Neurological Conditions

Question 1

A stroke occurs when blood flow to a region of the brain is obstructed, resulting in a rapid loss of brain functioning lasting for 24hr or more, or until death. T/F?

Answer 1

True - The majority of strokes are ischemic, due to thrombosis or embolism. a much smaller portion of strokes are hemorrhagic, caused by rupture of a vessel in the brain and consequent leaking of blood into the brain tissue or cerebrospinal fluid.

Question 2

What are some common experiences that may result from stroke?

Answer 2

> Paralysis (usually contralateral side to brain occlusion).
Problems with motor control (typically ataxia - inhibited ability to coordinate movement).
Sensory disturbance (especially pain sensation).
Language deficits (aphasia - inability to speak, write or communicate properly).
Memory and cognitive deficit (reduced short-term memory and attention span).
Emotional disturbance.

Question 3

Typically, people who have sustained a traumatic brain injury or stroke will have declined aerobic fitness, and significantly less efficient response to exercise. T/F?

Answer 3

True - aerobic capacity is typically 67-74% below height and age predicted values.

Question 4

What are three of the functional implications of a TBI or stroke?

Answer 4

SOB
rapid fatigue
reduced mobility efficiency

Question 5

Describe the FAST acronym for stroke emergency action.

Answer 5

Recognise the signs of stroke:
F - Face paralysis
A - Arm weakness
S - Speech difficulty
T - Time to act (immediate action)

Question 6

With respects to common experience of a stroke, what are three of the associated signs and symptoms?

Answer 6

> slurred speech
> double vision
> confusion
> unilateral numbness/weakness in face, arm or leg
> dizziness/loss of balance

Question 7

Exercise alone can reduce mortality due to stroke by 20% or more, T/F?

Answer 7

True

Question 8

Cycling and treadmill walking have been shown to improve VO2peak, workload response, blood pressure, resting heart rate, and cholesterol levels in stroke survivors, T/F?

Answer 8

True - cycling has been shown to increase VO2peak by 60%

Question 9

It is typical for stroke clients to be prescribed short-term anti-coags and long-term platelet inhibitors. What other medications may be given to manage hemorrhagic stroke (due to high blood pressure)?

Answer 9

anthihypertensives, i.e. ACE inhibitors, B-blockers, Ca-blockers, diuretics and sympathetic nerve inhibitors.

Question 10

Seizures and spasticity may necessitate long-term anticonvulsant and antispasmodic medications.

Answer 10

examples include;
>Phenobarbital
>Clonazepam
>Gabapentin
>Carbamazepine

Question 11

It is not uncommon for stroke survivors to fell depressive, and withdrawn from society. This typically leads to a need for anti-depressants and other drugs to manage mental health.

Answer 11

examples include;
>Venlafaxine
>Amitriptyline
>Desipramine
>Nortriptyline
>Fluoxetine
>Sertraline
>Lorazepam
>Diazepam
>Alprazolam

Question 12

Hypertonia is common in people who have sustained a stroke. It is characterised by what abnormalities? What is a typical drug prescribed to reduce the symtpoms of this condition?

Answer 12

abnormal increase in muscle tension and reduced ability to stretch that muscle (spasticity is interchangeably used).
Typically prescribed:
> Dantrolene
> Diazepam
> Baclofen

Question 13

Medications for stroke patients may affect acute physiological responses during graded exercise testing and sessions. What are the three most common affects?

Answer 13

> vasodilators may increase cool-down period needed to prevent hypotension post-exercise
meds inhibiting cardiac output may reduce HR/BP response to intensity and thus need to be monitored other ways
Diuretics reduce fluid volume and may upset electrolyte balance causing dysrhythmias (hypo/hyper- kalemia)

Question 14

All methods of testing should be considered for neurological conditions. Name 1 test of strength, endurance, flexibility and neuromuscular control that may be incorporated in a stroke Ax battery.

Answer 14

Str - dynamometry
End - 6MWT (functional)
Flex - limb-joint ROMS
NM - Gait, Posture, Berg Balance, Functional reach, Tinetti
** Functional - Duke mobility, FuncIndepMeas(FIM)

Question 15

There are a number of special considerations when assessing exercise capacity of stroke patients. List 4 of them.

Answer 15

> medications (CV, hypertensive, anticonvulsants, reduce muscle tone)
arthritis is a common comorbidity
reduced motor control may necessitate using only uninjured limb
modification of equipment necessary
closely monitor CVA clients with ECG in case of CAD
impaired sensation needs to be monitored
CVA clients may also have PAD - use of legs inhibited

Question 16

Absolute CIs to exercising stroke clients are…

Answer 16

Valvular heart disease
Electrolyte abnormality
Hypertension
Tach-/Brady-dysrhythmias
A-V Block

Question 17

List 4 goals of exercise rehab for stroke clients

Answer 17

+ reduced recurrence risk
+ optimise functional capacity (increase mobility efficiency)
+ improve QoL and ADL performance
+ enhance self-care and skill proficiency
+ prevent prolonged inactivity
+ increase aerobic endurance

Question 18

Incorporate aerobic, strength, flexibility and neuromuscular training following preliminary orthostatic training (sitting and standing - posture), T/F?

Answer 18

True - orthostatic training involves prolonged periods of sitting or standing, as tolerated to improve postural strength.

Question 19

Multiple sclerosis is thought to be an autoimmune disease that damages the insulating myelin sheaths of the central nervous system. T/F

Answer 19

True

Question 20

What are 4 typical effects MS has on exercise repsonse?

Answer 20

> Spasticity
> Incoordination
> Impaired balance
> Fatigue
> Muscle weakness, paresis or paralysis
> Sensory loss/numbness
> Cardiovascular dysautonomia (problems with autonomic nervous system inhibiting the cardiac cycle)
> Tremors
> Heat sensitivity

Question 21

There are multiple types of MS, what are the four most common?

Answer 21

relapsing-remitting, primary-progressive, secondary progressive, progressive-relapsing.