Community Based Physical Exercise for Stroke Rehabilitation

Community Based Physical Exercise for Stroke Rehabilitation

Stroke rehabilitation, also called stroke rehab, is a key part of your post-stroke care plan. Each year, more than 700,000 people in the United States have a stroke, and about two-thirds of them will need some type of stroke rehabilitation.The severity of stroke complications and each person's ability to recover lost abilities varies widely. However, stroke rehabilitation can usually help you achieve the best long-term results.


Those who live through a stroke should get special attention from their physicians and other health professionals to reduce their risk of having another one. And, because of their extra risk of suffering another stroke, those efforts should be especially stepped up in Mexican-Americans, the researchers say.

Stroke survivors rehabilitated with a technique that electrically stimulates the stroke-impaired arm and requires it to work in unison with the healthy arm regained motor skills better than those who stimulated the impaired arm alone, according to a report.Many survivors are left with mental and physical disabilities of varying severity, and nearly all stroke survivors can benefit from an appropriately structured and comprehensive rehabilitation program.

Rehabilitation following stroke is an interdisciplinary process which provides interventions to reduce impairments, optimise abilities and increase participation. The aim is to improve quality of life by reducing emotional, functional, cognitive, physical and communication disorders.

This program also features new clinical capabilities, especially in the area of minimally invasive procedures. This approach may allow doctors to avoid open-skull surgery when they need to close leaking brain blood vessels or open blocked ones while a stroke is occurring, or to repair brain aneurysms and other blood-vessel problems before they burst.All patients thought rehabilitation was important for recovery. High motivation patients were more likely to view rehabilitation as the most important means of recovery and to accord themselves an active role in rehabilitation.

The key components of a strategy for primary stroke prevention include: identification and treatment of hypertension; identification and treatment of atrial fibrillation; careful control of hypertension in diabetes; lifestyle advice with regard to smoking, diet, weight, and exercise; and treatment with a statin of patients with known vascular disease and elevated cholesterol.The same issues apply to treatment of people who have had a stroke or transient ischaemic attack (TIA), but because the risks of subsequent strokes are high, each is of relatively greater importance.

Patients with previous myocardial infarction (MI) and stroke are the highest risk group for further coronary and cerebral events. Survivors of MI are at increased risk of recurrent infarctions and have an annual death rate of 5% - six times that in people of the same age who do not have coronary heart disease . Similarly, patients who have suffered a stroke remain at an increased risk of a further stroke (about 7% per annum). There is considerable scientific evidence that specific interventions will reduce the risk of further vascular events in patients with MI and stroke. If these interventions are appropriately implemented, nearly one third of the fatal and non-fatal MI and strokes could be prevented.

Stroke is common in the elderly population and many survivors require rehabilitation. The goal of rehabilitation is to enable elderly patients to return as closely as possible to their premorbid functional status.Study over patients in the 85+ age group who are carefully selected for rehabilitation following stroke are similar in most basic clinical, mental, and functional characteristics to younger elderly populations undergoing the same process. The length of rehabilitation and the rate of complications are similar in the two groups. Although the success rate for rehabilitation is lower in the oldest old, the results still appear to justify the effort invested in rehabilitation in the 85+ group, at least no less than that in the younger elderly group.

Depression, particularly in the period shortly after a stroke, is a major contributor to cognitive and functional impairments, rather than a purely psychological response to such problems. Serotoninergic depression and noradrenergic dysfunction resulting from such lesions are further identified as contributors to post-stroke emotional disturbances and as targets for pharmacotherapy.

Finally, the treatment of post-stroke depression not only improves recovery from this condition but also improves stroke outcome more generally. Conversely, failure to treat post-stroke depression not only impedes recovery from stroke but also increases long-term post-stroke mortality.

After a stroke, patients should take all necessary measures, including medications and lifestyle changes, to prevent another stroke. For those whose stroke was ischemic, aspirin, warfarin, or both will usually be prescribed.

