CEREBROVASCULAR

ACCIDENT

CVA

nontraumatic brain injury

occlusion or rupture of cerebral blood vessel that

results in sudden neurologic deficit

loss of motor control, altered sensation, cognitive or

language impairment, disequilibrium, or coma

Epidemiology

third leading cause of death

Male > Female - 65 and 74.

women over 85 years of age

65 years old and above

Asian > US

Risk Factor
Non- modifiable

Age

Sex

Race

Hereditary

Modifiable risk factors

Hypertension

Heart Disease

Smoking

Hypercholesterolemia

Diabetes Mellitus

Lifestyle factors

Etiology

Etiology

Hemorrhagic-15%

It occurs due to bleeding that results from rupture of

specific vessels or arteries in the brain.

Ischemic -85%

It is the result of thrombus formation or embolism to the

brain from cardiac or arterial sources that results to loss of
blood flow/oxygen.

Ischemic stroke

Thrombosis - occlusion of a vessel, usually as a result of

atherosclerosis.

Embolism - dislodged platelets, cholesterol, or other

material that travels in the bloodstream and blocks a vessel.

Lacunar strokes - small, circumscribed lesions that measure

less than 1.5 cm in diameter and are located in subcortical
regions of the basal ganglia, internal capsule, pons, and
cerebellum, thalamus.

Hemorrhagic Stroke

Intracerebral (bleeding into the brain itself)

Subarachnoid (bleeding into an area surrounding the brain)

Both types may be caused by hypertension, arteriovenous

malformation, or aneurysm

AFFECTED AREA

AREA AFFECTED

Thalamus

The lateralisation of the thalamic functions affects both sensory

and motoric aspects.

Infarction or haemorrhage thalamic lesion can develop

somatosensory disturbances and/or central pain in the opposite
hemibody, analgesic or purely algesic thalamic syndrome
characterised by contralateral anaesthesia (or hypaesthesia) or
contralateral weakness, ataxia and, often, persistent
spontaneous pain.

AFFECTED AREA

AREA AFFECTED

Basal ganglia

Basal ganglia are involved in many neuronal pathways having

emotional, motivational, associative and cognitive functions as well.

Involvement of the basal ganglia is related to involuntary and

stereotyped movements or paucity of movements without
involvement of voluntary motor functions.The symptoms differ with
the location of the lesion. The commonest disturbances in basal
ganglia lesions are abulia (apathy with loss of initiative and of
spontaneous thought and emotional responses) and dystonia, which
become manifest as behavioural and motor disturbances,
respectively.

PRESENTATION BASED ON THE

LOCATION OF INFARCTION
Name
Pure motor stroke/hemiparesis
(most common lacunar
syndrome: 33-50%)

Location of infarct
posterior limb of the internal
capsule, basis pontis, corona
radiata

Ataxic hemiparesis (second

most frequent lacunar
syndrome)

posterior limb of the internal

capsule basis pontis and corona
radiate, red nucleus, lentiform
nucleus, SCA infarcts, ACA infarcts

Dysarthria/clumsy hand (ataxic

hemiparesis)

basis pontis, anterior limb or genu

of internal capsule, corona radiata,

basal ganglia and

thalamus, cerebral peduncle
Pure sensory stroke

contralateral thalamus, internal

capsule, corona radiata, midbrain

Mixed sensorimotor stroke

thalamus ,adjacent posterior

internal capsule, lateral pons

Presentation
It is marked by hemiparesis or
hemiplegia that typically affects the
face, arm, or leg of the
contralateral side. Dysarthria,
dysphagia, and transient sensory
symptoms may also be present.
It displays a combination of
cerebellar and motor symptoms,
including weakness and clumsiness,
on the ipsilateral side of the body. It
usually affects the leg more than it
does the arm; hence, it is known
also as homolateral ataxia and
crural paresis. The onset of
symptoms is often over hours or
days.
The main symptoms are dysarthria
and clumsiness (i.e., weakness) of
the hand or
hemiparesis/hemiplegia.
Marked by persistent or transient
numbness, tingling, pain, burning,
or another unpleasant sensation on
one side of the body.
This lacunar syndrome involves
hemiparesis or hemiplegia with

Neurological Complications
and Associated Conditions of
Stroke:
Altered Consciousness

Disorders of Speech and Language

Dysphagia

Cognitive Dysfunction

Altered Emotional State

Perceptual Dysfunction

Bladder and Bowel Dysfunction

Cardiovascular and Pulmonary Dysfunction

Deep Venous Thrombosis and Pulmonary Embolus

Osteoporosis and Fracture Risk.

DIFFERENTIAL DIAGNOSIS

Cerebral Tumor

Seizure

Sepsis

DEMOGRAPHIC DATA
Diagnosis:

Left Thalamo-ganglionic (Thalamobasal ganglionic area) CVA

OCCUPATIONAL HISTORY
Work/Vocational History

The client owns a grocery store.

Avocational History (leisure interests and pursuits)

The client used to go to different churches in different places.

