Lectures 21-23 Flashcards
Stroke (Cerebrovascular disease)
- Cerebro = _
relating to the brain
Stroke (Cerebrovascular disease)
- vascular = _
Relating to the vessel
Brain functions
- controls movements
- stores memories
- source of thoughts, emotions & language
- many other functions: perception, breathing & digestion, etc.
To work properly brain needs _
oxygen
Although brain makes up only 2% of body weight, it uses almost _ % of the oxygen
18.5%
Brain is No. _ major single-organ that consumes the most oxygen
2 (Liver, brain, heart)
Brain cells are very _ to decrease in oxygen & don’t survive or function well long without it
sensitive
Because brain cells will _ if the supply of blood which carries oxygen is stopped, the brain has _ for the blood
- Even if other organs need blood, the body attempts to supply the brain with a constant flow of blood
- The blood brings many materials necessary for the brain to function properly
- die
- top priority
Stroke Pathophysiology:
87% of all cases
- Blood flow is interrupted/reduced, cells die within minutes without oxygen
Blockage (ischemic stroke)
Stroke Pathophysiology:
Every cell needs oxygen to function
- Cells use oxygen to break down sugar to get energy from the food
– This process is called _
cellular respiration
Stroke Pathophysiology:
The brain can survive for up to _ minutes after the heart stops
- This is why CPR should be started within _ minutes of cardiac arrest
– After _ minutes without CRP however, the brain begins to die
6
Stroke Pathophysiology:
Occurs when a blood clot blocks or plugs an artery leading to the brain
- A blood clot often forms in arteries damaged by the build-up of plaques (atherosclerosis)
- It can occur in the carotid artery of the neck as well as other arteries
Ischemic stroke
Stroke Pathophysiology:
Sudden brain bleeding puts too much pressure on cells which damages and kills them
Burst (hemorrhagic stroke)
Stroke Pathophysiology:
Hemorrhage/blood leaks into brain tissue
Hemorrhagic stroke (Burst)
Stroke Pathophysiology:
Risk factors
- High blood pressure
- Atherosclerosis
- Genetics & family history
Stroke Pathophysiology:
medical emergency —> _ & _
disability & death
Stroke Pathophysiology:
Build up of fats, cholesterol, and other substances in and on the artery walls; narrowing of blood vessels and build-up of plaque on artery walls
Atherosclerosis
Stroke Pathophysiology:
Can’t be cured, but is _
preventable
Stroke in the US:
_ leading cause of death
5th
Stroke in the US:
Killing >/= 140,000 Americans/year: 1 of every _ deaths
20
Stroke in the US:
Someone has stroke every _, someone dies of stroke every _
- 40 sec
- 4 minutes
Stroke in the US:
Every year, about _ Americans have a stoke
- About 610,000 of these are first or new strokes
- About 185,000 are recurrent strokes
800,000
Stroke in the US:
Costs about _ annually
$34 Billion
Stroke Consequences:
Symptoms of stroke include _
trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg
Stroke Consequences:
_ disabilities
- Depending on how long the brain lacks blood flow & which part was affected
- Paralysis
- Loss of muscle movement
- Balance problems
Temporary or permanent
Stroke Consequences:
Difficulty _ & _
talking & swallowing
Stroke Consequences:
_ loss & _ difficulties
Memory loss & thinking difficulties
Stroke Consequences:
Emotions problems & _
depression
Stroke Consequences:
_ & numbness
pain
Stroke Consequences:
_ changes & _ ability
behavior changes & self-care ability
Stroke ages affected
- Some 0-2
- Some 19-40
- More 41-60
- Most 60+
Effects of stroke on Ex Response:
Lose approximately _% of aerobic capicity
50%
Effects of stroke on Ex Response:
Overall _ reduced
physical fitness
Effects of stroke on Ex Response:
_ diability
Neurological
Effects of stroke on Ex Response:
Energy costs _
doubled
Effects of stroke on Ex Response:
Physical activity can be sustained for a _
short period
Effects of stroke on Ex Response:
Most stoke survivors are unable to _
independently perform ADLs
Stroke - Ex Testing:
Stroke survivors
- oxygen uptake is _
- Incompetence & early-onset fatigue are common
lower
Stroke - Ex Testing:
