Tuesday, January 29, 2019

PT Pathologies: Cerebrovascular Accidents (CVA, Stroke)

Cerebrovascular Accidents (CVA)  also known as a stroke happen to 750,000 people a year in the US.  A CVA is when there is an interruption in the cerebral civulation that results in cerebral insufficiency, destruction of surrounding brain tissue, and subsequent neurological deficit.  It can either be very abrupt or evolve over 1 to 2 days.  CVA results from prolonged ischemia (inadequate blood supply) to a cerebral artery.  There are some modifiable and non modifiable factors for a CVA.  Modifiable includes hypertension, atherosclerosis, heart disease, diabetes, elevated cholesterol, smoking and obesity.  Non modifiable factors are age, race, family history, and sex.  A CVA can be diagnosed by CT scans which can confirm infarcted areas of the brain and an MRI can show where the ischemia happened within the brain almost immediately after onset.  FAST is an acronym that can help a person who is having a CVA.

F= Facial drooping
A= Arm Weakness
S= Speech difficulties
T = Time

If you are around someone and notice these signs, take them to a hospital immediately.

       The clinical presentation of CVA would be such things like hemiplegia, hemiparesis, sensory, visual and perceptual impairments, balance abnormalities, dysphagia, aphasia, cognitive deficits, incontinence and emotional labiality.  A CVA affects the opposite side of the body from where the ischemia occurred.  For example, if you had a right CVA the left side of your body would be affected.  Physical therapists would treat a stroke patient by doing therapy like pressure relief, sensory awareness, ROM, weight bearing, gait training, muscle reeducation, balance and postural control.  The outcome depends on the severity of the CVA and the patients overall health.  There has been research that indicates that a patient can continue to improve the control of movement and show progress for an average of 2 to 3 years post accident.  The first three months after a CVA is most critical because it is n indicator for long term outcome for measurable neurological recovery.

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