lecture 6: stroke Flashcards
1
Q
true or false: stroke only leads to physical imparement
A
false, also mental
2
Q
does stroke only affect old people
A
no , young too but more rate
3
Q
What do you think is your role as a KCEP in the rehab process of your client? (of strokeO
A
incraase functional and fitness levels through exercise training
4
Q
stroke is a type of injury to what organ
A
brain
5
Q
what is a stroke
A
An abrupt incident of vascular insufficiency or of bleeding into or immediately adjacent to the brain
6
Q
a blockage stroke is called
A
ischemic
7
Q
stroke is the BLANK leading cause of death behind heart diseases and cancer
A
3rd leading cause
8
Q
how many stroke cases are there in canada per year
A
60k-70k
740 000 canadian adults
9
Q
what percentage of stroke attacks are first attacks
A
80%
10
Q
what percentage of strokes are reoccruent attacks
A
20%e
11
Q
what is the average age of onset of stroke
A
72
12
Q
since the average age of onset is 72, strokes only happen to older populations
A
false, they can only occur in children and young adults as well
13
Q
what percentage of stroke causes are under the age of 65
A
1/4
14
Q
is the incidence of stroke equal in men and woman
A
yes
15
Q
which gender is more likely to survi ve a stroke
A
women
16
Q
what percentage of strokes result in death
A
29%
17
Q
is the percentage if strokes that result in death lower or higher for younger people
A
lower
18
Q
ischemic strokes account for what percentage
A
80%
19
Q
what are the 2 causes of ischemic stroke
A
cerebral thrombosis
cerebral embolism
20
Q
what is cerebral thrombosis
A
Development of a blood clot in a cerebral vessel (occlusion at atherosclerotic plaque)
21
Q
what is cerebral embolism
A
Displaced clot of bacterial mass that occludes downstream artery
=blood clots can break free from an thrombosis and lead to an occlusion
22
Q
when does ischemic strokes usually happen
A
periods of decreased acitiy (sleep)
23
Q
is conciousness preserved during ischemic strokr
A
ues
24
Q
inntracerebral hemorage acounts for what percent of total strokes
A
20%
25
what stroke is bleeding into the brain
intracerbral hemograge
26
what is the main cause of intracebreal hemorage
arterial rupture
27
what are the 2 principle causes of stroke i
ischemic and intercerbral hemorage
28
what percentage of strokes are intracerbral hemmorage
20%
29
whatt is arterior reupture associated with
Associated with aneurysms and arteriovenous malformations:
30
when do intracebral hemmorages occur
during periods of acvtiyty
31
what is the LOC for itracebral hemmorage
stupor or coma
32
what are the 5 signs and symptoms of stroke
```
weakness
trouble speaking
vision problems
headache
dizziness
```
33
explain weakness as a sign
Sudden loss of strength or sudden numbness in the face, arm or leg, even temporary
34
explain trouble speaking as a sign and is it assocaited with stroke i nthe left or right hemistpeherw
Sudden difficulty speaking or understanding or sudden confusion, even temporary (aphasia)
left
35
why do people have trouble speaking during a stroke
due to a stroke located in the left hemi
36
explain vision problems as a sign
Sudden trouble with vision, even temporary
37
wexplain headache as a sign
sudden sever and unusual headache
38
explain dizness as a sign
Sudden loss of balance, especially with any of the above signs (why?)
39
why is dizziness not a good sign alone
because you can be dizzy to many factors
40
fast is an aconym for
face, arms, speech and time
41
why does the fast test do
allows people to trecognize the signs of sroke
42
what is the fast test
ask person to smile
ask person to speak a simple snetence
ask person to raise both arms
=if they cannot do any of the 3 things get them to a hospital
43
Following a stroke, sensory and motor impairments are located on which body side?
opposite side as brain lesion
44
what is the most dominant risk factor for stroke
age!!
45
why is the incidence of stroke inreasing as time icnreases
because average populationn age is increasing
46
What is the median age (divides population into 2 groups of equal size) of the Canadian population?
