EHR525 Week 4c Considerations for Physical Conditioning in Clients with Neurological Deficits PDF

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of th...

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice School of Allied Health, Exercise and Sports Sciences 1 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 1 EHR525 EXERCISE FOR NEUROLOGICAL & MENTAL HEALTH CONDITIONS Considerations for Physical Conditioning in Clients With Neurological Deficits Presenter: Jack Cannon School of Allied Health, Exercise and Sports Sciences 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 WHAT WE WILL COVER: ■ Changes in physical activity levels and fitness after stroke. ■ Relationship between physical fitness and function after stroke. ■ Factors affecting the relationship between physical fitness and function after stroke. ■ General consideration for exercise prescription for neurological clients. School of Allied Health, Exercise and Sports Sciences 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 Introduction ■ Facilitating recovery by promoting neuroplasticity through physical training and exercise interventions is essential for achieving good functional outcomes following neurological damage or disease. ■ Increasing physical activity levels and improving exercise capacity are also important goals for neurological clients. ■ Necessary for improving health status, functional ability, and ability to perform ADLs. ■ This lecture will provide a rational for enhancing physical activity levels and improving physical conditioning in neurological clients and explore key considerations influencing exercise program design. School of Allied Health, Exercise and Sports Sciences 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 PHYSICAL ACTIVITY LEVELS AND FITNESS AFTER STROKE ■ PA levels= Daily step count. ■ Field et al. (2013) □ □ □ □ 26 studies; 315 participants. 3m-8yrs post. M= 1,389-7,379 steps/day. Lower compared with healthy comparison groups. School of Allied Health, Exercise and Sports Sciences 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 Physical Fitness After Stroke ■ Smith et. al. (2012): □ VO2 substantially lower after stroke (~55% of controls). □ Reductions persist long-term. □ Similar trends for longitudinal and cross-sectional studies. School of Allied Health, Exercise and Sports Sciences 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 Correlation Between V02 and Function After Stroke School of Allied Health, Exercise and Sports Sciences Data are inconsistent. Other factors may be involved? 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 Muscle Strength After Stroke School of Allied Health, Exercise and Sports Sciences 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 Muscle Power After Stroke Knight et al. (2014) School of Allied Health, Exercise and Sports Sciences 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 CORRELATION BETWEEN MUSCLE POWER AND FUNCTION AFTER STROKE Knight et al. (2014) No major difference in the association between affected and unaffected limb power and function (power of both limbs equally important) School of Allied Health, Exercise and Sports Sciences 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 Factors Other than Fitness Contributing to Function Post-Stroke ■ ■ ■ ■ ■ ■ ■ Reduced muscle tone. Joint ROM. Contractures. Impaired postural control. Balance impairment. Reduced mobility. Mood/depressive symptoms. School of Allied Health, Exercise and Sports Sciences Could be more factors not yet identified? 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 Fatigue Post-Stroke ■ Very common after stroke (29-77%). ■ Effects of exercise unknown. ■ Role of deconditioning? ■ Physical fitness can influence many pathways to reduce fatigue. School of Allied Health, Exercise and Sports Sciences 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 GENERAL CONSIDERATIONS FOR PHYSICAL CONDITIONING IN NEUROLOGICAL CLIENTS ■ Nervous system is complex and effects of injury or disease will substantially vary in terms of: □ Levels of severity. □ Levels of impairment. □ Signs/symptoms. ■ All neurological cases must be treated as individuals. ■ Interventions must be specific to the needs and capabilities of the client. School of Allied Health, Exercise and Sports Sciences 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13 Pariticipation is a Major Goals Relative Risk (All-cause mortality) 1 0.75 0.5 0.25 0 100 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 MET.min per week School of Allied Health, Exercise and Sports Sciences 14 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 14 Rate of Onset ■ Sudden onset: □ Stroke. □ ABI. ■ Progressive/Degeneration: □ MS. □ PD. ■ Role of exercise: Management vs. Protection. School of Allied Health, Exercise and Sports Sciences 15 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 15 Age of Onset ■ Young: □ Spinal cord injury. □ ABI. ■ Old: □ Stroke. □ PD. ■ Ageing effects, presence of comorbidities, more complexity. School of Allied Health, Exercise and Sports Sciences 16 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 16 Adapted Activity/Exercise ■ Neurological clients frequently have motor impairments and motor dysfunction. ■ Capacity to engage in normal activity may be limited. ■ Be creative and adapt to clients capabilities. School of Allied Health, Exercise and Sports Sciences 17 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 17 Use of Sensory Input ■ Sensation drives movement. ■ Use of sensory cues to address impairment. ■ Increasing sensory input may help to increase motor drive. ■ Enriched environment. School of Allied Health, Exercise and Sports Sciences 18 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 18 Systematic Adaptations ■ ■ ■ ■ ■ Cardiovascular. Autonomic dysreflexia. Respiratory. Thermoregulation. Endocrine system. School of Allied Health, Exercise and Sports Sciences 19 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 19 Neuropsychiatric Problems ■ Cognitive function. ■ Communication. ■ Mood. ■ Motivation. ■ Behavioural changes. School of Allied Health, Exercise and Sports Sciences 20 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 20 Chronic Pain and Fatiue ■ Chronic pain: Frequent component of many neurological disorders affecting 20–40% of clients. ■ Fatigue: A common symptom across many neurological conditions. ■ Needs to flexible in approach, be aware of factors affecting it. School of Allied Health, Exercise and Sports Sciences 21 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 21 Resistance Training ■ Should consist of exercises selected based on clients needs that are practiced both repetitively and with variations: □ Stage 1: Uses repetitive, isolated contractions for weak muscle groups. □ Stage 2: Uses functional resistance training for intersegmental control and maintenance of muscle length. □ Stage 3: Uses functional actions impaired by weakness or loss of control to facilitate transfer of training. School of Allied Health, Exercise and Sports Sciences 22 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 22 Aerobic Training ■ Provides a foundation for neurorehab and resistance training. ■ Traditional neurorehab sessions may not provide sufficient aerobic conditioning stimulus. ■ Increasing aerobic capacity can support neurological clients in terms of neuroplasticity, neuroprotection, and cognitive function. ■ Essential for reducing secondary disease risk. School of Allied Health, Exercise and Sports Sciences 23 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 23 Summary ■ Stroke survivors demonstrate lower level of physical activity. ■ Stroke survivors have lower level of physical conditioning compared with healthy counterparts. ■ Physical fitness appear to be related to function after stroke but other factors may also be involved. ■ There are a number of factors for exercise that should be considered when working with neurological clients. ■ The application of resistance and aerobic training should be based on individual needs with the goals of enhancing participation, function, and prevention of secondary impairment and disease. School of Allied Health, Exercise and Sports Sciences 24 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 24