external force
Postural control (anticipatory) reacting to destabilizing during self-initiated movements
Proprioception the awareness of position sense and posture
Right-Left discrimination the inability to identify the right and left side of one’s own body or of that of the examiner
Spatial relations syndrome a constellation of deficits that have in common a difficulty in perceiving the relationship between objects in space, or the relationship between the self and two or more objects
Spasticity a hypertonic motor disorder characterized by velocity-dependent resistance to passive stretch; the result of an upper motor neuron lesion
Synergies (mass) precise spatial and temporal organization; coordination involves control of speed, distance, direction, rhythm, and levels of muscle tension
Thalamic pain (thalamic syndrome) vascular lesion of the thalamus resulting in sensory disturbance and partial or complete paralysis of one side of the body, associated with severe, boring-type pain; sensory stimuli may produce an exaggerated, prolonged, or painful response
Unilateral neglect the inability to register and to integrate visual stimuli and perceptions from one side of the environment (usually the left) not attributable to sensory based problems. As a result, the patient ignores stimuli occurring in that side of personal space
Upper Motor Neuron are motor neurons that originate in the motor region of the cerebral cortex or the brain stem and carry motor information down to the final common pathway, that is, any motor neurons that are not directly responsible for stimulating the target muscle
Visual neglect (visual inattention) rare phenomenon in which a patient can see all of the visual field binocularly but somehow ignores objects on one side (e.g. patient may draw a diagram omitting one side or shave only one side of the face)
Volitional movement a planned intentional movement
Thrombus formation or development of a blood clot within an artery or its branches
Cerebral Embolus traveling bits of matter such as thrombi, tissue, fat, air, bacteria or other foreign bodies that produce occlusion and infarction
Hemorrhage abnormal bleeding due to rupture of a blood vessel
Primary Factors  High BP*  Heart Dz*  DM*  Elevated hematocrit  Hx of Cardiac surgery  Cigarette smoking  Hx of TIAs
Secondary Factors  physical inactivity  obesity  excessive alcohol  elevated blood cholesterol & lipids  Hx of prior stroke
Penumbra moderate ischemia delayed infarction (an area of moderately ischemic brain tissue surrounding an area of more severe ischemia; blood flow to this area may be enhanced in order to prevent the spread of cerebral infarction)
Core dense ischemia early infarction (central part)
L hemisphere CVA R Hemiparesis/plegia
R hemisphere CVA L Hemiparesis/plegia
Cerebral thrombosis The formation or development of a blood clot within the cerebral arteries or their branches; also includes extracranial vessels (carotid or vertebral arteries).
Cerebral infarction (CI) Ischemia and necrosis of an area of the brain following a reduction of blood flow that falls below the critical level necessary for cell survival.
ABI (Atherothrombotic Brain Infarction) A type of thrombus. The most common type of stroke which accounts for over half of the cases.
Cerebral embolus (CE) Bits of matter (blood clot, plaque, and less commonly air, fat) formed elsewhere are released into the bloodstream and travel to the cerebral arteries where they lodge in a vessel, producing occlusion and infarction.
Intracerebral hemorrhage (IH) rupture of a cerebral vessel with subsequent bleeding into the cerebral hemispheres.
Primary cerebral hemorrhage (nontraumatic spontaneous hemorrhage) typically occurs in small blood vessels weakened by atherosclerosis producing an aneurysm.
Aneurysm Localized arterial wall weakness with abnormal dilatation of a blood vessel due to congenital defect.
Subarachnoid hemorrhage (SH) rupture and bleeding of a cerebral vessel into the subarachnoid space; may occur spontaneously, the result of an aneurysm or arteriovenous malformation or secondary to trauma.
AVM (Arteriovenous malformation) an abnormality in embryonic development leading to a skein of tangled arteries and veins, usually without an intervening capillary bed; its rupture produces hemorrhage.
Hypertension/High blood pressure 70% of people have high hypertension
Heart disease 30 % of people have coronary heart disease, 15 % have congestive heart disease, 30 % have peripheral artery disease
Diabetes 15 % of people have diabetes
high blood pressure increase the risk of CVA due to the increased pressure on blood vessels which stress and may rupture the vessels.
Stroke is increased by four to six times in patients with high blood pressure (elevated above 160/95 mm Hg.)
LDL and HDL levels high levels of LDL increase the risk of stroke due to higher deposition of plaque materials in the blood vessels. HDL takes excess fat to the liver for break down. Less cholesterol in the body means less plaque in the vessels.
Hematocrit The hematocrit is the proportion, by volume, of the blood that consists of red blood cells.