_ method, pre-screening algorithm & CVD risk factor
self-guided
Stroke - Ex Testing:
Senior fitness test, FITNESSGRAM
- _ setting recommended for most stroke survivors
Lab setting
Stroke - Ex Testing:
Use _ walk when the condition is mild
6-minute (consider 3 mins)
Stroke - Ex Testing:
_ intensity during testing
Low
Stroke - Ex Programming:
For people with stroke, follow the _ guideline
chronic disease guideline
Stroke - Ex Programming:
For people with stroke, follow the chronic disease guideline
- Be _, start with _ & _
- Conservative
- low intensity & shorter time
Stroke - Ex Programming:
Include _
aerobic, muscular, flexibility & neuromotor
Stroke - Ex Programming:
Physical & occupational therapy are typically utilized for up to 3-6 months following a stroke to improve/restore _
functional mobility, balance, and return to ADL
Stroke - Ex Rx:
Patients may have _ such as other CVDs, arthritis, and metabolic disorders
- All _ should be considered when prescribing Ex
comorbidities
Stroke - Ex Rx:
Main objective is to _
restore a patient’s ability to return to ADL
FITT for Stroke Survivors:
Aerobic
- Frequency
3-5 days/week
FITT for Stroke Survivors:
Aerobic
- Intensity
– If HR data are available from a recent GXT, use _, in the absence of a GXT or if atrial fibrillation is present, use _
- 40-70% of HRr
- RPE of 11-14 on a 6-20 scale
FITT for Stroke Survivors:
Aerobic
- Time
progressively increase to 20 to 60 min/day
- Consider multiple 10 minute sessions
FITT for Stroke Survivors:
Aerobic
- Type
Cycle ergometry & semirecumbent seated steppers
- may need modification based on functional & cognitive difficulties
- Treadmill walking can be considered if patient has sufficient balance & ambulation with very minimal or no assist
FITT for Stroke Survivors:
Resistance
- Frequency
2 nonconsecutive days/week
FITT for Stroke Survivors:
Resistance
- Intensity
50-70% of 1RM
FITT for Stroke Survivors:
Resistance
- Time
1-3 sets of 8-15 repetitions
FITT for Stroke Survivors:
Resistance
- Type
use equipment & exercises that improve safety in those with deficits (ex: strength, endurance, movement, balance)
- Machine vs free weights
- Bar vs. hand-held weights
- Seated vs standing
FITT for Stroke Survivors:
Flexibility
- Frequency
> /= 2 days/week with daily being most effective
FITT for Stroke Survivors:
Flexibility
- Intensity
Stretch to the point of feeling tightness or slight discomfort
FITT for Stroke Survivors:
Flexibility
- Time
10-20 sec hold for static stretching
- 2-4 reps of each exercise
FITT for Stroke Survivors:
Flexibility
- Type
Static, dynamic, and/or PNF stretching
FITT for Stroke Survivors:
Neuromotor
- Frequency
2-3 days/week
FITT for Stroke Survivors:
Neuromotor
- Intensity
An effective intensity has not been determined
FITT for Stroke Survivors:
Neuromotor
- Time
> /= 20-30 min/day may be needed
FITT for Stroke Survivors:
Neuromotor
- Type
Exercise involving motor skills (ex: balance, agility, coordination, gait), proprioception exercise training, and multifaceted activities (ex: Tai Chi, yoga) are recommended for older individuals to improve & maintain physical function & reduce falls in those at risk for falling
Spinal cord:
- Normally 32-34 pieces
- Upper 24 pieces are _
- Lower 8-10 pieces are _
- separated by discs
- fused
Spinal cord function:
Brain and spinal cord together make up the _
central nervous system
Spinal cord function:
Transmit neural signals between the brain and the rest of the body
Motor
Spinal cord function:
Works as a conduit for sensory information travels up to brain, and finally as a center for coordinating certain reflexes
Sensation
Spinal Cord Injury (SCI):
Damage to any part of the spinal cord, often causes _ changes in strength, sensation and other body functions below the site of the injury
permanent
Spinal Cord Injury (SCI):
Depending on the location and severity
- All feeling and all ability to control movement are lost below the injury site
Complete
Spinal Cord Injury (SCI):
Depending on the location and severity
- Still have motor or sensory function below the affected area, since nervous signals are still able to travel thru the injured area of the cord.
