1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 16 Resistance-Training Strategies for Stroke Survivors

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Overview of Stroke Cerebral vascular accident (CVA) Results from reduction of blood supply to parts of brain Affected brain cells die –Alters neurologic function

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Overview of Stroke Rehabilitation occurs within first 30 days –When acute motor function recovery greatest Minimal progress occurs in subsequent three to six months

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Effects of Stroke Hemiparesis –Weakness on one side of body Hemiplegia –Paralysis on one side of body Aphasia Dysphagia

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Effects of Stroke Decreased field of vision and visual perception Behavioral and cognitive changes

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of Stroke 500,000 Americans have strokes annually 200,000 Americans have recurrent strokes annually Less than 30 percent fatal Third leading cause of death –157,000 die annually

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of Stroke Majority of victims age 55 or more Risk increases with age Men affected more than women –But women more likely to die

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Economic Impact of Stroke Leading cause of serious, long-term disability Over 1,100,000 adults report functional limitations Direct and indirect cost nationwide = $57.9 billion

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Economic Impact of Stroke Average individual cost over lifetime = $140,048 Costs higher for nursing home care and recurring strokes

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ischemic Stroke 80 to 85 percent of all strokes Artery supplying brain becomes clogged Thrombotic stroke –Result of arteriosclerosis Embolic stroke –Wandering clot lodges in artery leading to brain

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ischemic Stroke Systemic hypoperfusion stroke –Heart’s circulatory failure fails to deliver enough blood to brain –Reason 1 to 3 percent of all myocardial infarctions result in stroke

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hemorrhagic Strokes 15 to 20 percent of all strokes Ruptured blood vessel in brain Causes blood flow to enter extravascular space surrounding vessel Subarachnoid hemorrhage –Blood vessel on brain’s surface bleeds into space between brain and skull

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hemorrhagic Strokes Intracerebral hemorrhage –Blood vessel bleeds into deep brain tissue Ruptured aneurysm caused by high blood pressure most common cause for both types of hemorrhagic strokes

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Atherosclerosis Major risk factors: –Hypertension –Cigarette smoking –Diabetes All promote plaque formation and occlusive disease

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Transient Ischemic Attacks (TIAs) Also known as mini-strokes Produce stroke-like effects without lasting effects Recurring TIAs leading signal of impending stroke Caused by clots that temporarily block artery

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Transient Ischemic Attacks (TIAs) 15 percent of strokes preceded by TIA After TIA, 17 percent stroke risk within next 90 days

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Neurologic Impairments Related to Stroke Paresis Paralysis Spasticity Loss of balance Loss of sensation Visual perception or field of vision problems Neuromuscular imbalances

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Spasticity Uncontrolled contraction Causes permanently shortened and stiffened joint Results in posture change Can affect ability to walk, climb stairs, etc.

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Spasticity Person relies heavily on unaffected side –Creating imbalance Muscle strength reduced in affected limb

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Little research prior to mid-1990s Many studies did not utilize normal fitness equipment Few studies using conventional equipment showed strength increases Current research fails to provide full-body resistance training program

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Must understand variations in neurological deficit manifestations Older survivors show more symptoms New motor patterns often result of using affected side as brace

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Biggest challenge: –“Untraining” new motor patterns –Retraining original patterns

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise Testing Considerations Perform 1 RM strength testing unilaterally Testing time and rest intervals consequently take longer Always test each movement individually for strength changes to obtain baseline values and effectiveness

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise Testing Considerations Measure voluntary and passive ROM to assess spasticity Test muscular endurance of lower body using chair-rise and stair-climb tests Use 10 to 15 RM to test upper body Use stork-stand test to assess balance

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Special Considerations for Exercise Training Within first 12 weeks, majority of improvements neurologically based No data on success after 12 weeks Keep area free of tripping hazards Use spotting appropriately

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Special Considerations for Exercise Training Provide supervision and monitoring Consider repetition complete when individual moves through maximum voluntary ROM Manual spotting through ROM can assist with retraining lost motor pattern

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Undulating Periodization Circuit-training style of exercise Increasing load and volume over several training sessions Next, decreasing load and volume for short time Next, increasing both again –But to higher levels than before

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Assumes moderate training program will benefit most stroke survivors Include major muscle groups Include both multi- and single-joint exercises Include unilateral and bilateral movements

29. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Change exercise combinations to facilitate new motor patterns Keep rest intervals to one minute or less Review sample 24-Week Program