K1N4E4 F1NAI Flashcards
What are the signs of stroke? (fast)
Face (is it drooping)
Arms (can you raise both)
Speech (is it slurred or jumbled)
Time (call 911)
What are the recovery statistics for every 100 people who have a stroke?
15 die
10 require long-term care
40 with moderate-severe impairment
25 with minor impairment / disability
10 recover completely
What are the 3 types of ischemic stroke?
Thrombotic: arterial obstruction (atherosclerosis)
- large vessels
- small vessels
Embolic: cardioembolic (atrial fibrillation)
- thromboembolic
- paradoxical embolus
Hypoxic: hypoperfusion/hypoxemia
- perinatal stroke
- drowning
What are the 3 immediate treatments for hemorrhagic stroke?
Stop bleeding
Reduce intracranial pressure (ICP)
Stabilize vital signs (level of consciousness, headache)
What are the 2 types of hemorrhagic stroke?
Intracerebral: within brain, compresses & damages surrounding tissue
Subarachnoid: between pia & arachnoid mater, ruptured aneurysm
What symptoms result to a blockage of ophthalmic artery?
Severe loss of vision, no light perception
What symptoms result to a blockage of vertebral artery?
Dizziness, syncope, impaired vision, nausea, motor/sensory deficits
What symptoms result to a blockage of anterior cerebral artery?
Paraplegia affecting lower extremities, sparing face/hands, aphasia
What symptoms result to a blockage of middle cerebral artery?
Unilateral weakness, numbness, facial droop, speech deficits ranging from mild dysarthria and mild aphasia to global aphasia
What symptoms result to a blockage of posterior cerebral artery?
vision loss, diplopia, inability to see half of the view, difficulty reading perceiving colors, recognizing familiar faces
What symptoms result to a blockage of posterior inferior cerebellar artery?
Balance problems, lean to one side. Numbness on one side of face and body, eye droop, trouble swallowing.
What are silent strokes?
ones that happen and do not generate acute symptoms. In regions less directly associated with sensory/motor function
What are the 9 cell death mechanisms due to a lack of oxygen and glucose?
- Mitochondrial death pathways
- Apoptosis
- Pyroptosis
- Necrosis
- Autophagy
- Mitophagy
- Excitotoxicity
- Free radical release
- Inflammation
What are some contraindications to consider during assessment for exercise testing?
Resting BP 200/110mmHg
Unstable angina
Cardiorespiratory: can do treadmill test if patients can do at least 0.5mph floor walking
Strength: multiple reps to fatigue such as 10RM testing
ROM: goniometer and sit-and-reach test. prioritize testing joints affected by paresis
What are the 6 types of exercise testing?
Ramp, continual, graded, single grade, graded with breaks, combined
What are 5 common medications and what are their primary and exercise effects?
Warafin: anticoagulant, avoid high risk activity
Ticlopidine, clopodogrel, aspirin: antiplatelet
ACE inhibitors (rampipril, enalapril): decrease BP
Calcium channel blockers (nimodipine): decrease BP, increase exercise capacity in patients with angina
Diuretics (hydrocholothiazide): decrease BP
What is the difference between motor recovery and functional recovery?
Motor recovery: strength, functional capacity
Functional recovery: OT focus, feeding, dressing, hygiene, cooking, regain independence
What are the 3 steps of assessment and risk stratification?
- Current level of PA
- Presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease
- Desired exercise intensity
What signs or symptoms are you looking for with step 2 of the assessment?
- Pain/discomfort in chest, neck, jaw, arms
- Shortness of breath at rest or mild exertion
- Dizziness or syncope (loss of consciousness)
- Orthopnea or paroxysmal nocturnal dyspnea
- Ankle edema
- Palpitations or tachycardia
- Intermittent claudication
- Heart murmur
- Unusual fatigue
What 2 things do you need for intake history?
- Gather a comprehensive medical and physcial activity history
- Establish client’s desired goals and outcomes
What are the essentials for intake history?
- Reason for referral/consultation
- Demographics
- History or current conditions
- Current medications
- Past medical history
- Family history
- PA history
- Social history
What 5 things do you need to know about the patients current medical regimen? What 2 things are of importance to know?
- Name of drug
- Frequency
- Dose
- Time taken
- Time for therapeutic effect
- Does the drug have exercise response?
- Are there side effects that would affect client’s performance during exercise/safety?
What are the goals and outcomes of exercise?
- Improve exercise capacity
- Improve balance/mobility
- Increase muscular strength
- Reduce CVD risk
- Increase ROM
- Reduce risk of falls
What is the main goal of exercise prescription?
