How does exercise benefit patients affected by strokes?

What is a stroke?

Stroke or medically referred to as cerebrovascular accident (CVA) occurs secondary to vascular inadequacy in the brain. Common causes include thrombosis, embolism or haemorrhage. This results in cell death and results in an impairment of central nervous system function.

The resulting neurological impairments depend on both the size and the area of the ischemic area (a decrease in the blood supply to an organ, tissue, or part caused by constriction or obstruction of the blood vessels) in the brain.

Who is at risk?

·         Hypertension

·         Diabetes mellitus

·         Smoking

·         Alcoholism

·         Coronary artery disease

·         Obesity

·         Cholesterol

Neurological impairments following a stroke vary between patients and this therefore impacts on their ability to perform certain exercises.

What neurological deficits may be present in a stroke patient?

·         Impaired motor and sensory function in upper and lower extremity e.g. walking

·         Visual field deficits

·         Expressive and receptive aphasia (impaired ability to communicate through speech)

·         Mental confusion

·         Apraxia (impaired sequencing of voluntary movements)

The ability to exercise as well as the type of exercise depends on the severity of the stroke as well as the existing of co-morbidities like orthopaedic, arthritic, cardiovascular.

These are some examples of potential neurological deficits that will determine the type of exercise that will be selected by the Biokineticist or Physiotherapist to be performed by the patient:

·         Muscle weakness e.g. bed rest and fear of moving leads to muscle atrophy.

·         Limited range of motion e.g the affected limbs maybe very rigid(hypertonic).

·         Lack of adequate balance.

·         Impaired sensation may affect independent ambulation.

·         Receptive aphasia, mental confusion and/or apraxia may affect ability to understand and follow directions. This may affect execution of exercises.

Benefits of Exercise for stroke patients

·         Increase aerobic capacity and endurance e.g. walking distance and speed

·         Decrease dependence on walking aids for ambulation (walking)

·         Improve balance

·         Improve activities of daily living (ADLS)e.g. getting dressed, standing up from a chair, putting shoes on unassisted.

·         Increase independence in ADLS

However it depends on the severity of the neurological involvement and existing co-morbidities experienced by the person who has had the stroke.

Other benefits:

·         Exercise also reduces the patient’s risk factors that may have lead to the stroke occurring e.g. hypertension.

·         Reports show that patients who have experienced strokes and who exercise regularly are less likely to feel depressed.

NB: Goals must be decided on by the patient with his or her Physiotherapist and/or Biokineticist!

·         Examples: Standing up from a chair, walking without a walker, increasing aerobic capacity or walking speed, going to the toilet by yourself.

·        Goals must be individualised, realistic and attainable.

Exercises must be kept functional and fun!

The choices of exercises depend on neurological deficits. Here are some examples.

·        Increase aerobic capacity by choosing either an arm bike or upright leg stationary bike or treadmill.  Choice of aerobic exercises is determined by the patient’s ability to balance and ambulate.

·        Stretching – very important as one of the neurological deficits is a decrease in a range of motion and stiffness from lack of mobility.

·        Exercise to music that has a good beat will assist with rhythmic movements like walking.

·        Chair stands in order to sit on toilet or on chair.

·        Marching on the spot assist with balance and walking. Stand near a secure object.

·        Lifting one leg up and holding while holding on to asecure object. This assist with walking and balance.

NB! No exercise regime should commence without clearance from your doctor, especially cardiologist. These exercises should not be performed without supervision.  Please contact us for further information.

Exercise of any kind will make one feel better about one’s self and will empower you to reach for one’s goals. The sooner one starts exercise rehabilitation post stroke the better the outcome.

By
Tanya Bellon
Biokineticist