1
Q
Role as a KCEP in the rehab process
A
Increase the functional level (including mobility) of your client through exercise training
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
3
Q
What is the third leading cause of death in canada
A
Stroke, behind heart disease & cancer
4
Q
How many strokes happen yearly in Canada
A
between 60 000 to 70 000 cases
5
Q
Yearly strokes (percentages)
A
- 80 % are first attacks
- 20 % are recurrent attacks
6
Q
Average age of onset
A
- 72 years old
- can occur in children and young adults
- 1/4 are under age of 65
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
8
Q
Percentage of strokes resulting in death
A
- 29 % but lower for younger people
9
Q
Types of Strokes
A
- Ischemic stroke
- Intracerebral Hemorrage stroke
10
Q
Ischemic stroke
A
- 80% of all stroke 2 types: - Cerebral Thrombosis - Cerebral Embolism During periods of decreased activity and conscious
11
Q
Ischemic stroke - Cerebral Thrombosis
A
Development of a blood clot in a cerebral vessel (occlusion at atherosclerotic plaque)
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
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
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
15
Q
Intracerebral Hemorrhage Stroke - aneurysm
A
- Only becomes a problem upon rupturing
16
Q
Signs & Symptoms (5)
A
- Weakness
- Trouble Speaking
- Vision Problems
- Headache
- Dizziness
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
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)
19
Q
Signs & Symptoms - Vision problems
A
Sudden trouble with vision, even temporary
20
Q
Signs & Symptoms - Headache
A
Sudden severe and unusual headache
21
Q
Signs & Symptoms - Dizziness
A
Sudden loss of balance, especially with any of the above signs
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
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
Why is the Incidence of stroke in Canada increasing
Aging population
26
What is the median age of the Canadian Population
40
27
Risk factors we cannot control
- Age
- Sex
- Family History
28
Physical Inactivity
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
Second Strongest risk factor for stroke
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
What is the best type of exercise to prevent Stroke
Aerobic training
31
Two types of beneficial exercise
Aerobic training
| Functional Training
32
Effects of Aerobic training
reduces risk of a second stroke
- reduces hypertension
- reduces body fat
Increased ration HDL/LDL (more H, less L)
33
Effects of Functional Training
Increased ADLs + QofL
- improved muscular strength and endurance
- Improve motor functions (walking, balance, coordination)
34
Considerations to Exercise
- Reduced motor control on one side of the body
- Sensation may be impaired (stretching implications)
- Intolerance to high intensity exercises (decreased VO2 max)
35
The Foot drop observed after stroke is attributed to the paralysis of?
Tibialis Anterior
36
Why does VO2 Max decrease
- 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
ADL Range for METS
3 - 5 METS
38
METs
Indicates metabolic equivalent. One MET is the amount of energy used when sitting quietly (3.5ml/kg/min)
39
Stroke leads to motor FUNCTION disorders
- Restrictions of mvmts or paralysis on the affected side
- Weakness on the affected side
- Problems of coordination of the affected side
40
Stroke leads to motor performance disorders
- Decrease in balance
- Decrease in walking capacities
- Decrease in mobility
41
Are all individuals with stroke eligible to the exercise program
No, too good or too affected = no benefit
42
Exercise Program - Contradiction
Aerobic or resistance training at high intensity could potentially lead to major medical complications
- second stroke, CAD etc
43
Exercise Program - Rationale
In people with chronic stroke (1 year post-stroke), these disorders are increased by the absence of regular physical activity
44
Questionnaire
```
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
Examples of Exercises - UE
- 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
Examples of Exercises - LE
- 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
Exercise Sessions - Overview
- Group of 8 participants
- Frequency: 2/week
- Duration: 60 min/session
- Intensity: RPE (rating or perceived exertion) method (0-10 scale)
48
How to modify the exercise intensity?
- Increase the number of repetitions
- Increase ankle weights
- Decrease the use of parallel bar
- Increase exercise difficulty
49
Timed Up & Go
- 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
Berg Balance Scale
Most commonly used balance testing
- Goal: to provide comprehensive balance assessment
- Assessment form with 14 items
- Allow a better screening of balance impairments
51
6 Minute walk test
Goal: to evaluate sub-maximal cardiorespiratory endurance in individuals with CV conditions
- walk as far as you can within the 6 minutes
52
Stroke Impairment Assessment Set (SIAS)
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
Exercise Precautions
- 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
Exercise Supervision
In Group adapted exercise program
- 1 certified KCEP
- 1 or 2 KCEP interns
- 1 Volunteer from the center
55
Pre-Post exercise scores after 8 weeks
SIAS, Berg, and TUAG all saw significant changes after 8 week program
- no statistical difference for 6-min walk