Improve Functional Capacity (VO2 peak)
- average VO2 of stroke patient is 14.4mL/kg/min. Minimum for independent living is 20mL/kg/min
How do you calculate 40% HRR?
0.4(HRmax-HRrest) + HRrest
What is the recommended cardiorespiratory, resistance, and ROM training for stroke?
Cardio: 3-5d/wk, 40%-80%HRR, 15-30min, floor, treadmill, cycle ergometry, water exercise. Progress low to high intensity, HR and percieved effort.
Resistance: 3-5d/wk, up to 80%1RM, 30-45min, elastic bands, body weight, sandbags, water exercise, commercial strength training equipment
ROM: 3-5d/wk, 10-20min, passive, PNF, as tolerated, emphasis on paretic side
What are 5 types of field tests and what are they assessing?
Cardiorespiratory Fitness: 6 minute walk test
Flexibility/Range of Motion: Chair sit and reach
Muscular Fitness: 30 sec sit to stand & Manual Muscle Testing
Gait/Mobility: 10m timed walk test & Timed up and go
Balance/Falls Risk: Functional Reach
What are screening reasons not to do 6MWT?
Systolic BP >200mmHg or <60mmHg, Diastolic >110mmHg. If resting HR is >120 or <50 bpm. If resting SpO2% is <88%
What are reasons to terminate the 6MWT?
pO2 falls below 80%
Client asks to stop the test
Client experiences chest pain, intolerable dyspnea, leg cramps, staggering or demonstrates pale or ashen appearance during the test
What is the MCID for stroke for 6MWT?
34m
What is the MCD for PD for 6MWT?
82m
What is the MCID for chair sit and reach?
No MCID developed
What is the cut-off score (maintenance if independence for the 30sec sit-to-stand. What is the MCID?
9-17 stands (60-90yr olds)
MCID: 5 stands
What are the different grades for Manual muscle testing?
Grade 5 (Normal): Strong muscle contraction / no indication for specific strengthening
Grade 4+ (Good+): Moderately strong muscle contraction / no indication for specific strengthening
Grade 4 (Good): Minor weakness = indication for specific strengthening
Grade 4- (Good-): Weakness = indication for specific strengthening
Grade 3+ (Fair+): Moderate weakness = strong indication for strengthening
Grade 3 (Fair): Definite “functional threshold” – minimum muscle strength needed for ADLs = strong indication for strengthening
Grades 3- (Fair-) 2+ (Poor+), 2 (Poor), 2- (Poor-), Trace, and Zero: Severe weakness and absence of muscle activation indicative of neurological impairment = indication for referral to GP for further examination if undiagnosed = indication for specific ROM and strengthening exercises
What is the MCID for 10mWT for stroke?
0.14m/s
What is the MCD for TUG for stroke?
2.9s.
less than 20sec = lower risk of falling
more than 20sec = higher risk of falling
What are the cut off scores for mobility and fall risk?
<7cm = severely limited mobility
What is Parkinson’s disease?
a progressive neurological disorder caused by loss of dopaminergic neurons in the substantia nigra of the midbrain. No known cure.
What are the 3 risk factors for Parkinson’s?
Environmental toxins (paraquat & trichloroethylene)
Melanoma (skin cancer)
Trauma brain injury
What is the clinical diagnosis of Parkinson’s?
Bradykinesia (slowness of voluntary movements)
at least 1 of:
- muscle rigidity
- 4 to 6Hz resting tremor
- postural instability not caused by visual, vestibular, cerebellar, or proprioceptive dysfunction
What are the clinical considerations that you need 3 or more of to lead to a definitive diagnosis of Parkinson’s?
Unilateral onset of symptoms
Rest tremor present
Progressive change in symptoms
Persistent asymmetry of symptoms, with onset side having greater severity
Response (decrease in symptoms) to levodopa
Presence of levodopa-induced dyskinesia (involuntary movements)
Levodopa response ≥5 years
Clinical course ≥10 years
What are the non-motor symptoms of Parkinson’s?
- Drooling
- Nausea and vomiting
- Bladder dysfunction
- Hallucinations
- Excessive daytime sleepiness
- Restless leg syndrome
- Double vision
- Change in taste and smell
- Constipation
- Unexplained changes in weight
- Sexual dysfunction
- Insomnia
- Leg swelling
- Delusions and impulse control disorders
- Choking and swallowing difficulties
- Uncontrolled loss of stool
- Dementia and cognitive impairment
- Orthostatic hypotension
- REM sleep behaviour disorder
- Excessive sweating
What does each stage of the Hoehn and Yare Staging Scale of PD mean?
