Neuromuscular Conditions (1)

Question 1

What is a stroke?

Answer 1

Transient ischemic attack (brief episode of neurological dysfunction due to interrupted blood flow.

Cerebrovascular accident: ischemic = blockage & hemorrhagic = artery burst

Question 2

What percentage of stroke patients have CAD?

Answer 2

> 50%

Question 3

What part of the motor neuron is damaged?

Answer 3

Upper portion

Question 4

What is the risk of hemiparesis?

Answer 4

3x the risk

Question 5

Risk factors for stroke…

Answer 5

Inactivity
Smoking
Hypertension
Dyslipidemia
Obesity
Impaired glucose tolerance
Age
Gender
Family History

Question 6

How are spinal cord injuries classified?

Answer 6

Thoracic vertebrae (T1) is the key.

ABOVE = tetra/quadriplegic
BELOW = paraplegic

Question 7

What are the respiratory system changes that occur with spinal cord injury?

Answer 7

Diaphragm innervation (increased/decreased - C4 important)

Question 8

Is there increased or decreased blood flow to the legs or arms following a spinal cord injury?

Answer 8

Decreased to the legs
Increased to the arms

Question 9

Consequences of spinal cord injury

Answer 9

Muscle Atrophy
Reduced oxidative capacity

Question 10

What is Cerebral Palsy?

Answer 10

Motor impairment syndrome secondary to lesions or anomalies of the brain arising in the early stages of its development

Question 11

Incidence of cerebral palsy

Answer 11

0.1%

Question 12

Causes of cerebral palsy

Answer 12

Prematurity & low birth rate (also meningitis & trauma)

Question 13

Other conditions associated with cerebral palsy

Answer 13

Scoliosis & GI problems

Question 14

Stroke medication

Answer 14

Anticoagulants

Question 15

Psychological consequences of a stroke

Answer 15

Loss of motivation & fear of exercise depression (atleast 50%)

Question 16

What is the ideal RM assessment for a stroke?

Answer 16

10RM

Question 17

How should cardio health be assessed after a stroke?

Answer 17

Cycle ergometer

Question 18

What is the ideal heart rate for endurance training (Stroke)

Answer 18

15-30b/min above resting HR
RPE 12-13

Question 19

Stroke - endurance training (duration/frequency)

Answer 19

<15min, 2x/day & 5x/week

progress to 45 min sessions 3-5/week

Combined arm and leg ergometer ideal

Question 20

Stroke - Strength training

Answer 20

Multi-joint activities (functional), hypertrophy (8-12 reps), 2-3x/wk, include balance & proprioception training

Question 21

How does spinal cord affect heart rate and was is the recommended zone

Answer 21

HR alterations = decreased SV, increased HR, change in sympathetic nervous system.

HRmax = 130b/min

Question 22

In Stroke patients what is the main limitation to max work output

Answer 22

Peripheral

Question 23

How should physical assessments be conducted in stroke patients

Answer 23

Incremental exercise testing use arm ergometry (be aware of pressure sores)

Question 24

Exercise prescription for Spinal cord patients

Answer 24

Endurance focus (20-30% improvements in short time frame)

Arm crank ergometry important - initial loads will be low for 3-5 mins build to 15 mins then 30-45 mins (2-5 sessions)

Can use wheelchair on treadmill

Circuit training

Question 25

What should you be aware of in spinal cord patients

Answer 25

Thermal stress

EStimcan improve circulation

Question 26

Cerebral palsy medication

Answer 26

Baclofen: sustained muscular contractions and slow movements of the appendicular musculature (Anti-parkinsons).

Clonazepam: spontaneous movements

Question 27

Physical assessment for cerebral palsy

Answer 27

Hypo/hypertonia (muscle tone)
Focus on function, balance, strength and speed of movement)

Wheelchair or arm crank ergometry

3RM testing for strength

Question 28

Exercise prescription and guidelines (Cerebral Palsy)

Answer 28

Functionality and strength focus
Endurance 15 mins 3x/wk 50-65% MHR
Strength - hypertrophy, 3x week