40
47
what are the 3 risk factors we cannot control
age
sex
family hisotry
48
increases age is the dominant risk factor for strokr?
true
49
what is the relationsjip between heart disease and age
all major forms of heart disease increase with advancing age
50
as the canaidan population increased, what is expected in terms of stroke
number of individauls with heart disease and stroke will increase
51
true or false, the incidience for women and men are the same for strokr
true
52
what is another important risk factor besides age for strokr
family hisoty of early coronary disease
53
what is an independant risk factor for stroke
family histry
54
facots that contribute to the assocationn of fam hisotry and CAD may include what
familial dyslipedimia, lifestule and molecular defects in vascular physiology which render the vessel walls more susceptible to atheroscelorsis
55
what are 2 examples of modifable risk factors for strokep
physicial inactivtiy
| high BP
56
which age groups were very phydscually inactive
5-11
12-17
60-79
57
WHAT CAN REGULAR PA redcude
Regular physical activity (PA) can reduce body weight, improve serum lipids and cholesterol, blood pressure and diabetes, and thereby overall stroke risk
58
national guidelines recomend what in terms of PA
recommend 150 min of moderate- to vigorous- intensity aerobic PA per week
59
High BP is a major risk factor for what
both coronary artery disaese and stroke peripheral vascular disease and congestive heart faility
60
High BP incrased overall cardiovascular risk by what
by 2 to 3 fold
61
which individuals are more liekly to develop high BP
indivudals who have excess weight , are physically inactive, use alcohol heavily, excesive salt intake
62
what type is the best exercuse program for stroke prevention
aerobic training
63
what are the 2 modes of training that are beneficials
aerobic training and fucntional training
64
aerobic rtaining decraes risk of 1st or 2nd stroke
2nd
65
what are the beneficial effects of aerobic rtaining
Reduced hypertension
Reduced body fat
Increased ratio HDL/LDL
66
what dies functinal trainingn icnrase
increase ADLS and QoL
67
what are the beneficial effects of functional trianing
Improve muscular strength and endurance
| Improve motor functions (walking, balance, coordination)
68
what are tthe 3 special consideration to exercise for strtoke
Reduced motor control (weakness or paralysis) on one side of the body
Sensation may be impaired (implications for stretching)
Intolerance to high intensity exercises (↓VO2 max capacities)
69
what percentage of men in age 5-11 were meeting guidelines
18
70
what percentage of women in age 5-11 were meeting guidelines
8
71
what percentage of men in age 12-17 were meeting guidelines
8
72
what percentage of women in age 12-17 were meeting guidelines
3
73
what percentage of men in age 60-79 were meeting guidelines
13
74
what percentage of women in age 60-79were meeting guidelines
11
75
The foot drop phenomenon observed after stroke is attributed to the paralysis of _________
a) Gastrocnemius
b) Tibialis Anterior
c) Soleus
d) Rectus Femoris
tib ant
76
peopel wil stroke have poor or good fitness level
poor
77
why do those with stroke have a decraed VO2
1) neural drive
2) blood flow
3) muscle mass
78
the affected limb becomes what type of limb
paretic
79
compared to a age matched sedentary person, someone with a stroke has a lower or high VO2 man
lower
80
how much lower is someone with a stroke's VO2 in cormpared to normal
50% of whatt it would normally be
81
what is a reason ADL for people with stroke can be compromoed
poor cardiovascular fintess
82
BLANK can compromise performance of daily living
poor cardio vascular fitness
83
trtue or false: in terms of vo2 max, a age matched sedentary person can easily do ADLs in comparison to strokr
yes, because people with stroke cardiovascular VO2 is 50% less they are not able to easily complete the entire ADL range
84
MET indicates metabolic equivalent. One MET is the amount of energy used when _______ (3.5 ml/kg/min)
sitting qiueitly
85
what is the peak MET for stroke
3.5
86
what are some mild acitvities of daily living that people with stroke can do
playing piano
canoeing (leusire)
walking (2mp)
87
what is the mmoderate activtity that those with a stroke can do
cycling (leasuirely)
88
true or false: if you have a storke , you cant cycle
false, you can, just leisurely
89
true or false: those with stroke can do vigourouse activtiyies and why
false, they cannot because it requries a VO2 max higher than what they have
90
what are some examples of ADLS that those with a stroke cannot usually do
swimming, walking (4) tennis and jogging
91
what does hemiparetic mean
weakness/inbiability to move 1 side of the body
92
in the case study, stroke leads to what type of disrorders
motor functiton and motor perfornace
93
explain how stroke can cna lead to motor function disorders
Restriction of mvts or paralysis on the affected side
Weakness of the affected side
Problems of coordination of the affected side
94
explain how stroke leads to motor performance disorders
Decrease in balance
Decrease in walking capacities
Decrease in mobility
95
decrase in blaance, walking or mobility is an example of a motor performance or motor function disorder
motor performance
96
restrinction or fmovement, weakenss and problems of coordination are examples of motor function or motor performatnce disorders
motor function
97
Are all individuals with stroke eligible to the exercise program?
