Stroke 2

Question 1

What is the aim for rehab in Stroke patients?

Answer 1

Reduce rate or reverse deconditoning

Question 2

What are 3 main reasons for low fitness levels in stroke patients?

Answer 2

1. Body composition changes
2. Advancing age
3. Physical inactivity

Question 3

Why does body composition change in stroke patients?

Answer 3

1. Reduced central neural drive - main cause of de-conditioning
2. Muscle atrophy
3. Muscle fibre-­‐type changes
4. Activated inflammatory pathway
5. Hemi-paretic side osteoporosis
6. Impaired peripheral blood flow

Question 4

Describe the relationship between thigh muscle mass and fitness in stroke patients

Answer 4

Size of thigh muscles correlates with Vo2peak.
- The paretic thigh mass is usually about 20% lower than the normal thigh.
- The inter-muscular area in the paretic thigh is usually 20% higher than the normal thigh
(Elevated intramuscular fat is linked to insulin
resistance.)

Question 5

What happens to muscle fibre types in stroke patients?

Answer 5

The convert Type 1 fibres to Type 2.
Therefore less Type 1 fibres which are resistant to fatigue and insulin sensitive
This normally occurs due to inactivity but can also occur due to neural activities

Question 6

How does an activated inflammatory pathway affect a stroke patient?

Answer 6

It causes an increase of cytokines in the body therefore excessive cyotkines contributes to muscle dystrophy and insulin resistance

Question 7

Describe some consequences of hemi-paretic osteoporosis in stroke patients

Answer 7

Less physical activity 
Muscle atrophy
Poor cardiorespiratory fitness
Higher risk of fracture
14% decline in bone density in the first year

Question 8

The skeletal muscle, bone, and vasomotor
regulatory abnormalities on the paretic side
may contribute to worsening cardiovascular
risk how?

Answer 8

By propagating physical inactivity, insulin resistance and the metabolic syndrome

Question 9

Benefits of exercise in stroke patients:

Answer 9

Aerobic Training:
Increases capacity by 8 - 23%
Improves sensorimotor function

Resistance Training:
Strengthening of lower limb helps with balance
Increases walking speeds

Balance Training
Varied responses depending on spared brainstem

Question 10

What improvements could be made in the experimental designs in which Stroke patients take part in?

Answer 10

1. Pre-evaluation of medical history, physical examination, ECG and graded exercise test
2. Exercise tests should be adapted to the patient based on their capabilities.

Question 11

What are the leading causes of mortality in stroke patients?

Answer 11

• Recurrent Strokes and cardiovascular disease

Question 12

What are some benefits of aerobic exercise in stroke patients?

Answer 12

• Can improve CVD risk factors, therefore making management of stroke easier
• Evidence that leisure time physical activity reduces the risk of stroke
• Stroke patients are able to train as much as healthy people in their age range