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KCEP 210 midterm > Stroke > Flashcards

Stroke Flashcards

1
Q

Role as a KCEP in the rehab process

A

Increase the functional level (including mobility) of your client through exercise training

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2
Q

What is a stroke?

A
  • Type of brain injury
  • Abrupt incident of vascular insufficiency or of bleeding into or immediately adjacent to the brain
    • Stop receiving blood or bleeding inside the brain
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3
Q

What is the third leading cause of death in canada

A

Stroke, behind heart disease & cancer

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4
Q

How many strokes happen yearly in Canada

A

between 60 000 to 70 000 cases

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5
Q

Yearly strokes (percentages)

A
  • 80 % are first attacks

- 20 % are recurrent attacks

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6
Q

Average age of onset

A
  • 72 years old
  • can occur in children and young adults
  • 1/4 are under age of 65
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7
Q

Who is more likely to survive a stroke

A
  • Equal incidence but woman are more likely to survive

- THEORY: estrogran can protect women from the lack of oxygen in the brain due to a stroke

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8
Q

Percentage of strokes resulting in death

A
  • 29 % but lower for younger people
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9
Q

Types of Strokes

A
  • Ischemic stroke

- Intracerebral Hemorrage stroke

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10
Q

Ischemic stroke

A 
- 80% of all stroke
2 types:
- Cerebral Thrombosis
- Cerebral Embolism
During periods of decreased activity and conscious
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11
Q

Ischemic stroke - Cerebral Thrombosis

A

Development of a blood clot in a cerebral vessel (occlusion at atherosclerotic plaque)

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12
Q

Ischemic stroke - Cerebral Embolism

A
  • Displaced clot of bacterial mass that occludes downstream artery
  • Blood clots can break free from a thrombus and lead to artery occlusion
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13
Q

Intracerebral Hemorrhage Stroke

A
  • 20% of all stroke and generally more severe
  • Bleeding into the brain
    2 types:
  • Arterial rupture
  • Aneurysm
    During periods of activity (pressure goes up) and Stupor or coma
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14
Q

Intracerebral Hemorrhage Stroke - arterial rupture

A
  • Associated with aneurysms & arteriovenous malformations
  • can be congenital
  • Crossing over of the blood vessels leading to them being stretched out . They tangled up and get weaker
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15
Q

Intracerebral Hemorrhage Stroke - aneurysm

A
  • Only becomes a problem upon rupturing
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16
Q

Signs & Symptoms (5)

A
  1. Weakness
  2. Trouble Speaking
  3. Vision Problems
  4. Headache
  5. Dizziness
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17
Q

Signs & Symptoms - Weakness

A
  • Sudden loss of strength or sudden numbness in the face, arm or leg, even temporary
  • On one side of the body
  • Ask for sensation
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18
Q

Signs & Symptoms - Trouble speaking

A

Sudden difficulty speaking or understanding or sudden confusion, even temporary (in case of stroke can become permanent)
- due to stroke location in the left hemisphere (frontal lobe)

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19
Q

Signs & Symptoms - Vision problems

A

Sudden trouble with vision, even temporary

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20
Q

Signs & Symptoms - Headache

A

Sudden severe and unusual headache

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21
Q

Signs & Symptoms - Dizziness

A

Sudden loss of balance, especially with any of the above signs

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22
Q

F.A.S.T. Test

A 
An acronym for:
F - face
A - arms
S - speech
T - time
- helps people recognize the signs of stroke
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23
Q

F.A.S.T. Test (order)

A
  • Ask the person to smile
  • Ask the person to speak a simple sentence
  • Ask the person to raise both arms
  • If they cannot do any or all of these three things, act quickly to get them to a hospital
24
Q

Following a stroke, sensory and motor impairments are located on which side of the body?

A

Opposite side as brain lesion

25
Q

Why is the Incidence of stroke in Canada increasing

A

Aging population

26
Q

What is the median age of the Canadian Population

A

40

27
Q

Risk factors we cannot control

A
  • Age
  • Sex
  • Family History
28
Q

Physical Inactivity

A

Risk factor we can control

  • Regular PA can reduce body weight, improve serum lipids and cholesterol, BP and diabetes
  • National guidelines recommend 150 min of moderate to vigorous intensity aerobic PA per week
29
Q

Second Strongest risk factor for stroke

A

High Blood pressure

  • go hand in hand
  • individuals who have excess weight, are physically inactive, use alcohol heavily, or excessive salt intake increased chances of high BP
  • Trend: more chance of getting diagnosed with high BP the older you get
30
Q