no
| some participants are too good (no serious complications) and some are too affected (cannot stand and do exercisdes)
98
what is the best type of participant for tthe exercise program
those who are affected by can still take an acitve part in the training/rehab
99
in the case study, what is the major contradiction to exercise
Aerobic or resistance training at high intensity could potentially lead to major medical complications (2nd stroke, heart attack, etc.)
100
Aerobic or resistance training at high intensity could potentially lead to wha
major medical complications (2nd stroke, heart attack, etc.)
101
true or false: Aerobic or resistance training at low intensity could potentially lead to major medical complications (2nd stroke, heart attack, etc.)
false, only at high intensityes
102
what is the rational behind the exercise program for people witth stroke/case study
In people with chronic stroke (1 year post-stroke), these disorders (motor perfomance and function) are increased by the absence of regular physical activity
103
what is chronic strokr
1 year post stroke
104
the motor function and motor performance disorders are increased or decreaed by absense of PA
increased
105
true or false: you cannot make signifc ant gains (in 5 movements) 6 months post strokr
true
106
what is the experimental questions for the case study exercise program
Can people with chronic stroke improve their physical condition (i.e. functional level) through the participation in a 8-week group exercise program?
107
what are the 4 main bullet points for making an exercise program
1) desciptibion of participants condition
2) prepartion of a questionnaire
3) elaboraion of the exricse program
4) evalutaion
108
in the prepareation of the questionaire, what type of information is collection
medical hisotry (ex: high BP)
meds
PA status (ex: level of fitness, balance, walk capacity, balance)
-goals of participant
109
why are the goals of the participant necessary for the progam
MOTIVATION
| more likely to see results and comeback if they are motivated and actvitely participating
110
what did the exerceise prgram focussed on
strengthening the affected extremities and practicing functional tasks involving the upper and lower limbs.
111
explaon some examples of execruse for upper limbs
push ups in standing
strtecth band in sitting position
ROM with wooden stick
112
explain who push up in standing postition is good
to imporve elbow extensions and easier to icnrease or decrease diffucilty
113
for upper limb exercises, they acnn do normal push ups?