- There are varying degrees.
Incomplete
Spinal Cord Injury (SCI):
_ be cured
Can’t
Approx. 60% SCI patients have an _ injury
incomplete
80% of those with an SCI are _
male
Approx. half of those with SCI have a _
C lesion
Results of Spinal Cord Injuries:
- Paralysis in arms, hands, torso, and legs. Patient may need help breathing
C1-C4
Results of Spinal Cord Injuries:
- Patient can raise arms and bend elbows. Likely to have some or total paralysis of wrists, hands, torso, and legs.
C5
Results of Spinal Cord Injuries:
- Typically paralysis in hands, torso, and legs. Can often bend wrists.
- Little control of bowl or bladder, but may be able to manage with special equipment.
C6
Results of Spinal Cord Injuries:
- Most can straighten arms and have normal movement of shoulders.
- Little control of bowl or bladder, but may be able to manage with special equipment.
C7
Results of Spinal Cord Injuries:
- Should be able to grasp and release objects.
- Little control of bowl or bladder, but may be able to manage with special equipment.
C8
Results of Spinal Cord Injuries:
- Corresponding nerve affects muscles, upper chest, mid-back, and abdominal muscles.
- Arm and hand function is usually normal.
T1-T5
Results of Spinal Cord Injuries:
- Normal upper-body movement.
- Little control of bowel or bladder, but may be able to manage with special equipment.
T6-T12
Results of Spinal Cord Injuries:
- Some loss of function in the hips and legs.
- Little control of bowel or bladder, but may be able to manage with special equipment.
L1-L5
Results of Spinal Cord Injuries:
- Generally results in some loss of function of the hips and legs.
- Most likely will be able to walk.
S1-S5
Effects of SCI on Ex Response:
- Lose approx. 50% _
aerobic capacity
Effects of SCI on Ex Response:
- Overall physical fitness _
reduced
Effects of SCI on Ex Response:
- _ disability
Neurological
Effects of SCI on Ex Response:
- Energy costs _
doubled
Effects of SCI on Ex Response:
- Physical activity can be sustained for _ period
VERY short
Effects of SCI on Ex Response:
- Most SCI individuals are _ to independently perform many ADL
unable
Ex Testing for SCI:
- Individuals with SCI have a high risk for the development of _
secondary conditions
Ex Testing for SCI:
- Consider test _, level and site of SCI, physical fitness level
purpose
Ex Testing for SCI:
- Functional assessments
- Trunk ROM
- Wheelchair mobility
- Transfer ability
- Upper & lower extremity
Ex Testing for SCI:
- Self-guided method, pre-screening, & CVD risk factor
- Senior fitness test
- _ setting recommended
Lab
FITT for SCI:
Aerobic
- Frequency
Minimum of 2 days/week
- Progress to 3 days/week, athletes can increase to 3-5 days/week
FITT for SCI:
Aerobic
- Intensity
Beginners: Moderate intensity (40-59% HRr)
Athletes: 75-90% HRr
FITT for SCI:
Aerobic
- Time
Initially, bouts of 5-10 min alternating 5-min active recovery periods
- Gradually increase to at least 20 min per session and decrease or eliminatee rest periods
FITT for SCI:
Aerobic
- Type
Engage the largest possible muscle mass: Voluntary arm + leg ergometry or combined FES-LCE and voluntary arm ergometry or rowings, recumbent steppings, arm ergometry, wheelchair ergometry/rollers, or wheeling.
FITT for SCI:
Resistance
- Frequency
Minimum of 2 days/week
FITT for SCI:
Resistance
- Intensity
Initially, use 20-RM for each exercise
FITT for SCI:
Resistance
- Time
Initially, 1-2 sets of each exercise per session
- Gradually progress to 3 sets of 9-10 repetitions
FITT for SCI:
Resistance
- Type
Accessible resistance exercise machines are convenient and safe.
