Stroke

Role of a Kinesiologist/CEP: To optimize functional capacity and fitness through exercise training.

A stroke is defined as a type of brain injury, characterized by an abrupt incident of vascular insufficiency or bleeding into or adjacent to the brain. Two main types:
- Ischemic Stroke
- Intracerebral Hemmorage

Stroke is the 3rd leading cause of death, following heart diseases and cancer.
In Canada, there are approximately 60,000 to 70,000 cases of stroke per year among 740,000 Canadian adults.
About 80% of these strokes are first attacks, while 20% are recurrent attacks.
The average age of onset is 72, but strokes can also occur in younger populations (1 in 4 are under 65).
Incidence is equal between males and females, but females are more likely to survive a stroke than males.
The percentage of strokes that result in death is 29%, which is lower for younger individuals.

Account for 80% of all strokes.
Cerebral Thrombosis: Occurs when a blood clot develops in a cerebral vessel, often due to occlusion at an atherosclerotic plaque.
Cerebral Embolism: Involves a displaced clot of bacterial mass that occludes a downstream artery, usually happening during periods of decreased activity (e.g., sleep).
Consciousness is typically preserved unless complicating factors occur.

Accounts for 20% of strokes and is defined as “bleeding into the brain.”
Causes include arterial rupture related to aneurysms and arteriovenous malformations (tangled blood vessels).
Occurs during periods of activity and may result in stupor or coma if massive bleeding occurs.

Weakness: Sudden loss of strength or numbness in the face, arm, or leg, even if temporary.
Trouble Speaking: Sudden difficulty speaking, understanding, or confusion (aphasia), even if temporary.
Vision Problems: Sudden trouble with vision, potentially temporary.
Headache: Sudden severe headache that is unusual.
Dizziness: Sudden loss of balance, particularly if accompanied by any of the previous symptoms.
Identifying Signs: Recognizing the signs of stroke requires awareness of these symptoms.

FAST is an acronym that stands for:
- Face: Ask the person to smile.
- Arms: Ask the person to raise both arms.
- Speech: Request that the person speaks a simple sentence.
- Time: If the person cannot do any of these tasks, act quickly and get them to a hospital.

Post-stroke impairments are generally located on the side of the body opposite to the brain lesion.

The incidence of stroke is increasing due to the aging population, with equal rates among males and females.
Estimated and projected numbers of individuals experiencing the effects of stroke in Canada (2001 to 2038) show a rising trend.

Includes age and sex, with median age of the Canadian population being 40 years.

Physical Inactivity: Regular physical activity can reduce the risk of stroke by improving various health indicators such as body weight, blood pressure, serum lipids, and diabetes management.
National guidelines recommend 150 minutes of moderate to vigorous intensity aerobic physical activity per week.

The best type of exercise program for stroke prevention is aerobic training.

Two main training modes:
- Aerobic Training: This mode reduces the risk of a second stroke, lowers hypertension, reduces body fat, and increases HDL/LDL cholesterol ratio.
- Functional Training: This mode enhances activities of daily living (ADLs) and overall quality of life (QofL) through improved muscular strength, endurance, and motor function (walking, balance, coordination).

Impaired motor control may present as weakness or paralysis on one side of the body.
Sensation deficits could impact the stretching process.
Many stroke patients exhibit intolerance to high-intensity exercises, resulting in lower VO2 max capacities.
The foot drop phenomenon following a stroke is attributed to paralysis of the tibialis anterior muscle.

An example from an internship at Cummings Center focused on stimulation, education, and exercise for seniors.
Utilized a yogger for biomechanical assessment and elastic bands to mimic fascia lines to encourage knee flexion and hip extension, showcasing the need for creativity in addressing hemiparetic gait issues.

Group exercise sessions for individuals post-stroke:
- Consist of groups of 8 participants.
- Frequency: 2 times per week.
- Duration: 60 minutes per session.
- Intensity is assessed using the Rating of Perceived Exertion (RPE) method on a 0 to 10 point scale.

Evaluation tools include:
- Timed Up & Go Test: Assesses balance and mobility skills, with scores < 10s indicating independence and > 30s indicating dependence.
- Berg Balance Scale: A comprehensive balance assessment with a scoring scale out of 56, where scores below 45 indicate a risk of falling.
- 6-Minute Walk Test: Measures cardiorespiratory (submaximal) endurance in cardiovascular conditions.
- Stroke Impairment Assessment Set (SIAS): Assesses motor function and coordination for upper and lower extremities among stroke patients.

Ensure medical clearance from a physician.
Detailed capturing of each participant’s medications and blood pressure checks are essential before program initiation.
Participants must be advised to exercise at their own pace while emphasizing the importance of moderation leading to performance improvements.

In group sessions, supervision is necessary:
- Involving at least 1 certified KCEP.
- Including 1 or 2 KCEP interns and 1 volunteer from the center.

Significant pre- and post-exercise changes observed:
- SIAS Motor Score: Increased from 13.8 ± 5.8 to 16.2 ± 6.0.
- Berg Balance Scale: Improved from 45.4 ± 6.9 to 49.6 ± 5.4.
- Timed-up and-Go: Reduced time from 26.3 ± 13.7 to 21.7 ± 10.0.

These results demonstrate significant improvements in the functional abilities of individuals participating in the exercise program following their stroke, underscoring the importance of structured rehabilitation efforts for optimal recovery.