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*CLINICAL EXERCISE PHYSIOLOGY > FINAL/CH30- Stroke > Flashcards

FINAL/CH30- Stroke Flashcards

1
Q

4 types of CV disease

A

-coronary heart disease
-heart failure
-hypertension
-stroke

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2
Q

2 types of stroke

A

-ischemic strokes
-hemorrhagic strokes

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3
Q

scope of strokes

A

-2nd leading cause of death among CV disease
-5th leading cause of death in US
-occurs every 40 seconds in US

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4
Q

women/men have higher lifetime risk of stroke

A

women
-mainly due to longer life span + increased risk of CVD associated with menopause

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5
Q

ischemic stroke

A

loss of blood flow to a region of the brain CAUSED BY buildup of atherosclerotic plaque in cerebrovascular arteries (blocked blood vessel)

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6
Q

most common type of strokw

A

ischemic stroke
-87%

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7
Q

ischemic stroke pathophysiology

A

blood flow to brain blocked by clot formation within a vessel

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8
Q

2 categories of ischemic stroke

A

-thrombotic stroke
-embolic stroke

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9
Q

thrombotic stroke

A

blood clot (thrombus) locks flow of blood in brain

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10
Q

embolic stroke

A

fatty plaque or blood clot (embolism) breaks away + flows to brain where it blocks an artery

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11
Q

pathophysiology of stroke

A

-begins with same pathophysiology as CVD + PAD
1. endothelial injury (chronic or excessive injury)
2. inflammatory response (monocyte, platelet, LDL-C aggregation)
3. endothelial dysfunction (increased wall adhesivness, impaired vasodilation)
4. plaque formation (lesions progress from endothelium to intima)

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12
Q

hemorrhagic stroke

A

excessive bleeding/swelling in a cerebral artery that prevents blood from flowing to brain cells downstream of the hemorrhage
-less common but GREATER LIKELIHOOD OF DEATH

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13
Q

which stroke type has greater likelihood of death

A

hemorrhagic stroke

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14
Q

hemorrhagic stroke pathophysiology

A

blood flow to brain is “blocked” by leak/rupture of vessel

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15
Q

2 categories of hemorrhagic stroke

A

-subarachnoid hemorrhage
-intracerebral hemorrhage

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16
Q

subarachnoid hemorrhage

A

outer part of brain

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17
Q

intracerebral hemorrhage

A

inside brain

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18
Q

stroke risk factors

A

same as those for CVD + PAD

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19
Q

signs/symptoms of stroke

A

-memory loss + paralysis are 2 of the more consistent symptoms
-brain damage causes paralysis on OPPOSITE side of body
-right-brain damage
-left-brain damage

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20
Q

right-brain damage

A

vision problems + awkward/inappropriate behavior

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21
Q

left-brain damage

A

speed + language issues + cautious behaviors

22
Q

a pt suffering from ACUTE stroke can have any of the following symptoms

A

-numbness/weakness of face, arm, or leg
-confusion, speech problems, + cognitive defects
-impaired bilateral/unilateral vision
-impaired coordination + walking
-headache

23
Q

acronym used for stroke symptoms

A

BE FAST

B- balance (does pt have sudden loss of balance?)
E- eyes (has the pt lost vision in one or both eyes?)
F- face (does pt’s face look uneven?)
A- arms (is one arm weak or numb?)
S- speech (is pt’s speech slurred? does pt have trouble speaking or seem confused?)
T- time (CALL 911 NOW)

24
Q

history + physical exam

A

-assess for hemiplegic gait
-screen for frequently present risk factors for CVD such as hypertension + diabetes
-resting ECG + symptoms of ischemia should be assessed, as coronary artery disease often presents in stroke pts
-psychological assessment may be warranted, as many stroke pts develop mental depression during the post-stroke period

25
Q

hemiplegic gait

A

stiff leg on 1 side of body

26
Q

diagnostic testing

A

-ultrasound, MRI, + angiography
-noncontrast CT
-diffusion-weight MRI

27
Q

what is the gold standard of imaging for hemorrhagic stroke

A

non-constrast CT

28
Q

diffusion-weighted MRI is used for which type of stroke

A

ischemic stroke

29
Q

diffusion-weighted MRI

A

-assesses restriction to movement of water molecules
-restrictions are detected by MRI + appear as bright white spots on image

30
Q

DW-MRI image

A

white areas represent where occlusion (blood floow restriction) has taken place

31
Q

treatment IF advanced carotid atherosclerosis (70-99% narrowing)

A

-carotid endarterectomy
-stenting with embolic protection

32
Q

carotid endarterectomy

A

removal of plaque inside carotid artery

33
Q

other forms of treatment

A

-pharmacologic treatment
-PT, OT, + speech therapy
-may include registered dietitian + psychological counseling

34
Q

pharmacologic treatement

A

-anticoagulants (blood thinners, warfarin)
-antiplatelet (clopidogrel)
-ACE-inhibitors (“-prils”)

35
Q

stroke has a large influence on ____

A

quality of life (QOL)

36
Q

of survivors ____% are institutionalized + ____% are unable to walk without assistance 6 months after stroke

A

26% are institutionalized
30% are unable to walk without assistance 6 months after stroke

37
Q

primary aim of all rehabilitation for stroke

A

to restore…
-balance
-movement
-coordination
-QOL

38
Q

exercise testing

A

-follow ACSM contraindications
-assess pre-exercise resting BP (remember hypertension is a major risk in hemorrhagic stroke)
-because of high incidence of CAD with ischemic stroke, important to assess for unstable angina

39
Q

____ is major risk in hemorrhagic stroke

A

hypertension

40
Q

important to assess for ____ during exercise testing in pts with ischemic stroke

A

unstable angina

41
Q

exercise testing- CV fitness

A

-not all stroke patients can complete a traditional GXT to assess functional capacity
-modified GXT: self-selected speed with 2% grade increase every 2 min appears appropriate for a stroke patient + may allow detection of undiagnosed CAD
-make sure appropriate mode is selected

42
Q

exercise testing- resistance training

A

handgrip dynamometer or 10-RM testing
-use to assess strength differences between affected (paretic) vs unaffected sides of body

43
Q

major goal of ExRx

A

improve functional capacity (FC)

44
Q

average FC of stroke pt

A

14.4 ml/kg/min

45
Q

minimum FC for independent living

A

20 ml/kg/min

46
Q

____ is highly correlated with FC

A

reduced muscle mass
-CRITICAL to address muscular strength + endurance in stroke pts

47
Q

what else is common in stroke pts

A

loss of flexibility

48
Q

overall need for what type of ExRx

A

comprehensive
-muscular strength
-endurance
-flexibility
-CV, etc.

49
Q

for stroke pts, we want to focus on movements that….

A

mimic ADLs

50
Q

ExRx special considerations

A

flexibility
-give special attention to paretic limbs, especially muscle groups that are experiencing a large degree of muscle spasticity

51
Q

2 examples of exercise training

A

-leg lifts +/or marching in place
-knee flexion

*CLINICAL EXERCISE PHYSIOLOGY (18 decks)

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