Cours 6 : Stroke

Question 1

What can a stroke lead to?

Answer 1

Physical and mental impairment

Question 2

What is the role of a KCEP in the rehab process of the client?

Answer 2

To increase the functional + fitness levels through exercise training

Question 3

What is a stroke?

Answer 3

A type of brain injury

An abrupt incident of vascular insufficiency or of bleeding into or immediately adjacent to the brain

Question 4

What is the epidemiological considerations?

Answer 4

3rd leading cause of death behind heart diseases and cancer

In Canada 60 000 to 70 000 cases a year (740 00 Canadian adults

About 80% of these are 1st attacks and 20% are recurrent attacks

Average age of onset : 72 years but can occur in children and young adults as well (1/4 are under age 65)

Incidence : Euqal between females and males, but females are more likely to survive a stroke than males

% of strokes that result in death = 29% (lower for young people)

Question 5

What an Ischemic Strokes?

Answer 5

Accounts for 80% of all strokes

Cerebral Thrombosis
Cerebral Embolism

When periods of decreased activity

Preserved consciousness (if you get to the hospital early, you can get less damage to your body and your brain)

Question 6

What is Cerebral Thrombosis?

Answer 6

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

Question 7

What is Cerebral Embolism?

Answer 7

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

Question 8

What’s an Intracerebral Hemorrage?

Answer 8

Bleeding into the brain (20% of all strokes)

Arterial rupture : associated with aneurysms and arteriovenous malformations : blood vessels can get tangled up

When : during periods of activity
Consciousness : stupor and coma

Question 9

What are the signs and symptoms of a stroke?

Answer 9

1. Weakness : Sudden loss of strength or sudden numbness in the face, arm or leg, even temporary
2. Trouble speaking : Sudden difficulty speaking or temporary (aphasia)
3. Vision problem : Sudden trouble with vision, even temporary
4. Headache : Sudden severe and unusual headache
5. Dizziness : Sudden loss of balance, especially with any of the above signs (why - drop of BP will make you dizzy)

LEFT PART OF THE BRAIN THATS ATTACKED

Question 10

What is the fast test?

Answer 10

Acronym for face, arm, speech and time. Helps people recognize the signs of stroke

You ask the person to smile - other side will go up and the other one won’t move

You ask the person to speak a single 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 their are having a stroke.

Question 11

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

Answer 11

Opposite side as brain lesion

Question 12

What’s the incidence of stroke in Canada?

Answer 12

As you age, the rates of all major forms of heart disease increases. It is to be expected that the number of individuals with heart disease and stroke will increase.

MEDIAN AGE OF CANADIAN POPULATION : 40 years old

Question 13

What are the risk factors : physical inactivity?

Answer 13

Regular physical activity can reduce body weight, improve serum lipids and cholesterol, blood pressure and diabetes, and thereby overall stroke risk

National guidelines recommend 150 min of moderate - to vigorous - intensity aerobic PA per week

If you start early, you get to be more active when you get older

Question 14

What is the relation between high blood pressure and stroke?

Answer 14

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.

Individuals who have excess weight are physically inactive, use alcohol heavily or have excessive salt intake are more likely to develop high blood pressure. HP is commonly associated with other metabolic cardiovascular risk factors such as insulin resistance, obesity, hyperuricemia and dyslipidemia

Question 15

What is the best type of exercise program for stroke prevention?

Answer 15

Aerobic training

Question 16

What does aerobic training helps with?

Answer 16

Decreases the risk of a 2nd stroke
- Reduced hypertension
- Reduced body fat
- Increased ratio HDL/LDL

Question 17

What does functional training helps with?

Answer 17

Improve muscular strength and endurance

Improve motor function (walking, balance, coordination

About 80% of strokes are 1st attacks and 20% are recurrent attacks

Question 18

What are the special considerations to exercise?

Answer 18

Reduced motor control (weakness or paralysis) on one side of the body

Sensation may be impaired (implications for stretching )

Intolerance to high intensity exercises (decreases VO2 max capacities)

Question 19

The foot drop phenomenon observed after stroke is attributed to the paralysis of what?

Answer 19

Tibialis Anterior

Question 20

Decrease VO2 max capacities due to decreased (35 to 40 is a good V02max

Answer 20

Neural drive
Blood flow
Muscle mass = Paretic limbs (weakness)

Age 25 is when we can achieve peak VO2

Question 21

What are special considerations to exercise?

Answer 21

Poor cardiovascular fitness can compromise performance in activités of daily living
One MET is the amount of energy used when (3.5 ml/kg/min) by sitting quietly

Question 22

What are the other risk factors?

