Stroke Flashcards
What are the two types of strokes and what are their characteristics?
1) Ischemic stroke, a blood clot blocks or plugs a blood vessel in the brain
2) Hemorrhagic stroke, a blood vessel in the brain breaks or ruptures
What are the signs of a stroke?
Facial weakness
Arm or leg weakness
Speech problems
Loss of sight in one eye
What is a transient ischaemic attack (TIA) and what are the characteristics?
Transient ischaemic attack is a mini stroke, a temporary disruption in the blood supply, usually lasts one hour and can be resolved within 24 hours but could be a signal of a CVA (full stroke).
What are the major determinants of cerebral supply and demand?
Cerebral O2 Supply:
1) 02 carrying capacity of blood (problems= anaemia, lung disease etc.)
2) Cerebral blood flow: Cerebral perfusion pressure, cerebral vasculature resistance, external compression, intrinsic regulation (local metabolites, endothelial factors, neural innervation)
Cerebral O2 demand:
1) Constant blood supply needed (brain cells only function aerobically)
What are the risk factors of a stroke?
Smoking Hypertension Medical conditions (DM, irregular HR) Regular heavy drinking Diet Lack of exercise Oral contraceptives
Why is exercise important for stroke patients?
1) May promote other lifestyle changes
2) Reduces TLC, LDL, increases HDL
3) Reduces BP
4) Active
5) Increases caloric expenditure and LBM
6) Reduces plasma fibrinogen levels
7) Improved insulin sensitivity
8) Improved sense of wellbeing/stress management
What are long term symptoms?
Impairment of motor sensory function in upper and lower body extremity or both extremities on the involved side
Flaccidity/contractures
Mental confusion
Apraxia (impaired sequencing of voluntary movement)
Ataxia (problems affecting balance, co-ordination and speech)
Muscle weakness, limited ROM and impaired sensation may preclude independent ambulation or standing exercise
Hemianopia= impaired vision or visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes
Dysphasia/ aphasia (difficulty with language
Neglect
Pain
Tiredness/ Fatigue
What are the impact of a stroke on physical function?
14% achieve full recovery 50% experience long-term effects 25-50% need some assistance with ADLS Intolerance to activity Increased energy cost associated with activity Fatigue Presence of CVD risk factors
What are the other considerations?
Cognitive and behavioural implications of conditions can influence adherence to exercise.
Mainly elderly population affected-participation by arthritis, orthopaedic conditions and CV problems.
What are the exercise testing recommendations for Stroke patients?
Aerobic (Cycle: 5-10 W.mins1 ramp protocol/Treadmill: 0.5-2 METs with 3 min.stages/ seated ergometer: arm or stepper. Measures include 12 Lead ECG,HR or BP and RPP and RPE and VO2 peak and Endpoints are serious dysrhythmias, > 2mm ST-segment depression / elevation, Ischaemic threshold, SBP > 250 mmHg or DBP > 115 mmHg, Volitional fatigue
Endurance (6 or 12 min walk/Cycle ergometer). Measures distance walked, time of exercise @ 60% peak power and Endpoints are note time, distance and symptoms at rest stops.
Strength (Manuel muscle test/Dynamometer testing).Measures force generated dynamometer. Endpoints are pounds, kilograms, repetitions, maximum torque
Flexibility (Handheld goniometer). Measures include ROM in shoulder, elbow, wrist, knee, ankle and other joints of affected limbs. Distance reached. Endpoints are degrees of full flexion/extension, total arc of movement
Neuromuscular (Gait analysis) measures include gait speed and symmetry of movement. Endpoints timed up and go test
Functional testing: measures include performance of ADLs.
What are the exercise programming for stroke patients?
Aerobic (Upper/lower body ergometer, cycle ergometer, treadmill, seated stepper) Prescription= 40-70% VO2 peak, RPE 13-20, 3-5 days, 20-60 mins/sessions or multiple 10 mins. Goals include increase independence in ADLs, increase walking speed and decrease risk of CVD.
Strength (Isometric exercise, weight machines, free weights), Prescription= 3 sets of 8-12 reps, 1-2 sets, 2 days/week. Goals include increase independence in ADLs
Flexibility (Stretching), Prescription= 2 days/week (before or after aerobic activities. Goals include increase of ROM of involved extremities, prevent contractures.
Neuromuscular (Co-ordination and balance activities) Prescription= 2 days/ week same day as strength activities
What are the stroke medication and what are the implication for exercise?
1) Short-term use of anticoagulants (warfarin) & long-term platelet-inhibiting agents (aspirin or clopidogrel): Implications for exercise: bleed profusely if injured
2) Statins: To reduce blood cholesterol (target <3.5 mmol.L -1) and prevent further blockages)- Implications for exercise: joint/muscle pain
3) Antihypertensive medication (beta-blockers, ACE inhibitors, diuretics)- Implication for exercise= hypotension (prolong cool-down); postural hypotension (avoid sudden changes in posture).
4) Vasodilators if vasospasms of cerebral arteries is suspected. Implications for exercise= sudden drop in BP