What is the best type of exercise to prevent Stroke

A

Aerobic training

31
Q

Two types of beneficial exercise

A

Aerobic training

Functional Training

32
Q

Effects of Aerobic training

A

reduces risk of a second stroke
- reduces hypertension
- reduces body fat
Increased ration HDL/LDL (more H, less L)

33
Q

Effects of Functional Training

A

Increased ADLs + QofL

  • improved muscular strength and endurance
  • Improve motor functions (walking, balance, coordination)
34
Q

Considerations to Exercise

A
  • Reduced motor control on one side of the body
  • Sensation may be impaired (stretching implications)
  • Intolerance to high intensity exercises (decreased VO2 max)
35
Q

The Foot drop observed after stroke is attributed to the paralysis of?

A

Tibialis Anterior

36
Q

Why does VO2 Max decrease

A
  • Neural drive = from motor cortex to the muscles (contractions)
  • Blood flow = to the active muscles
  • Muscle Mass = atrophy
    Paretic limbs:
    • Pare = weak
    • Means on the side the stroke happens / the side affected
37
Q

ADL Range for METS

A

3 - 5 METS

38
Q

METs

A

Indicates metabolic equivalent. One MET is the amount of energy used when sitting quietly (3.5ml/kg/min)

39
Q

Stroke leads to motor FUNCTION disorders

A
  • Restrictions of mvmts or paralysis on the affected side
  • Weakness on the affected side
  • Problems of coordination of the affected side
40
Q

Stroke leads to motor performance disorders

A
  • Decrease in balance
  • Decrease in walking capacities
  • Decrease in mobility
41
Q

Are all individuals with stroke eligible to the exercise program

A

No, too good or too affected = no benefit

42
Q

Exercise Program - Contradiction

A

Aerobic or resistance training at high intensity could potentially lead to major medical complications
- second stroke, CAD etc

43
Q

Exercise Program - Rationale

A

In people with chronic stroke (1 year post-stroke), these disorders are increased by the absence of regular physical activity

44
Q

Questionnaire

A 
Question on medical history
- medications
- PA status (level of fitness, balance, walking capacity, walking aids)
- Goals of the participant
Establish a partnership with the patient
- tends to lead to greater results
45
Q

Examples of Exercises - UE

A
  • Push up in standing position to improve elbow extensors
  • Stretch bands exercise in sitting position to improve shoulder flexors, extensors, and abductors
  • ROM exercise with wooden stick
46
Q

Examples of Exercises - LE

A
  • Step exercise (forward, backward, side steps) to improve lower limb ROM and Strengthen the weak side
  • Sit-to-Stand (improving functional mobility)
  • Standing on one leg on the step (balance)
  • Standing tandem (balance)
47
Q

Exercise Sessions - Overview

A
  • Group of 8 participants
  • Frequency: 2/week
  • Duration: 60 min/session
  • Intensity: RPE (rating or perceived exertion) method (0-10 scale)
48
Q

How to modify the exercise intensity?

A
  • Increase the number of repetitions
  • Increase ankle weights
  • Decrease the use of parallel bar
  • Increase exercise difficulty
49
Q

Timed Up & Go

A
  • Evaluation technique before and after program
  • Goal: to detect balance and mobility problems
  • Instructions: stand up from chair walk 3m turn around and walk back to seat
  • Score: independent in balance and mobility <10s
    • > 30s = dependent in most ADLs
50
Q

Berg Balance Scale

A

Most commonly used balance testing

  • Goal: to provide comprehensive balance assessment
  • Assessment form with 14 items
  • Allow a better screening of balance impairments
51
Q

6 Minute walk test

A

Goal: to evaluate sub-maximal cardiorespiratory endurance in individuals with CV conditions
- walk as far as you can within the 6 minutes

52
Q

Stroke Impairment Assessment Set (SIAS)

A

Goal: to assess motor function and coordination for upper and lower extremities in individuals with stroke
- Easy to administer but scoring is often difficult because not detailed enough

53
Q

Exercise Precautions

A
  • Medical clearance
  • List of medication
  • BP check before starting program
  • HB before each session
  • Instructions given to participants:
    - 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
54
Q

Exercise Supervision

A

In Group adapted exercise program

  • 1 certified KCEP
  • 1 or 2 KCEP interns
  • 1 Volunteer from the center
55
Q

Pre-Post exercise scores after 8 weeks

A

SIAS, Berg, and TUAG all saw significant changes after 8 week program
- no statistical difference for 6-min walk

KCEP 210 midterm (7 decks)

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