1. Stroke Jessica Lucas

2. Quick Facts 3 rd leading cause of death in U.S 1 million reported functional limitations Greater chance in men 55-64, greater chance in women over 85 Each year 800,000 people will have a stroke

3. What is it? Loss of blood flow to a region in the brain Brain cells die from lack of oxygen and nutrients 0ccurs from a blocked artery (ischemic) or bursting of a blood vessel (hemorrhagic) Often called “brain attack” Impairs voluntary muscle movement, speech, vision, and judgment

4. Types of Stroke Ischemic Accounts for about 87% “Heart attack” of the brain Occurs from clogging of fatty deposits lining the vessel walls Embolic Blood clot forms and travels to brain Thrombotic Blood clot that forms inside an artery that supplies blood to the brain Hemorrhagic Major risk factor: Hypertension Other causes: aneurysm, brain tumor, drug use Intracerebral vs. Subarachnoid Little warning Headache, vomiting, large increase in BP

5. Symptoms Numbness or weakness of face, arm, leg Especially on one side of the body Confusion Speech problems Vision changes Sudden, severe headache Impaired coordination/walking *** 2 most common symptoms post stroke: memory loss and paralysis

6. Treatment Most of the plaque is removed from artery wall Medications are prescribed depending on type of stroke Ex: Ischemic stroke patients--- meds include statins and diabetes meds to control risk factors Cholesterol and blood pressure lowering meds are used Meds preventing blood clots are common Anticoagulant and Antiplatelet meds Physical therapy To restore balance, coordination, movement Speech therapy Psychological referrals

7. Exercise Prescription Average functional capacity of a stroke patient 14.4 ml/kg /min. Minimum for independent living is 20 ml/kg/min Improvements in patients who follow ACSMs guidelines for healthy populations Aggressive program is important! Combining aerobic and resistance training will improve functional capacity the best

8. Exercise Testing Contraindications are the same for all patient populations Systolic blood pressure under 200 mmHg, and diastolic under 110 mmHg Patients unable to achieve at least.5mph during floor walking can use cycle ergometry or arm ergometry If they are able to achieve test, they can perform a graded exercise treadmill test

9. Case Study The patient is a 57 year old male with a history of hypertension. He is 3 month post hemorrhagic stroke, and was mildly affected by the stroke. He suffered from left brain damage and has slow behavior, balance, and some speech problems. His resting BP is 170/90.

10. Training Method ModeIntensityFrequencyDurationNotes AerobicWalking, cycle ergometry, aquatic ex 50% to 80% HRR 3-5 days per week 15-30 minsSupported treadmill works best ResistanceBody weight, resistance bands, machines As tolerated 2-3 days per week 30-45 mins FlexibilityPNF stretching As tolerated 3-5 days per week 10-20 minsStretch muscles on paretic side more BalanceDynamic movements Tai chi Standing ex yoga 2-3 days per week 30-60 minsDecreases fear of falling!

11. References Chan, B. K. S., Ng, S. S. M., & Ng, G. Y. F. (2015). A home-based program of transcutaneous electrical nerve stimulation and task- related trunk training improves trunk control in patients with stroke: A randomized controlled clinical trial. Neurorehabilitation and Neural Repair, 29(1), 70-79. doi:10.1177/1545968314533612 Ehrman, J. (2003). Clinical exercise physiology. Champaign, IL: Human Kinetics. Stinear, C. M., Barber, P. A., Smale, P. R., Coxon, J. P., Fleming, M. K., & Byblow, W. D. (2007;2006;). Functional potential in chronic stroke patients depends on corticospinal tract integrity. Brain : A Journal of Neurology, 130(Pt 1), 170-180. doi:10.1093/brain/awl333 Williams, O. (2010). Stroke diaries: A guide for survivors and their families. New York: Oxford University Press.