- If unable, use dumbbells, cuff weights, or elastic bands/tubing
FITT for SCI:
Flexibility
- Frequency
Daily, especially in presence of joint contracture, spasticity, or frequent wheelchair propulsion and manual transfers
FITT for SCI:
Flexibility
- Intensity
Do not allow stretching discomfort >2 on the 0-10 pain scale
FITT for SCI:
Flexibility
- Time
Stretch each muscle group repeatedly for 2-4 min/day, preferably after warm-up or following training/competition
FITT for SCI:
Flexibility
- Type
Active stretching is prefered, but if this is not possible, low intensity passive stretching may be used by the individual or assistance
Ex Rx for SCI:
The goals of exercise training include the prevention of _; improved _ (ex: weight management, glucose homeostasis, lower CVD risk); and improved _ for functional independence (Wheelchair mobility, transfers, ADL), for prevention of falls and sports injuries, and for improved performance (safety and success in adaptive and recreational activities).
- deconditioning
- wellness
- muscular strength, muscular endurance, and flexibility
Ex Rx for SCI:
Currently, there are _ published consensus recommendations for developing and Ex Rx for the SCI population.
no
Ex Programming for SCI:
- Review with _ prior to engaging in a new Ex program
physician
Ex Programming for SCI:
- For people with SCI, follow the _
chronic disease guideline
Ex Programming for SCI:
For people with SCI, follow the chronic disease guideline
- Be conservative, start with _ & _
low intensity & shorter time
Ex Programming for SCI:
- begin early _ and Ex training
mobilization
Ex Programming for SCI:
FITT includes _
Aerobic, muscular, flexibility, and neuromotor
Special Considerations for SCI:
- Empty _ before Ex
bladder or urinary bag
Special Considerations for SCI:
- Aerobic: 5-10 min _ bout with 5 min rest advances to 10-20 MVPA bout with 5 min rest. Wheelchair ergometer training.
LMPA
Special Considerations for SCI:
- _ Ex from seated position in wheelchair should be complemented with non-wheelchair Ex bouts
Muscular strength
Special Considerations for SCI:
- _ from wheelchairs to Ex equipment should be limited
Transfers
Special Considerations for SCI:
- Lower body Ex should not be _
ignored
Parkinson’s disease is a condition that has been known about since ancient times
- It is referred to in the ancient Indian medical system
- However it was not until 1817 that a detailed medical essay was published on the subject by London doctor _
James Parkinson
Parkinson’s Disease Pathophysiology:
- Loss/death of nerve cells in _
substantia nigra
A disorder of the central nervous system that affects movement, often including tremors
Parkinson’s Disease
Parkinson’s Disease Pathophysiology:
- Decreased _, causes abnormal brain activity, leading to symptoms of PD
dopamine
A brain chemical involved movement, motivation, reward, and addiction
- It is released during pleasurable situations and stimulates one to seek out the pleasurable activity or occupation: food, sex, addiction
- Affects movement and cognition: A part of the brain called the basal ganglia regulates motor movement & cognition, emotion, etc. Basal ganglia in turn depend on a certain amount to function at peak efficiency
Dopamine
Parkinson’s Disease Pathophysiology:
- Tremor, stiffness (rigid), loss of _
balance
Parkinson’s Disease Pathophysiology:
- Risk factors
- Genetic mutations
- Environmental triggers
- Age: average onset is 55-yr
- Gender: men > wom
Parkinson’s Disease Pathophysiology:
- Can’t be cured, but _ may help
treatment
Parkinson’s Disease in the US:
As many as _ million affected
1.5 million
Parkinson’s Disease in the US:
About _ newly diagnosed each year
60,000
Parkinson’s Disease in the US:
More than _ deaths each year
23,000
Parkinson’s Disease ages affected
41-60 & 60+
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 0.0
No signs of disease
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 1.0
Unilateral disease
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 2.0
Bilateral disease, without impairment of balance
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 2.5
Mild bilateral disease, with recovery on pull test
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 3.0
- Mild-to-moderate bilateral disease
- some postural instability
- physical independent
