According to AHA Statistical Update4 annually 795 000 people in the US experience a stroke or recurrent stroke. According to a Swedish follow-up study the crude incidence rate for stroke (ischemic or haemorrhagic) was 7.74 per 1,000 person-years in men. 6
Considerable spontaneous recovery follows acutely after stroke, yet a variety of deficits may remain. For example muscle strength deficits following stroke are common and seem to be presented bilaterally, although they are more prominent on the contralateral side (to the lesion).3 Also upper-limb spasticity is present in 46% of the stroke survivors at 12 months post-stroke.5
Individualised goals for physical activity (PA) depend on the exercise tolerance, impairments, activity limitations, participation restrictions, stage of recovery, social support and environmental facilities and last but not least individual PA preferences.1
The main goal in acute post-stroke rehabilitation for PA is preventing effects of prolonged inactivity and also to regain voluntary movement and recover basic activities of daily living. To mobilise the patients as early as possible is essential as it has been shown to have positive effects on functional recovery and ability to walk.So after doctor has qualified the patient to be medically stable it is time to start an exercise regimen. The goal is to at least regain physical activity levels that the patient had before stroke or even exceed them.1
Physical and occupational therapy can inner hold gait training, balance and cardiovascular and muscle strength exercises as well as exercises to improve upper extremity function, efficiency in ADL-functions for example.1 Remembering also to train cardiorespiratory fitness is important as it has an effect on ability to execute ADL-functions.1, 2 Task related training is essential when rehabilitation aims to improve functional skills. 2 Strength training should be incorporated into other training modalities as there is still insufficient evidence to support it as the only training modality. 2
The aim of post-stroke rehabilitation is also to help the patient to adopt and maintain active lifestyle after active rehabilitation, for prevention of recurrent stroke and other cardiac events and to maintain physical functioning.1
In summary the exercise programming recommendations according to Billinger et al. (2014): Structured treadmill or cycle ergometer exercise programs should be complemented by
- muscular strength/endurance training
- flexibility training
- increased everyday casual physical activity.
Also neuromuscular rehabilitation in form of tai chi, yoga, modified recreational activities (e.g. ball and paddle games) etc. may be beneficial for stroke patients.
PhysioTools offers educational and exercise resources for health care professionals working in the field of neurology:
- General Neurology (PT12)
- Neurological Rehabilitation (PX9)
- Hand and Upper Extremity (PX26)
- Managing at home (PT16)
References
1) Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, et al. Physical Activity and Exercise Recommendations for Stroke Survivors. A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2532-2553
2) Saunders DH, Sanderson M, Brazzelli M, Greig CA, Mead GE (2014) Physical fitness training for patients with stroke: An updated review. Stroke 45: e54-e55.
3) Andrews W, Bohannon RW. Distribution of muscle strength impairments following stroke. Clin Rehabil 2000 14: 79
4) Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation 2014;129:e28–29.
5) Opheim A, Danielsson A, Alt Murphy M, Persson HC, Sunnerhagen KS: Upperlimb spasticity during the first year after stroke: stroke arm longitudinal study at the University of Gothenburg. Am J Phys Med Rehabil 2014;93:884-896.
6) Novak M, Tore K, Lappas G, Giang Kok W, Jern C, Wilhelmsen L, Rosengren A. Occupational status and incidences of ischemic and hemorrhagic stroke in Swedish men: a population-based 35-year prospective follow-up study. Eur J Epidemiol (2013) 28:697–704