Endocarditis A serious infection of one of the four heart valves. Caused by a growth of bacteria on one of the heart valves, leading to an infected mass called a "vegetation"
Atrial fibrillation (AF) The most common, abnormal rhythm of the heart. The heart contracts (beats) and pumps blood with a regular rhythm, for example, at a rate of 60 beats per minute there is a beat every second.
Modifiable STROKE RISK FACTORS Smoking, obesity, lack of exercise, diet and excess alcohol consumption
“Early Warning Signs of Stroke” Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
“Early Warning Signs of Stroke” Sudden confusion, trouble speaking or understanding
“Early Warning Signs of Stroke” Sudden trouble seeing in one or both eyes
“Early Warning Signs of Stroke” Sudden trouble walking, dizziness, loss of balance or coordination
“Early Warning Signs of Stroke” Sudden, severe headaches with no known cause
“time is brain” The significance of recognizing early warning signs rests with prompt initiation of emergency care under the rule that “time is brain.”
tissue plasminogen activator [t-PA] clot-dissolving enzymes. To be effective, thrombolytic therapy such as t-PA must be given within 3 hours of the onset of symptoms and cannot be given with hemorrhagic stroke because the drug may worsen bleeding.
Cerebral circulatory arrest results in irreversible cellular damage with a core area of focal infarction within minutes.
Ischemic penumbra The transitional area surrounding the core (the area where the infarction is happening); consists of viable but metabolically lethargic cells. The extension of the infarction into the penumbra area generally takes place over a period of 3 to 4 hours.
Ischemic cascade (secondary injury) Brain cell injury and death that progresses rapidly within the core infarction area and over time within the ischemic penumbra (the transitional area surrounding the ischemic core)
Transient Ischemic attack (TIA or mini stroke) Temporary interruption of blood supply to the brain.
Major stroke the patient is in the presence of stable, usually severe, impairments.
Deteriorating stroke the patient whose neurological status is deteriorating after admission to the hospital. The change is status may be due to cerebral or systemic causes (e.g., cerebral edema, progressing thrombosis).
Young stroke a stroke affecting the persons younger than 45. Younger individuals may have potential for better recovery.
Lacunar infarction (lacunar syndrome) ): Blood flow is blocked in very small arterial vessels deep within the cerebral white matter with involvement of the internal capsule; characterized by contralateral pure motor or sensory deficits without visual field, cognitive, or speech deficits.
Extracranial injuries to the vertebral arteries as they travel through the cervical spine can also produce vertebrobasilar signs and symptoms. Forceful neck motions (e.g., whiplash or aggressive neck manipulations)
Computerized Tomography (CT) most commonly used imaging devise, used to rule out other brain lesions such as tumor or abscess and to identify hemorrhagic stroke
Magnetic Resonance Imaging (MRI) more sensitive diagnosis of acute strokes, allowing detections of cerebral infarction within 2-6 hours of stroke, able to detail the extent of infarction or hemorrhage and can detect smaller lesions than CT
Positron Emission Tomography (PET) imaging of regional blood flow and localized cerebral metabolism, used in subacute stage to distinguish infarcted areas and in identify areas of tissue where ischemia is reversible
Transcranial and Carotid Doppler noninvasive imaging of the neck and chest vessels
Cerebral Angiography injection of radiopaque dye into bloodstream, provides visualization of the vascular system and is often used when surgery is considered
Endarterectomy surgical removal of the lining and plaque of an artery. This is used to prevent strokes but not to treat actual strokes.
Cerebral perfusion pressure, or CPP the net pressure gradient causing blood flow to the brain (brain perfusion). It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inadequate blood flow), too much pressure causes ICP
Bobath- three main stages of recovery: 1)initial flaccid stage 2)spastic stage 3) stage of relative recovery
Brunnstrom Stage 1 flaccidity; No movement of the limbs
Brunnstrom Stage 2 minimal voluntary movement; spasticity begins to develop
Brunnstrom Stage 3 voluntary control of the movement synergies,spasticity has further increased and may become severe
Brunnstrom Stage 4 movement combinations that do not follow the paths of either synergy are mastered, spasticity begins to decline
Brunnstrom Stage 5 difficult movement combinations are learned,synergies lose their dominance
Brunnstrom Stage 6 disappearance of spasticity, individual joint movements become possible and coordination approaches normal
Astereognosis (tactile agnosia) Inability to recognize the form and shape of objects by touch. (remember classroom demonstration) find keys, sharp objects, medications/recognize pills, etc.
Paresis inability to generate normal levels of force needed to initiate and control movement or maintain posture (like in a chair).
Homonymous hemianopsia The patient experiences loss of vision in the contralateral half of each visual field; that is, the nasal half of one eye and temporal half of the eye corresponding to the hemiplegic side
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