Stage 1: Unilateral involvement with minimal or no functional disability
Stage 2: Bilateral or midline involvement without impairment of balance
Stage 3: Bilateral disease. mild to moderate disability with impaired postural reflexes, physcially independent
Stage 4: Severely disabling disease, still able to walk or stand unassisted
Stage 5: Confinement to bed or wheelchair unless aided
What are the 4 parts of the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)?
Part 1: Non-motor experiences of daily living (patient reported, mood, cognition…)
Part 2: Motor experiences of daily living (patient reported, speech, handwriting,…)
Part 3: Motor Examination (clinician assessment)
Part 4: Motor complications (self-report, fluctuations, dyskinesias)
What type of diagnostic testing can be done for PD?
No specific diagnostic tests for PD. Brain imaging tests can confirm diagnosis of PD.
DaTscan
Single-photon emission computerized tomography (SPEC)
18F-DOPA PET
What is the associative circuit and limbic circuit?
Associative: executive function, time management, planning
Limbic: emotion, fear, sadness, nonmotor symptoms
What are the 4 steps of assessment and risk stratification for Parkinson’s?
- Current level of PA
- Presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease
- Desired exercise intensity
- Assess fall history
What exercise tests are there for cardiovascular, muscle strength, gait/mobility, flexibility/fall?
Cardiovascular:
- GXT, for stress test and cardiovascular fitness (H&Y 1-2)
- Challenging for H&Y 3 and not needed above
- 6MWT
Muscle Strength:
- H&Y 1-2, 1RM
- Sit-to-Stand 30sec
Gait/Mobility:
- TUG, 10m WT
Flexibility/Fall:
- Chair sit-reach
- Back scratch test
- Functional reach test
What intake history is important to get for PD patients? What are the essentials?
Gather a comprehensive medical and PA history
Establish clients’ desired goals and outcomes
Essentials:
o Reason for referral/consultation
o Demographics
o History of current condition(s)
o Current medications
o Past medical history
o Family history
o PA history
o Social history
What is amantadine?
- Not to reduce tremor, more for dyskinesia (involuntary movements) different than dystonia (dyskinesia is flowing type of movement) when it reaches peak dose, can generate random movements. Giving drug, it’s going overboard lots of random movements. Give alongside L-DOPA.
What are COMT inhibitors?
L-dopa: precursor. Want to convert into dopamine. Every reaction governed by enzyme AADC, primary step is to convert. However, can get converted to 3-0 methyl… Enzyme that takes L-dopa is comp
- If you want to keep L-dopa circulating in blood and want to make more dopamine, want to inhibit COMP (use comp inhibitors)
- Maintaining half-life of L-dopa
- Metabolism step, inhibit to keep it circulating for longer. Larger exercising window
What are the goals of exercise prescription?
- Improve exercise capacity
- Improve balance/mobility
- Increase muscular strength
- Reduce CVD risk
- Increase ROM
- Reduce risk of falls
What is the 3 primary goals of exercise prescription?
- Delay disability
- Prevent secondary complications
- Improve overall QOL
What are the special considerations for exercise with PD?
- Autonomic nervous system dysfunction that can be magnified by some medications
- Orthostatic hypotension
- Fatigue management
- Balance impairments and fall prevention
- Attention issues
- 30-20-10 after 3 Rule: HR goes up by 30, systolic drops by 20mmHg, diastolic drops by 10mmHg within 3 mins of changing posture
What is the recommended cardiorespiratory exercise for PD?
F 3 / week
I start as dictated by risk stratification, (high intensity may neuroprotect dopaminergic neurons)
T 30 min (cont/ or accum/) > progress to 150 min/week
Type: * Stationary cycle ergometry * Water-based exercise * Boxing * Treadmill * Dancing
What is the chronic effect of cardiorespiratory exercise on healthy people vs PD?
Healthy People:
- Preserve brain volume
- Inhibit cognitive decline
- Maintain CBF increase age
- Control blood pressure
PD patients also improvements for:
- Gait
- Balance
- Cognition especially EF
What is the benefits of resistance training for PD on GAIT?
- Twice weekly training at 60-70% of 1RM
- Increased stride length
- Increased shoulder, wrist, hip, knee, ankle velocity
- Improved gait initiation (longer first step, faster leg movement, better control of posture, better coordination of muscles)
- Walk faster with better control
