Secondary Impairments After Stroke (3) Flashcards
When is learned non-use particularly an issue after stroke?
In the upper arm. Walking - forced to use both limbs
What are the secondary impairments following a stroke?
Loss of fitness Learned non-use Contracture Swelling Shoulder subluxation Pain
What are some characteristics of loss of fitness after stroke?
Up to 75% of people with stroke have coronary artery disease
Paretic muscle
Fatigue
Environmental factors
What does the prevalence of coronary artery disease in people with stroke indicate?
That this is likely a population that already has decreased fitness
How does paretic muscle contribute to loss of fitness after stroke?
Decreased oxidative metabolism
Decreased endurance
How does fatigue contribute to loss of fitness after stroke?
Low aerobic fitness
Low muscle endurance
Is fitness training effective after stroke?
Australian stroke guidelines:
Rehab should include interventions aimed at increasing cardiorespiratory fitness once patients have sufficient strength in the large lower link muscle groups (A)
Patients should be encouraged to undertake regular, ongoing fitness training (GPP)
What can improve with cardiorespiratory training after stroke?
Speed
Tolerance
Independence during walking
Further trials need to determine optimal prescription and any long term benefits
When should fitness training be done after stroke?
Regardless of stage of recovery, significant benefit
Results generalised to those who are mildly or moderately impaired and who had relatively low risk of cardiac complications with exercise
When fitness training after stroke,what should be done to make sure they will receive benefits of training?
Put a HR monitor on to make sure they are at 50-80% max heart rate
What are the characteristics of contracture after stroke?
Muscles :
Lose sarcomeres
Become shorter and stiffer
Changes in cross bridge connections
Connective tissue:
Water loss
Collagen deposition
What is the prevalence of contracture?
Within 6 months after stroke about half of all patients develop a contracture
How to predict contracture
No one factor predicts development of contracture
Muscle strength is a significant predictor of elbow, wrist and ankle contractures
- but cannot accurately predict development of contractures in these joints
muscles are at risk of contracture?
Gastroc/soleus Shoulder internal rotators Elbow flexors Wrist flexors, long finger flexors Forearm pronators Thumb web space Hip flexors
Prevention of contracture
NO additional benefit of routine stretching
Use: routine positioning, active practice
However, monitor for the development of contracture - GPP
do not use pulleys
