1
Q
can a stroke lead to physical or mental health
A
both
2
Q
role as a KCEP in the rehab process of your client?
A
increase functional + fitness levels through exercise training
3
Q
what is a stroke
A
- A type of brain injury
- An abrupt incident of vascular insufficiency or of bleeding into or immediately adjacent to the brain
4
Q
ischemic or hemorragic
A
ischemic
5
Q
Epidemiological Considerations: _____ leading cause of death behind heart diseases and cancer
A
third
6
Q
In Canada : _______to_______ cases /
year (740 000 Canadian adults)
A
60 000 to 70 000
7
Q
About ____ of these are 1st attacks and
____ are recurrent attacks
A
80% – 20%
8
Q
Average age of onset: _________…but
can occur in children and young adults
as well (1/4 are under age 65)
A
72 years
9
Q
Incidence : _____ between ♂ and ♀,
but ♀ are more likely to survive a stroke
than ♂
A
equal
10
Q
% of strokes that result in death =
____ (lower for young people
A
29%
11
Q
Ischemic Strokes (account for ___ of all strokes)
A
80%
12
Q
Cerebral Thrombosis
A
Development of a blood clot in a cerebral vessel (occlusion at atherosclerotic plaque)
13
Q
Cerebral Embolism
A
Displaced clot of bacterial mass occludes downstream artery blood clots can break free from a thrombus and lead to artery occlusion
14
Q
when can you get ischemic strokes
A
periods of decreased activity (sleep)
15
Q
arteriovenous malformations:
A
blood vessels get tangled up
15
Q
principle causes of stroke
A
intracerebral hemorrage
‘‘Bleeding into the brain” – (20% of all strokes)
16
Q
Arterial rupture:
A
Associated with aneurysms and
arteriovenous malformations
17
Q
Intracerebral Hemorrage: When?
A
During periods of activity Consciousness? Stupor or coma
18
Q
5 signs of a stroke
A
weakness
trouble speaking
vision problems
headache
dizziness
19
Q
weakness
A
Sudden loss of strength or sudden
numbness in the face, arm or leg, even temporary
20
Q
Trouble speaking:
A
Sudden difficulty speaking or
understanding or sudden confusion, even
temporary (aphasia) -> due to stroke located in right or left hemisphere
21
Q
Vision problems:
A
Sudden trouble with vision, even temporary
22
Q
Headache:
A
Sudden severe and unusual headache
23
Q
Dizziness:
A
Sudden loss of balance, especially with any of the above signs (why?)
24
test acronym
FAST; Face, arm, speech, time
25
test questions
You ask the person to smile
You ask the person to speak a simple sentence
You ask the person to raise both arms
If they cannot do any or all of these three things, act quickly to get them to hospital. It is likely they are having a stroke.
26
Following a stroke, sensory and motor impairments are located on which body side?
Opposite side as brain lesion
27
Incidence of Stroke in Canada no1 factor
age, males=females
28
What is the median
age (divides
population into 2
groups of equal
size) of the
Canadian
population?
40
29
risk factors we can't control
age, sex, family history
30
age risk
increased age is the dominant risk factor for heart disease and stroke. Rates of all maior forms of heart disease increase with advancing age. As the Canadian population ages, it is to be expected that the number of individuals with heart disease and stroke will increase.
31
family history
A family history of early coronary disease is an important risk factor for CAD. It is also an independent risk factor for stroke. The factors that contribute to this association may include familial dyslipidemias, lifestyle and molecular defects in vascular physiology which render the vessel wall more susceptible to atherosclerosis.
32
Risk Factors for a Stroke:
Physical Inactivity
33
Percent of Canadians meeting the Canadian Physical Control Activity guidelines by age and sex (Age Groups)
5 to 11 years 18% M - 8% W
12 to 17 years 8% M - 3% W
18 to 39 years 35% M - 30% W
40 to 59 years 25% M - 18% W
60 to 79 years 13% M - 11% W
34
Regular physical activity (PA) can
reduce body weight, improve serum lipids and cholesterol, blood pressure and diabetes, and thereby overall stroke risk
35
National guidelines recommend
150 min of moderate- to vigorous- intensity aerobic PA per week
36
high blood pressure = ___ strongest risk factor for a stroke
2nd
37
high blood pressure
a major risk factor for both coronary artery disease and stroke peripheral vascular disease and congestive heart failure.
It increases overall cardiovascular risk by 2 to 3 fold.
38
Individuals who have excess weight are
physically inactive, use alcohol heavily, or have excessive salt intake are more likely to develop high blood pressure?
39
What is the best type of exercise program for stroke prevention?
aerobic training
40
Two main modes of training:
aerobic training
functional training
41
aerobic training ↓ risk of a ______
reduces...
