CVA/ Stroke

While the deficits that occur is highly dependent on exactly which artery was
affected by the CVA; it is important to remember that most deficits will occur on the
opposite side from where the CVA occurred. The following is a list of expected
deficits for each hemisphere of the brain.
LEFT HEMISPHERE
Aphasia & communication deficits
Confusion of Time
Decreased Problem Solving
Dressing Apraxia
Info. Processing Delays
Poor Right/Left Discrimination
Easily Frustrated
Underestimate abilities
Inability to Communicate through Writing
Right Sided Paresis or Plegia

RIGHT HEMISPHERE
Visual field deficits/neglect
Poor Insight & Judgement
Spatial-perceptual analysis deficits
Disorientation
Emotional Lability
Decreased Attention Span,
Increased Verbalizations
Decreased Motivation
Body Schema Perception Disorders
Left Sided Paresis or Plegia

As healthcare professionals it is be our job to help our patients overcome the effects
of the CVA as best as possible. Part of our role is to educate the patient and
caregivers with information that will help them adjust to this condition. One
resource for caregivers and CVA patients is www.mystrokecaregiver.com.
Many patients who suffer a CVA are at greater risk for a glenohumeral subluxation
(shoulder dislocation). As a healthcare team is our job to make sure the patient is
safe and protected from this condition. Muscle tone is often affected following a
CVA, and subluxation is often the result of low muscle tone and improper positioning
or transfer techniques.
It is common following a stroke for the patient to experience different amounts of
muscle tone. Tone is the normal resting tension within a muscle. Soon after a CVA it
is common to be flaccid or hypotonic (low tone). As more time passes it is common
for the patient to experience hypertonicity or spasticity (high tone). It is also
common for some muscles to be hypotonic while others are hypertonic. Bed and
wheelchair positioning should either increase or decrease tone.
For wheelchair positioning a trough is recommended for patients experiencing high
tone. The affected side should be placed in the trough, palm down, and hand open.
A restraint may be necessary to hold extremity in position. Patient should be taught
how to release restraint. A patient experiencing low tone should be fitted with a tray
that supports the elbow. The fingers are closed around an object (which may need
to be strapped in place) with the thumb pointing up. Instruct patient on how to
remove the strap holding the item in hand. Trays and troughs DO NOT need to be
removed during transfers.

NEVER PULL OR LIFT A PATIENT BY OR UNDER THE AFFECTED SIDE DURING

TRANSFERS, BED POSITIONING, OR WHEELCHAIR ADJUSTMENTS.
For supine position, ensure the pillow is behind the head and
not underneath the shoulders at all. If the pillow is under the
shoulders it can cause an anterior subluxation. The affected
forearm should be in a palm up position. Place a second
pillow below the affected arm. This pillow should support the
length of the arm and often will need to be placed between
the affected arm and patients body to inhibit elbow flexion.
Typically, the affected arm is not to be placed on the body,
but rather alongside as pictured.
*Shaded area is the affected side.
Supine position*
Make sure that the affected shoulder in not resting on the
pillow just under the patients head. The patient will be lying
on the affected side so special care will be needed to make
sure the patient is not lying directly on the shoulder. To fix
this issue make sure the patients affected scapula is
forward (the patient will be lying on the flat part of the
scapula). The affected arm can be either bent or straight
depending on if tone is present. The affected leg is straight
and affected knee is slightly bent. For patient comfort other
pillows may be added to support the unaffected lower
extremity.
Side lying on affected side*
While lying on the unaffected side the affected side needs
to be completely supported by pillows. The weight of the
upper extremity (and lower extremity) could cause a
subluxation. The pillows for the upper extremity need to
hold the affected limb level with the chest. The upper
extremity should be straight, palm down, and fingers
extended. The lower extremity should be flexed at the hip
and knee joints and supported for most (if not all) the length
of the lower extremity.
%20Positioning%20for%Optimum%20Patient%20Safety
%20and%20Support.pdf
Side lying on the unaffected side*