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 4.0
- Severe disability
- Still able to walk or stand unassisted
The Hoehn & yahr Staging Scale of Parkinson’s Disease:
- Stage 5.0
Wheelchair bound or bedridden unless aided
Parkinson’s Disease Progression of symptoms:
- In the early stages, face may show _
little or no expression
Parkinson’s Disease Progression of symptoms:
- Then, arms may not _
swing when walk
Parkinson’s Disease Progression of symptoms:
- Speech may become _
soft or slurred
Parkinson’s Disease Progression of symptoms:
- Symptoms _ as condition progresses over time
worsen
Parkinson’s Disease Effects on Ex Response:
Effect on Ex is difficult to characterize
- No two individuals are _
alike
Parkinson’s Disease Effects on Ex Response:
Effect on Ex is difficult to characterize
- Even the same person can be different from _
day to day
Parkinson’s Disease Effects on Ex Response:
Effect on Ex is difficult to characterize
- Symptoms fluctuate from _
hour to hour
Parkinson’s Disease Effects on Ex Response:
In general, overall physical fitness, functioning, movement _
reduced
Parkinson’s Disease Effects on Ex Response:
Most PD individuals are _ to independently perform many ADL
unable
Ex Testing for Parkinson’s Disease:
Focus on _ due to the effects from rigidity, gait-balance, tremor
- Pull test
- Tandem stand
- 360o turn
- Functional reach or chair sit and reach
- Reaction time
- Gait speed
- Timed walk (6-min walk)
- Sit to stand
functioning
Ex Testing for Parkinson’s Disease:
Self-guided method & CVD risk factor classification
- Need _ to complete
help from significant others
Ex Programming for Parkinson’s Disease:
- Hoehn and Yahr class 1, 2, 2.5 follow _
healthy individual guideline
Ex Programming for Parkinson’s Disease:
- Hoehn and Yahr class _ follow healthy individual guideline
1, 2, 2.5
Ex Programming for Parkinson’s Disease:
- Hoehn and Yahr class 3, 4, 5 follow _
chronic disease guideline
Ex Programming for Parkinson’s Disease:
- Hoehn and Yahr class _ follow chronic disease guideline
3, 4, 5
Ex Programming for Parkinson’s Disease:
- FITT
aerobic, muscular, flexibility and neuromotor
Ex Rx for Parkinson’s Disease:
_ programming should be used when prescribing exercise for individuals with PD
Individualized
Ex Rx for Parkinson’s Disease:
The main goal of exercise is to _
delay disability, prevent secondary complications, and improve quality of life as PD progresses
Ex Rx for Parkinson’s Disease:
4 key health outcomes are improved _
- gait
- transfers
- balance
- joint mobility and muscle power to improve functional capacity
FITT for Parkinson’s Disease:
Aerobic
- Frequency
3 days/week
FITT for Parkinson’s Disease:
Aerobic
- Intensity
40-<60% VO2r or HRr or RPE of 11-13 on a scale of 6-20
FITT for Parkinson’s Disease:
Aerobic
- Time
30 min of continuous or accumulated exercise
FITT for Parkinson’s Disease:
Aerobic
- Type
Aerobic activities such as walking, cycling, swimming, or dancing
- A stationary bicycle, recumbent bicycle, or arm ergometer are safer modes for individuals with more advanced PD
FITT for Parkinson’s Disease:
Resistance
- Frequency
2-3 days/week
FITT for Parkinson’s Disease:
Resistance
- Intensity
40-50% of 1 RM for individuals with PD beginning to improve strength
- 60-70% 1 RM for more advanced exercisers
FITT for Parkinson’s Disease:
Resistance
- Time
> /= 1 set of 8-12 repetitions
- 10-15 repetitions in adults with PD starting an exercise program
FITT for Parkinson’s Disease:
Resistance
- Type
Emphasizes extensor muscles of the trunk and hip to prevent faulty posture, and all major muscles of lower extremities to maintain mobility
FITT for Parkinson’s Disease:
Flexibility
- Frequency
1-7 days/week
FITT for Parkinson’s Disease:
Flexibility
- Intensity
Full extension, flexion, rotation, or stretch to the point of slight discomfort
FITT for Parkinson’s Disease:
Flexibility
- Time
Perform flexibility exercises for each major muscle-tendon unit
- Hold stretches for 10-30 seconds
FITT for Parkinson’s Disease:
Flexibility
- Type
Slow static stretches for all major muscle groups should be performed
FITT for Parkinson’s Disease:
Neuromotor
- _ training during functional activities should be included
Static, dynamic, and balance
FITT for Parkinson’s Disease:
Neuromotor
- _ are other forms of exercise to improve balance in PD
Tai chi, tango, and waltz
