User:Susan Coyle-Hughes/sandbox/Chronic Stroke Survivors - How can Exercise Help?

This page has been created for the purpose of analyzing the article "Muscle Strengthening and Physical Conditioning to Reduce Impairment and Disability in Chronic Stroke Survivors" by Teixeira-Salmela, L., Olney, S., Nadeau, S., & Brouwer, B. (1999), for the University of Canberra unit Health Disease and Exercise.

Research Background
Strokes are a global health care problem, it is one of the main causes of death and is the “6th leading cause for disability worldwide”. Most stroke patients survive the initial event and require long term rehabilitation and support. It is estimated that the treating and rehabilitation costs are in the billions.

A stoke is defined is a “focal neurological deficit secondary to a vascular event lasting more than 24hrs” (WHO Reference). This means that part of the brain has had a sudden loss of blood supply to part of the brain, and results in infraction (cell death). There are two main causes for this, a blocked artery which is known as Ischemic stroke and accounts for 85% of stroke cases, or the leaking or bursting of a blood vessel within the brain itself, a Haemorrhagic stroke. (Mayo Clinic Reference). The result of this is that the part of the brain that has had limited or cut off blood supply dies, and this results in many cognitive and mechanical impairments leading to many disabilities in the long term.

Disabilities such as paralysis of limbs, loss of muscle control which can affect speech and swallowing capabilities, memory loss or thinking difficulties, pain, behavioural and emotional changes are to name a few (Stroke Care Ref). One of the most debilitating of these is the loss of muscle control and paralysis. This in turn affects standing, walking abilities, balance and mobility and can affect daily living to such an extent that personal and household tasks cannot be performed.

Much research has been undertaken to find the best and most cost affective ways to rehabilitate chronic stroke survivors. Muscle strength training, (Musce st train, gait and physio ref), and general physical conditioning (REFERENCE) are the most common as it targets motor control, gait patterns and functionality which can reduce the risk of falls (REFERENCE) and improve quality of life, as targeted in this study by Teixeira-Salmela and Olney et al.

Where is this Research From?
This study was conducted by Teixeira-Salmela from the Universidade Federal de Minas Gerais, Brazil and Olney, Nadeau and Brouwer from the School of Rehabilitation Therapy, Queens University Canada. The subjects chosen where 13 community dwelling survivors who suffered the event at least 9 months prior to this intervention. (REFERENCE)

Research Type
This research was a qualitative study involving a randomized pre-and post-test control group then a single-group pre- and post-test, with 13 participants total.

Research Method
The design of this testing method was a randomized pre-test and post undertaken, then allocated to treatment and control groups. The treatment group undertook a 10 week training program, and then both groups were retested. After this second testing the baseline control then also undertook the same 10 week program and were again retested at its competition. The effects of this intervention were measured by functional performance, from gait speed and in the Human Activity profile (REFERENCE), improvement in quality of life, measured by the Nottingham Health Profile (REFERENCE). Lower Extremity Muscle Strength and Muscle Tone where also tested using Cybex 2 isokinetic dynamometer and pendulum test respectively. The training program itself were supervised exercise sessions conducted three mornings a week for 10 weeks, lasting 60-90 mins. Each session involved a warm up, aerobic exercises (walking plus stepping or cycling), strength training and a cool down period. Emphasis was placed on the lower extremity muscles and trunk flexibility. (REFERENCE).

What Where the Basic Results?
Overall there was a significant improvement in the reduction of impairment and disability for the subjects.

In functional performance walking speed on average improved by 30.7% and the rate of stair climbing also improved by 37.4%. This correlated with an increase of 38.2% with perceived abilities. These figures are all in relation to pre-post testing average measures with the treatment group. Lower extremity strength, measured by the combined mean peak torque of all the measured muscle groups improved by 42.3% from baseline measures. There were no significant differences found between baselines and post measures for lower extremity muscle tone.

Quality of life, measured by the NHP index showed an improvement of 77.8% following the intervention. This can be linked to the improvements in gait and strength as it leads to more independence of the subject, self-confidence and improvements in quality of life.

REFERNCE REFERENCE REFERENCE

Interpretation of Results
Some conclusions that can be made from this research are.....

Limitations
What are some of the major limitations of this research, some of the implications and supporting research. What areas could be impr0ved or looked into in the future?

What can we take away from this?
From this research and supporting articles it is clear that muscle strengthening and physical conditioning is a useful and appropriate tool to use to reduce impairment and disability in Chronic Stoke patients. It must be taken into consideration however that though it is a useful tool it must be appropriate for the individuals needs.

Further Information and Resources
For any further information and resources please refer to the following...