STROKE & BRAIN INJURY Anna Bocchino

CLASSIFICATIONS OF A STROKE/BRAIN INJURY Various kinds of brain injuries with different levels Acquired brain injury- results from damage caused by stroke, tumors, diseases, etc. Traumatic brain injury- direct blow to the head, closed and open head injuries Mild, moderate, severe A stroke is the loss of blood flow to a region of the brain

PATHOPHYSIOLOGY Strokes occur usually from a blockage (ischemic stroke) or a rupture (hemorrhagic stroke) About 50% of patients in older populations who experience TIA (transient ischemic attacks) do not report it to a clinician TIAs- major predictor of stroke, follow massive strokes 87% as ischemic (clots can travel to brain) Hemorrhagic- bleeding inside the brain, or in and around the surrounding spaces (Ehrman, )

THE DAMAGE DONE Neurons in the brain die Accompanying brain damage is the main cause of subsequent disability in stroke survivors Brain damage can: Impair voluntary muscle movement Speech Vision Judgment

SIGNS AND SYMPTOMS Acute Impaired vision, coordination, walking, cognition, headache FAST Face, arms, speech, time Memory loss Paralysis Effects opposite side of the body from damaged side of brain (Ehrman, 561)

FACTS TO KNOW Each year nearly 800,000 people experience a new or recurrent stroke. A stroke happens every 40 seconds. Stroke is the fourth leading cause of death in the U.S. Every 4 minutes someone dies from stroke. Up to 80 percent of strokes can be prevented. Stroke is the leading cause of adult disability in the U.S. (NSA)

RISK FACTORS Certain chronic conditions increase your risk of stroke. These include: High blood pressure High cholesterol Diabetes Obesity Out of your control: Family history Age (WebMD) Certain behaviors also increase the risk of stroke: Smoking Getting too little exercise Heavy use of alcohol Diet Other considerations: Women more than men African-Americans, Native Americans, and Alaskan Natives are at greater risk compared to people of other ethnicities.

CASE STUDY Medical History: The patient is a 10 year old female 9 years post stroke. History of type 2 diabetes and obesity from grandparents. Traumatic brain injury sustained at 1 month old, fractured right frontal bone. Required surgery at 8 mo. During surgery suffered cardiac arrest, 2 minutes without oxygen, and there appeared to be a blood clot. Client has a gene mutation Leiden 2, which allows her blood to clot faster than normal, usually genetically passed from 1 parent * not the known cause of stroke

CASE STUDY Diagnosis: Patient sustained 17 seizures in the ICU and 1 massive ischemic stroke in the right PCA (posterior cerebral artery) Years of OT, PT, speech therapy, vision therapy, ankle orthotics for interrupted gait, homonymous hemianopsia (defective vision in half the visual field of one or both eyes), ADHD, LD, retrieval issues, sensory trouble, trouble with fine motor skills No medications

RISK STRATIFICATION Cleared with Physician before exercise Patient has undergone head scans, MRIs, vision testing, etc. Exercise testing Cardiovascular: treadmill self selected speed, increasing 2% grade every 2 minutes, measure ECG, VO2, HR, BR This test allows to assess gait, no significant ECG changes, peak HR 160 BPM Strength: free weights, 10 RM testing of handgrip Significant weakness in left side ROM: goniometer, sit-and-reach

RISK GROUP AND GOALS Given the amount of time passed without any other TIA or stroke, family history, personal history, and age, I would conclude the client to be a moderate risk Goals Build strength Enhance balance Work on gait Increase sensory motor function

SPECIAL CONSIDERATIONS Client might have trouble with basic activities Testing should be done for functional ability to perform certain tasks on affected side Fine motor skills for this client and sensory issues incorporate possible issues with certain exercises Retrieval ability will call for repeating, patience, practice, non-natural form

EXERCISE PRESCRIPTION Aerobic: Mode- Floor and treadmill walking, cycle ergometer Intensity % HRR Frequency- 3-5 d/wk Duration min Progress from low to high intensity and longer durations Resistance: Mode-elastic resistance bands, body weight, sandbags, water exercises, active motion, and commercial strength equipment Intensity- as tolerated, up to 80% of 1RM Frequency- 3-5 d/wk Duration min Progress as tolerated Range of Motion: Mode- passive movements, proprioceptive neuromuscular facilitation (PNF) Intensity- below the point of discomfort Frequency- 3-5 d/wk Duration min Progress as tolerated * emphasis on stretching muscles on the affected side (Ehrman, 565)

REFERENCES Ehrman, J., Gordon, P., Visich, P., & Keteyian, S. (2013). Stroke. In Clinical Exercise Physiology (3rd ed., pp ). Champaign, IL: Human Kinetics. Physical Activity and Exercise Recommendations for Stroke Survivors. (2004, January 1). Retrieved January 3, 2015, from Stroke Pictures: Signs and Causes of Strokes and Mini Strokes. (2014, April 15). Retrieved January 3, 2015, from stroke-overview What is stroke? (2014, July 16). Retrieved January 3, 2015, from