Answer 22

Age (#1) : increased age is the dominant risk factor for heart disease and stroke. Rates of all major forms of heart disease with advancing age. As Canadian population ages, it is to be expected that the number of individuals with heart disease and stroke will increase

Sex : at younger ages, men are at much higher risk than women of developing coronary. There appears to be a teen-year for women in the development off CAD.

Family History = A family history of east coronary disease is an important risk factor for CAD. It is 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.

Question 23

What is the percentage of Canadians meeting the Canadian Physical Activity guidelines by age and sex for 5 to 11 years for Men/boys and Women/Girls?

Answer 23

Men/Boys = 18%
Women/Girls = 8%

Physical inactivity is something we can control, if you start early you get to be more active when you get older

Question 24

What is the percentage of Canadians meeting the Canadian Physical Activity guidelines by age and sex for 12 to 17 years for Men/boys and Women/Girls?

Answer 24

Men/Boys = 8%
Women/Girls = 3%

Physical inactivity is something we can control, if you start early you get to be more active when you get older

Question 25

What is the percentage of Canadians meeting the Canadian Physical Activity guidelines by age and sex for 60 to 79 years for Men/boys and Women/Girls?

Answer 25

Men/Boys = 13%
Women/Girls = 11%

Where stroke starts the most, so staying active physically will decrease the risk.

Question 26

What are the energy requirement of common daily activities in mild leisure activities?

Answer 26

Playing the piano - 2.3
Canoeing (leisurely) - 2.5
Walking (2mph) - 2.5

Question 27

What are the energy requirement of common daily activities in moderate leisure activities?

Answer 27

Cycling (leisurely) - 3.5 (peak of stroke participants
Swimming (slow) - 4.5
Walking (4 mp)- 4.5

Question 28

What are the energy requirement of common daily activities in vigorous leisure activities?

Answer 28

Chopping wood - 4.9
Tennis (doubles) - 5.0
Jogging (10 min mile) - 10.2

Question 29

What is the description of the participant’s condition?

Answer 29

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

Stroke leads to motor performance disorders:
Decrease in balance
Decrease in walking capacities
Decrease in mobility

Question 30

What is the muscle that does a concentric motion?

Answer 30

Tibialis interior

Question 31

What is the major contraindication to exercise?

Answer 31

Aerobic or resistance training at high intensity could potentially lead to major medical complications (2nd stroke, heart attack, etc.)

Question 32

What is rationale?

Answer 32

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

Question 33

What is the preparation of a questionnaire?

Answer 33

Questions on medical history (high BP?), medications, physical activity status (level of fitness, balance, walking capacity, walking aids), goals of the participant

Question 34

What is the elaboration of the exercise program?

Answer 34

The exercise program focused on strengthening the affected extremities and practicing functional tasks involving the upper and lower limbs.

Question 35

What are the exercises of the upper limbs?

Answer 35

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

Question 36

What are the exercises of the lower limbs?

Answer 36

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)

Question 37

With training, is it possible to go back to the original value?

Answer 37

It depends to be honest, it’s going to be hard. It’s because you can no longer contract your heart the same as before and can no longer use your body the same day.

Question 38

What are the exercise sessions?

Answer 38

Group of 8 participants
Frequency : 2 times / week
Duration : 60 minutes / session
Intensity : RPE (rating of perceived exertion) method (0 to 10 point scale)

Question 39

What intensity can be modified by what?

Answer 39

↑ the number of repetitions
↑ ankle weights
↓ the use of parallel bar
↑ exercise difficulty

Question 40

What is the evaluation of time up & Go?

Answer 40

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

Question 41

What is the evaluation of berg balance scale?

Answer 41

/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

Question 42

What is the evaluation of the 6-minute walk test?

Answer 42

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.

The task is to cover as much ground as possible in 6 minutes

Question 43

What is the evaluation of the stroke impairment assessment set?

Answer 43

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.

Question 44

What are the exercise precautions?

Answer 44

Medical clearance from the physician

List of medications of each participant

Blood pressure check before starting the program

Heart beat before each session

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…
(Beta Blocker gonna stop the heart rate after 110 bpm. Prevents from allowing HR going over a certain amount

Question 45

What are the results of the different tests?

Answer 45

SIAS Motor Score (/25)
Pre-Exercise (mean ± sd) : 13.8 ± 5.8
Post Exercise (mean ± sd) : 16.2 ± 6.0

Berg Balance Scale (/56) Pre-Exercise (mean ± sd) : 45.4 ± 6.9
Post Exercise (mean ± sd) : 49.6 ± 5.4

Timed-up and-Go
Pre-Exercise (mean ± sd) : 26.3 ± 13.7
Post Exercise (mean ± sd) : 21.7 ± 10.0