falsse, standing push ups
114
w=what position are stretch band exercises dont
in sitting position
115
whey are stretch band exrecises done in sitting positions
to impove shoulder flexors, extensors and abductors
116
why use ROM with wooden stick
unaffected limb can lead to other)
117
what are some examples of lower limb exercises
step exericses
sit to stand
standing on 1 leg
standing in tandem
118
explain the step exrcised for lower limb
forward, backward, side steps) to improve lower limb ROM and strengthen the weak side
119
what is the function of step exrcises
to improve lower limb ROM and strengthen the weak side
120
explain the stit to stand exercise for loweer limb (what does it improve)
Sit-to-stand from a chair with forward and backward steps for improving functional mobility
121
why is the sit to stand exercise effective
for improving functional mobility
122
what is the function of standing on one leg as execier
imporoving balance
123
whta is the function of tandem stance
improve balance
124
which muscle is uxed for elbow extension
triceps (but ofeten will try to cheat with shoulder and torso)
125
how many particpantts are in the exrceise session groups
8
126
what is the frequency of exercise session
2/week
127
what is the duration of exercise session
60 min/session
128
what is the intenisty of the exreicse sessions
RPE (rating of perceived exertion) method (0 to 10 point scale)
129
why is it good to use RPE for intensity
because HR and BP will usually fluctutaet because of meds
130
what are the ways to modify the intensity
↑ the number of repetitions
↑ ankle weights
↓ the use of parallel bar
↑ exercise difficulty
131
decreasing the use of the parallel bar increases or decreased intensity
icnreases
132
evaluation is done only before a exercis prgram
false, before and after
133
what are 4 tests for evaulution in the case strudy
time up and go
berg balance test
6 min walk test
stroke impairement asessment set
134
what is the goal of time up and go
to detect balance and mobility problems in the elderly
135
what is the instructions for time up anf go
Subjects stand up from a chair, walk 3m, turn around and return to sit back down
136
what is the scoring for time up and go
Neurologically intact adults who are independent in balance and mobility skills < 10s. If > 30s = dependent in most ADLs and balance and mobility skills
137
which test main goal is to detect balance and mobility
timed upo and go
138
how long should the timed up and go take for neurogloically intact adults
less than 10 secs
139
if you take greater than 30 secondns for the timed up and go, what does that mean
person is usually dependent in most ADLs and balance and mobility skills
140
what is the goal of the berg balance test
to provide a comprehensive balance assessment
141
which test main ghoal is to provide a comprehensive balance assessment
berg balance
142
the assessment form for berg balance has how many items
14
143
where is the berg balance test mainly used
widcely used in clinical research field
144
the berg test is very BLANK and easy/hard to admisiter
very edtailed and easier to administer
145
the berg balance allows allows a better stcreening of what
balance imporants
146
what is the goal of the 6 minute walk test
to evaluate cardiorespiratory (submaximal) endurance in individual with cardiovascular conditions
147
which test has the goal of to evaluate cardiorespiratory (submaximal) endurance in individual with cardiovascular conditions
6 minute walk test
148
what are the instructions for 6 minute test
The participants are instructed to walk from end to end, covering as much ground as they could during the allotted time.
149
what does SIAS stand for
stroke imporaiment assessment set
150
what is the goal of SIAS
to assess motor function and coordination for upper and lower extremities in individuals with stroke
151
which test has the goal of to assess motor function and coordination for upper and lower extremities in individuals with stroke
SIAS
152
is the SIAS easy to adminster
yes
153
is teh berg balance easy to adminster
yes
154
is scoring easy or diffult for SIAS and why
scoring is often difficult because not detailed enough.
155
true or false: beofre completeing exrcise, those with a stroke need medical clearance
yes from a physician
156
true or false: you need a list of meds for a stroke patient
true
157
whatt measruent is needed to check befgore starting the program
BP
158
what measurent is always taken before each session
heart beat
159
what are the 3 main instructions giving to partticipatn
Exercise at your own pace
Try to start each session slowly before increasing the pace
Stop exercising if you have one of these symptoms: severe fatigue, feeling faint, feeling of dizziness etc…
160
true or false: the participants need to follow the exrise program pace
false, they can exercise at their own pace
161
they should start the execrise session quicly;
false, start each session slowly before increasing the pace
162
what are some symptoms that mean the patient should stop exerciseing
severe fatigue, feeling faint, feeling of dizziness etc…
163
for a group adapted exersice program, what is the supervision needed
1 certified KCEP
1 or 2 KCEP interms
1 vlunteer from the center
164
which tests had significant chagnes between pre and post exrcise
SIAS motor scole
berg balance scale
timed u opand go
165
what is the score out of for the brg balance
/56
166
if you score a 45 or less for berg balance, you are at risk of what
falling
167
the SIAS motor score is out of what
/25
168
what is the 2nd strogner risk factor for strike
high BP
169
what is atriovenous malformations and what can they cause
they are when the blood vessels get all tangled and can cause arterial rupture
170
what are some typical arm stances for those with stroke
flaccid arm or tripple flexed
171
which test did not show any significant changes between pre and post exrecise
6 min walk