Aspirin is the most often prescribed medication to prevent a recurrent stroke or heart attack. Study reinforces the importance of compliance with aspirin therapy in patients with symptomatic atherosclerosis, including previous stroke. Patients and physicians should be aware of a possible increased risk of stroke when aspirin is stopped.

Having a neurologist as the primary doctor after a stroke, rather than some other specialist or primary care doctor, significantly increases the chance for survival. Patients or their families should be persistent in requesting the best care possible during this important early period.

The device, built by a research team,can assess the effectiveness of the physical therapy so adjustments can be made to the regimen if necessary.Recent research suggests that stroke survivors can recover significant use of their arms by performing repetitive motor function exercises over a period of time.

Several important factors underscore the potential value of exercise training and physical activity in stroke survivors. Previous studies have demonstrated the trainability of stroke survivors and documented beneficial physiological, psychological, sensorimotor, strength, endurance, and functional effects of various types of exercise. Moreover, data from studies involving stroke and able-bodied subjects have documented the beneficial impact of regular physical activity on multiple cardiovascular disease risk factors and provided evidence that such benefits are likely to translate into a reduced risk for mortality from stroke and cardiac events

Researchers found that hand function is directly related to brain activity and that changes in the brain well after the stroke are paralleled by changes in physical ability. The less active the motor cortex -- the part of the brain controlling muscle function -- and the weaker the connections, the less able the stroke survivor is to use their hand muscles.

The findings offer insight into which of the measures currently used to evaluate signals from the brain to the muscle during stroke recovery are most strongly linked to muscle function and therefore which treatment strategies work best for particular patients at early and later stages of recovery.

Occupational therapy makes a huge difference to patients who have suffered a stroke, a UK study has found.Disability such as arm weakness and difficulty walking is common after strokes, and can prevent victims washing and dressing themselves or carrying out simple household tasks.

This study assesses the reliability of the 2-, 6-, and 12-minute walk tests to assess walking speed and endurance following stroke.Each test showed acceptable reliability and high inter-test correlations in assessing walking fitness following stroke. The 12-minute walk test was the most responsive to change in walking and most useful in predicting gait outcomes.

For stroke survivors who have completed rehab and are ambulatory, exercise training is feasible and improves physical functioning and aspects of mental health, an exploratory study conducted in the UK shows.

"There was also strong anecdotal evidence of social benefits," first author Dr. Gillian E. Mead of the University of Edinburgh told Reuters Health.

The study involved 66 stroke patients who were able to walk without assistance. The average patient age was 72 and the patients had no significant speech impairment, confusion or medical conditions that would keep them from exercise training. All of the patients completed their rehabilitation and had been discharged from the hospital.

They were randomly assigned to a 12-week program of exercise training three times a week, which included endurance and resistance training, or to relaxation sessions focusing on "attention control."

According to a report of the study in the Journal of the American Geriatrics Society, stroke patients tolerated the exercise training well, with high rates of attendance at exercise classes and individual exercises.

Compared with the non-exercise attention control intervention, exercise training led to "greater improvements in physical function and physical fitness," Mead said.

Specifically, at 3 months, the exercisers performed significantly better than the non-exercisers on the timed up-and-go test, walking economy and the role-physical item on the Short Form Health Survey-36.

At 7 months, however, only role-physical function remained significantly better in the exercise group, "suggesting that benefits of exercise training are lost after the exercise sessions cease," the authors write.

"This work," Mead said, "justifies the provision of exercise classes in the community for stroke patients, and further larger multicenter trials to investigate whether exercise training can reduce disability and to explore its cost-effectiveness."

Another study shown that although the risk of primary cardiac arrest is transiently increased during vigorous exercise, habitual vigorous exercise is associated with an overall decreased risk of primary cardiac arrest.

Stroke survivors who received therapist-supervised, progressive therapy after completing in-hospital rehabilitation .significantly improved their endurance, balance and walking ability, according to a small study reported in today's rapid access issue of Stroke: Journal of the American Heart Association.

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