lecture 6: stroke Flashcards
true or false: stroke only leads to physical imparement
false, also mental
does stroke only affect old people
no , young too but more rate
What do you think is your role as a KCEP in the rehab process of your client? (of strokeO
incraase functional and fitness levels through exercise training
stroke is a type of injury to what organ
brain
what is a stroke
An abrupt incident of vascular insufficiency or of bleeding into or immediately adjacent to the brain
a blockage stroke is called
ischemic
stroke is the BLANK leading cause of death behind heart diseases and cancer
3rd leading cause
how many stroke cases are there in canada per year
60k-70k
740 000 canadian adults
what percentage of stroke attacks are first attacks
80%
what percentage of strokes are reoccruent attacks
20%e
what is the average age of onset of stroke
72
since the average age of onset is 72, strokes only happen to older populations
false, they can only occur in children and young adults as well
what percentage of stroke causes are under the age of 65
1/4
is the incidence of stroke equal in men and woman
yes
which gender is more likely to survi ve a stroke
women
what percentage of strokes result in death
29%
is the percentage if strokes that result in death lower or higher for younger people
lower
ischemic strokes account for what percentage
80%
what are the 2 causes of ischemic stroke
cerebral thrombosis
cerebral embolism
what is cerebral thrombosis
Development of a blood clot in a cerebral vessel (occlusion at atherosclerotic plaque)
what is cerebral embolism
Displaced clot of bacterial mass that occludes downstream artery
=blood clots can break free from an thrombosis and lead to an occlusion
when does ischemic strokes usually happen
periods of decreased acitiy (sleep)
is conciousness preserved during ischemic strokr
ues
inntracerebral hemorage acounts for what percent of total strokes
20%
what stroke is bleeding into the brain
intracerbral hemograge
what is the main cause of intracebreal hemorage
arterial rupture
what are the 2 principle causes of stroke i
ischemic and intercerbral hemorage
what percentage of strokes are intracerbral hemmorage
20%
whatt is arterior reupture associated with
Associated with aneurysms and arteriovenous malformations:
when do intracebral hemmorages occur
during periods of acvtiyty
what is the LOC for itracebral hemmorage
stupor or coma
what are the 5 signs and symptoms of stroke
weakness trouble speaking vision problems headache dizziness
explain weakness as a sign
Sudden loss of strength or sudden numbness in the face, arm or leg, even temporary
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
why do people have trouble speaking during a stroke
due to a stroke located in the left hemi
explain vision problems as a sign
Sudden trouble with vision, even temporary
wexplain headache as a sign
sudden sever and unusual headache
explain dizness as a sign
Sudden loss of balance, especially with any of the above signs (why?)
why is dizziness not a good sign alone
because you can be dizzy to many factors
fast is an aconym for
face, arms, speech and time
why does the fast test do
allows people to trecognize the signs of sroke
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
Following a stroke, sensory and motor impairments are located on which body side?
opposite side as brain lesion
what is the most dominant risk factor for stroke
age!!
why is the incidence of stroke inreasing as time icnreases
because average populationn age is increasing
What is the median age (divides population into 2 groups of equal size) of the Canadian population?
40
what are the 3 risk factors we cannot control
age
sex
family hisotry
increases age is the dominant risk factor for strokr?
true
what is the relationsjip between heart disease and age
all major forms of heart disease increase with advancing age
as the canaidan population increased, what is expected in terms of stroke
number of individauls with heart disease and stroke will increase
true or false, the incidience for women and men are the same for strokr
true
what is another important risk factor besides age for strokr
family hisoty of early coronary disease
what is an independant risk factor for stroke
family histry
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
what are 2 examples of modifable risk factors for strokep
physicial inactivtiy
high BP
which age groups were very phydscually inactive
5-11
12-17
60-79
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
national guidelines recomend what in terms of PA
recommend 150 min of moderate- to vigorous- intensity aerobic PA per week
High BP is a major risk factor for what
both coronary artery disaese and stroke peripheral vascular disease and congestive heart faility
High BP incrased overall cardiovascular risk by what
by 2 to 3 fold
which individuals are more liekly to develop high BP
indivudals who have excess weight , are physically inactive, use alcohol heavily, excesive salt intake
what type is the best exercuse program for stroke prevention
aerobic training
what are the 2 modes of training that are beneficials
aerobic training and fucntional training
aerobic rtaining decraes risk of 1st or 2nd stroke
2nd
what are the beneficial effects of aerobic rtaining
Reduced hypertension
Reduced body fat
Increased ratio HDL/LDL
what dies functinal trainingn icnrase
increase ADLS and QoL
what are the beneficial effects of functional trianing
Improve muscular strength and endurance
Improve motor functions (walking, balance, coordination)
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)
what percentage of men in age 5-11 were meeting guidelines
18
what percentage of women in age 5-11 were meeting guidelines
8
what percentage of men in age 12-17 were meeting guidelines
8
what percentage of women in age 12-17 were meeting guidelines
3
what percentage of men in age 60-79 were meeting guidelines
13
what percentage of women in age 60-79were meeting guidelines
11
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
peopel wil stroke have poor or good fitness level
poor
why do those with stroke have a decraed VO2
1) neural drive
2) blood flow
3) muscle mass
the affected limb becomes what type of limb
paretic
compared to a age matched sedentary person, someone with a stroke has a lower or high VO2 man
lower
how much lower is someone with a stroke’s VO2 in cormpared to normal
50% of whatt it would normally be
what is a reason ADL for people with stroke can be compromoed
poor cardiovascular fintess
BLANK can compromise performance of daily living
poor cardio vascular fitness
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
MET indicates metabolic equivalent. One MET is the amount of energy used when _______ (3.5 ml/kg/min)
sitting qiueitly
what is the peak MET for stroke
3.5
what are some mild acitvities of daily living that people with stroke can do
playing piano
canoeing (leusire)
walking (2mp)
what is the mmoderate activtity that those with a stroke can do
cycling (leasuirely)
true or false: if you have a storke , you cant cycle
false, you can, just leisurely
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
what are some examples of ADLS that those with a stroke cannot usually do
swimming, walking (4) tennis and jogging
what does hemiparetic mean
weakness/inbiability to move 1 side of the body
in the case study, stroke leads to what type of disrorders
motor functiton and motor perfornace
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
explain how stroke leads to motor performance disorders
Decrease in balance
Decrease in walking capacities
Decrease in mobility
decrase in blaance, walking or mobility is an example of a motor performance or motor function disorder
motor performance
restrinction or fmovement, weakenss and problems of coordination are examples of motor function or motor performatnce disorders
motor function
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)
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
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.)