2nd stroke
Reduced hypertension
Reduced body fat
Increased ratio HDL/LDL
42
FUNCTIONAL TRAINING (↑ ADLs + QofL):
Improve muscular strength and endurance
Improve motor functions (walking, balance, coordination)
43
about ___% of strokes are 1st attacks and ___% are recurrent attacks
80%, 20%
44
Special Considerations to Exercise:
Reduced motor control (weakness or paralysis) on one side of the body
Sensation may be impaired (implications for stretching)
Intolerance to high intensity exercises (↓VO2 max capacities)
45
The foot drop phenomenon observed after stroke is attributed to the paralysis of
tibialis anterior
46
↓VO2 max capacities due to decreased:
1) neural drive
2) blood flow
3) muscle mass
47
1) neural drive
2) blood flow
3) muscle mass
paretic limbs
48
Poor cardiovascular fitness can compromise performance in
in activities of daily living
49
MET indicates metabolic equivalent. One MET is the amount of energy used when _______ (3.5 ml/kg/min)
sitting quietly
49
Stroke leads to motor function disorders :
Restriction of mvts or paralysis on the
affected side
Weakness of the affected side
Problems of coordination of the affected side
50
Stroke leads to motor performance disorders:
Decrease in balance
Decrease in walking capacities
Decrease in mobility
51
Are all individuals with stroke eligible to the exercise program?
no! too good or too affected = no benefit
52
Major contradication to exercise:
Aerobic or resistance training at high intensity
could potentially lead to major medical complications (2nd stroke, heart attack, etc.)
53
Rationale:
In people with chronic stroke (1 year post-stroke), these disorders are increased by the absence of regular physical activity
54
Experimental Question:
Can people with chronic stroke improve their
physical condition (i.e. functional level) through the participation in a 8-week group exercise program?
55
Preparation of a questionnaire (1-2 pages)
Questions on medical history (high BP?),
medications, physical activity status (level of
fitness, balance, walking capacity, walking
aids), goals of the participant…
55
Elaboration of the exercise program
The exercise program focused on strengthening the affected extremities and practicing functional tasks involving the upper and lower limbs.
56
Why is it important to ask our participants' goals?
Motivation
57
Upper limbs
Push up in standing position to improve elbow
extensors
Stretch bands exercises in sitting positions to
improve shoulder flexors, extensors and
abductors
ROM exercises with wooden stick
58
Lower limbs
Step exercises (forward, backward, side steps)
to improve lower limb ROM and strengthen the weak side
Sit-to-stand from a chair with forward and
backward steps for improving functional mobility
Standing on one leg on the step to improve
balance
Standing on one foot in front of the other to
improve balance (tandem stance)
59
Examples of exercises :
Lower limbs =
Tandem Stance (balance exercise)
60
Intensity can be modified by :
↑ the number of repetitions
↑ ankle weights
↓ the use of parallel bar
↑ exercise difficulty
61
Evaluation (before and after the program)
Timed Up & Go
Goal : to detect balance and mobility problems in the elderly
Instructions : Subjects stand up from a chair, walk 3m, turn around and return to sit back down
SCORE: Neurologically intact adults who are
independent in balance and mobility skills < 10s. If > 30s = dependent in most ADLs and balance and mobility skills
62
Berg balance scale /56 (45 and less = risk of falling)
Goal : to provide a comprehensive balance assessment
Assessment form with 14 items
Very detailed and easy to administer
Allow a better screening of balance impairments
63
The 6-minute walk test
Goal : to evaluate cardiorespiratory
(submaximal) endurance in individual with cardiovascular conditions.
The participants are instructed to
walk from end to end, covering as much ground as they could during the allotted time.
64
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.
65
Exercise Precautions:
Medical clearance from the physician
List of medications of each participant
Blood pressure check before starting the
program
Heart beat before each session
66
Instructions given to the 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 etc…
67
Exercise Supervision
Group Adapted Exercise Program:
1 Certified KCEP
1 or 2 KCEP interns
1 Volunteer from the centre
68
Pre- and Post- Exercise Scores following the 8- week program. Which had significant changes ?
SIAS Motor Score (/25)
Berg Balance Scale (/56)
Timed-up and-Go
6-Minute Walk (m)
SIAS Motor Score (/25)
Berg Balance Scale (/56)
Timed-up and-Go
Significant changes between pre- and post- exercise
69
What is Clinical Exercise Physiology?
* Relatively new career field (since the late
1960s)
* Found within the healthcare realm,
primarily in medical settings, where
exercise is used to help clients manage
or reduce their risk of chronic disease
* Exciting and growing profession that is
more and more organized and recognized
at the provincial and national levels – and
with the upcoming changes in the field of
healthcare, it’s an exciting time to be a
Clinical Exercise Physiologist!
70
Which motor component of fitness is the CEP mainly targeting with this exercise?
coordination
KCEP 210
flashcards
Decks in class (14)
# Cards
-
Wheelchair Ambulation Transfers40
-
Senior Fitness Test48
-
Blindness and visual impairments47
-
intellectual disability55
-
Stroke73
-
KIN & CE34
-
Cerebral Palsy48
-
Osteoporosis49
-
Spinal Cord Injury68
-
Multiple Sclerosis61
-
Traumatized Brain Injury48
-
Hypertension44
-
Aging and Frailty35
-
Exercise Recommendations for Frail Seniors12
