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STROKE download-1 - Coggle Diagram
STROKE 
Introduction
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Unfortunately, standard physical therapy does not typically improve functional capacity in this
population.
However, incorporation of a regular exercise program can be a determinant of whether the patient can live independently or perform standard daily tasks without assistance.
Definition
Ischemic Stroke
The loss of blood flow to a region of the brain because of a manifestation of cardiovascular disease, characterized by the buildup of atherosclerotic plaque in cerebrovascular arteries. In most ischemic strokes, a blood clot ultimately seals off the narrowing artery. (common)
Haemorrhagic stroke
A stroke that occurs because of excessive bleeding in a cerebral artery. The excessive bleeding and swelling in
the brain prevent blood from flowing to brain cells downstream of the hemorrhage.
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The brain damage can impair voluntary muscle movement, speech, vision and
judgement.
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Neurons in the brain die, and the accompanying brain damage is the main cause of subsequent disability in stroke survivors.
Pathophysiology
The atherosclerotic process that causes cerebrovascular disease, and ultimately an ischemic stroke, proceeds in the same fashion as plaque progression in coronary artery
disease (CAD).
The traditional and nontraditional risk factors that are related to the development and progression of CAD and peripheral arterial disease (PAD) are associated with the development of ischemic cerebrovascular disease.
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Ischemic = Embolic, Thromotic & Lacunar.
Hemorrhagic = Intracerebral haemorrhage & Subarachnoid haemorrhage
Clinical Considerations
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Exercise Testing
Ensure blood pressure is below the contraindicative values, systolic pressure of 200 mm Hg and diastolic blood pressure of
110 mm Hg.
Ischemic stroke is highly associated with CAD, screening should ensure that symptoms of CAD such as unstable angina are not present (absolute
contraindication).
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Treatment
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Physical Therapy
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Functional movements such as chair stands, transferring from bed
Restore balance, movement and coordinations
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Exercise prescription
Goals
Resistance
• Significant reductions in muscular strength and endurance exist, and a reduced muscle mass is highly with correlated functional capacity.
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Flexibility
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• Exercise programs should focus on aerobic exercise, strength training, and flexibility
Aerobic
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• The average Functional capacity of a stroke patient is near 14.4 mL/kg.min, whereas 20 mL/kg/minis the minimum for independent living.
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Flexibility
• Focus should be on all major joints, with special attention given to paretic limbs, especially muscle groups that are experiencing a large degree of muscle spasticity.
• A raised platform can be very useful as it assists the stroke patient’s ability to lie down and return to a standing position after exercising
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Exercise training review
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Exercise and the brain
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• Treadmill training has been shown to increase brain activation in the posterior cerebellum and midbrain during movement of the paretic leg
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Stroke, Exercise & Quality of Life
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Stroke, Exercise and Blood pressure
As BP is an important risk factor for both ischemic and hemorrhagic strokes, another important adaptation is a decrease in BP in response to acute exercise.
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