She also used to cook and clean her condominium.

ACTIVITIES GIVEN

Interview

Gripping and pinching digiflex

Stacking of cones and Elevated stacking cones

Transferring of balls (RCGR)

Theraputty on beads
Picking up chips and cubes

Wristroller

Translation of pegs

Twisting pipe

Putting clothes pin on the clothes pin tower .

Writing activity (name. date, place, birthday and signature)

Evaluation Tool

Sensory Evaluattion

MMT

ROM

Standardized tool

FIM

Ashworth Scale

Muscle bulk no atrophy/hypertrophy as compared to (N)

extremity

Muscle tone Normotonic in BUE


GLOBAL MENTAL FUNCTIONS
Energy

and Drive

SPECIFIC MENTAL FUNCTION

Memory short term memory

Performance Skills
Poor motor skills:
Aligns
Stabilizes
Positions
Bends
Reaches
Manipulates
Grip

(R)

Coordinates
Moves
Lift

(R)

Walks
Flows(R)
Transports
Calibrates
Endures
Paces

(R)

Performance Skills
Good motor skills on specifically:

Grip (L)

Manipulates (L)

Lifts (L)

Calibrates (L)

Move (L)

Paces (L )

Performance Skills
Process skills:

Navigates (R)

Social Interaction Skills:

Produces speech

Speaks fluenty

Performance Pattern

ROLES

HABITS

RITUALS

PREMORBID

CURRENT

As a mother and grandmother, she is a caring

and loving. She usually cook for her children
and grandchildren.

As a friend, she is trustworthy and reliable.

She always make sure that she does not do
any unnecessary things that may cause
trouble.

The client takes a bath in the evening

The client watches TV before he sleeps.
The client drinks coffee every morning.
The client often go to different churches.
The client likes to cook.

As a mother and grandmother, she is a caring

and loving and a happy person.

As a friend, she is trustworthy. She does not do

any unnecessary things that may cause
trouble.

She believes that nothing is impossible with God

She believes that nothing is impossible with God

The client watches TV before he sleeps.

The client plays every afternoon.

Performance Pattern- Routine

TYPICAL WEEKDAY AND WEEKEND
PREMORBID
TIME
CURRENT
TIME
Client wakes up
4 AM Client wakes up 5 AM

5 AM
5 AM
6 AM
7 AM
8 AM
8 AMAM
9 AM
10 AM

11 AM
8 PM

Breakfast time
Cleans

5 AM 6 AM

her 6 AM 7AM

Breakfast Oral
Takes a Bath

condo

9 Watching TV

7AM 8 AM

Feeding time PEG

Takes a bath

8 AM- 9AM

Playing table top activities

with the caregiver

Going
different
churches/
places

9AM 10 AM
10 AM- 11 AM
11 AM- 12 PM
12 PM 1 PM
to
1 PM 2 PM
2 PM 3 PM
3 PM 5 PM
5 PM 6 PM
6 PM 7 PM
for 7 PM 8 PM

8 PM Cooks
dinner
9 PM
Sleeping time
10 PM

9 PM 10

Occupational Therapy session

Physical Therapy Session
Lunch time - Oral
Sleeping time
Watching TV
Mirienda time - Oral
Physical Therapy session
Dinner time- Oral
Watching TV/Sleeping time
Feeding PEG
Sleeping time

PRIORITIZED PROBLEM LIST

LOM on BUE

RUE weakness

Impaired Bilateral coordination

Poor dexterity on L hand

FOR
Biomechanical FOR

The therapist will use biomechanical FOR to focus on regaining

functional ROM, bilateral coordination of the BUE of the patient
and in strengthening her LUE in order for her to be able to
engage on her areas of occupation since the client can still use
her dominant hand which is her L hand functionally. This FOR can
be useful for her condition in improving her ROM and to maintain
the remaining skills of the client and to prevent deterioration.

TUS
Modes:

Collaborating

Instructing

Encouraging

ENVIRONMENTAL
MODIFICATION TECHNIQUES

The client is positioned on the left side the therapist with the
table in front of them. The place should be spacious enough to be
able to move without restriction when performing the exercises
and activities.

TUA
Preparatory

PROM exercises of the BUE AP 10R

AAROM exercises AP of the LUE 10R

Passive stretching of BUE AP 10CH 5sets

Purposeful

Wrist roller exercise FW and BW for 10R 3 sets

Wristisizer (wrist extension on B hands for 5 CH 5 R) (wrist flexion on L hand)

Cone stacking on RUE (R to L)

Elevated cone stacking 10 R on LUE (L to R)

Ball transfer on RUE for 5 r (R to L)

Elevated ball transfer on LUE for 10 R (L to R)

Occupation Based

Feeding using spoon

Combing her hair

Scrub her head during bathing

RCGR of cup

RECOMMENDATION

To continue OT sessions daily

To continue her PT and ST session

To have a checkups often with her physician to prevent further

complication and re-occurrence of the condition.

To modify the room

To facilitate cognitive stimulation leisure activities for the client.