Aerobic or resistance training at high intensity could potentially lead to wha
major medical complications (2nd stroke, heart attack, etc.)
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
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
what is chronic strokr
1 year post stroke
the motor function and motor performance disorders are increased or decreaed by absense of PA
increased
true or false: you cannot make signifc ant gains (in 5 movements) 6 months post strokr
true
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?
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
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
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
what did the exerceise prgram focussed on
strengthening the affected extremities and practicing functional tasks involving the upper and lower limbs.
explaon some examples of execruse for upper limbs
push ups in standing
strtecth band in sitting position
ROM with wooden stick
explain who push up in standing postition is good
to imporve elbow extensions and easier to icnrease or decrease diffucilty
for upper limb exercises, they acnn do normal push ups?
falsse, standing push ups
w=what position are stretch band exercises dont
in sitting position
whey are stretch band exrecises done in sitting positions
to impove shoulder flexors, extensors and abductors
why use ROM with wooden stick
unaffected limb can lead to other)
what are some examples of lower limb exercises
step exericses
sit to stand
standing on 1 leg
standing in tandem
explain the step exrcised for lower limb
forward, backward, side steps) to improve lower limb ROM and strengthen the weak side
what is the function of step exrcises
to improve lower limb ROM and strengthen the weak side
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
why is the sit to stand exercise effective
for improving functional mobility
what is the function of standing on one leg as execier
imporoving balance
whta is the function of tandem stance
improve balance
which muscle is uxed for elbow extension
triceps (but ofeten will try to cheat with shoulder and torso)
how many particpantts are in the exrceise session groups
8
what is the frequency of exercise session
2/week
what is the duration of exercise session
60 min/session
what is the intenisty of the exreicse sessions
RPE (rating of perceived exertion) method (0 to 10 point scale)
why is it good to use RPE for intensity
because HR and BP will usually fluctutaet because of meds
what are the ways to modify the intensity
↑ the number of repetitions
↑ ankle weights
↓ the use of parallel bar
↑ exercise difficulty
decreasing the use of the parallel bar increases or decreased intensity
icnreases
evaluation is done only before a exercis prgram
false, before and after
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
what is the goal of time up and go
to detect balance and mobility problems in the elderly
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
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
which test main goal is to detect balance and mobility
timed upo and go
how long should the timed up and go take for neurogloically intact adults
less than 10 secs
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
what is the goal of the berg balance test
to provide a comprehensive balance assessment
which test main ghoal is to provide a comprehensive balance assessment
berg balance
the assessment form for berg balance has how many items
14
where is the berg balance test mainly used
widcely used in clinical research field
the berg test is very BLANK and easy/hard to admisiter
very edtailed and easier to administer
the berg balance allows allows a better stcreening of what
balance imporants
what is the goal of the 6 minute walk test
to evaluate cardiorespiratory (submaximal) endurance in individual with cardiovascular conditions
which test has the goal of to evaluate cardiorespiratory (submaximal) endurance in individual with cardiovascular conditions
6 minute walk test
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.
what does SIAS stand for
stroke imporaiment assessment set
what is the goal of SIAS
to assess motor function and coordination for upper and lower extremities in individuals with stroke
which test has the goal of to assess motor function and coordination for upper and lower extremities in individuals with stroke
SIAS
is the SIAS easy to adminster
yes
is teh berg balance easy to adminster
yes
is scoring easy or diffult for SIAS and why
scoring is often difficult because not detailed enough.
true or false: beofre completeing exrcise, those with a stroke need medical clearance
yes from a physician
true or false: you need a list of meds for a stroke patient
true
whatt measruent is needed to check befgore starting the program
BP
what measurent is always taken before each session
heart beat
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…
true or false: the participants need to follow the exrise program pace
false, they can exercise at their own pace
they should start the execrise session quicly;
false, start each session slowly before increasing the pace
what are some symptoms that mean the patient should stop exerciseing
severe fatigue, feeling faint, feeling of dizziness etc…
for a group adapted exersice program, what is the supervision needed
1 certified KCEP
1 or 2 KCEP interms
1 vlunteer from the center
which tests had significant chagnes between pre and post exrcise
SIAS motor scole
berg balance scale
timed u opand go
what is the score out of for the brg balance
/56
if you score a 45 or less for berg balance, you are at risk of what
falling
the SIAS motor score is out of what
/25
what is the 2nd strogner risk factor for strike
high BP
what is atriovenous malformations and what can they cause
they are when the blood vessels get all tangled and can cause arterial rupture
what are some typical arm stances for those with stroke
flaccid arm or tripple flexed
which test did not show any significant changes between pre and post exrecise
6 min walk
