EFFECTIVENESS OF EXERCISE INTERVENTIONS Critical Analysis the Effectiveness of Exercise Interventions Prescribed for Stroke Survivors

Effectiveness of Exercise Interventions for Stroke Survivors

Introduction

The World Health Organization's International Classification of Functioning, Disability, and Health organize the effects of conditions such as stroke into problems in the “body structure and function dimension” and in the “activity and participation dimension.” Body structure and function effects (known as “impairments”), such as hemiplegia, spasticity, and aphasia, are the primary neurological disorders that are caused by stroke. Activity limitations (also referred to as “disabilities”) are manifested by reduced ability to perform daily functions, such as dressing, bathing, or walking. The magnitude of activity limitation is generally related to but not completely dependent on the level of body impairment (i.e., severity of stroke) (Goldstein, 2001, 163-182).

Other factors that influence level of activity limitation include intrinsic motivation and mood, adaptability and coping skill, cognition and learning ability, severity and type of pre-existing and acquired medical co morbidity, medical stability, physical endurance levels, effects of acute treatments, and the amount and type of rehabilitation training. Therapeutic interventions to improve sensorimotor performance after stroke vary considerably. Although there is emerging evidence that rehabilitation can be effective in improving both intrinsic motor control and functional status, systematic trials comparing the relative effectiveness of various motor control intervention types generally have been few in number and suboptimal in design.

Analysis

Although ˜14% of stroke survivors achieve a full recovery in physical function, between 25% and 50% require at least some assistance with activities of daily living, and half experience severe long-term effects such as partial paralysis. Consequently, activity intolerance is common among stroke survivors, especially in the elderly. Ambulatory persons with a history of stroke may be able to perform at ˜50% of peak oxygen consumption and 70% of the peak power output that can be achieved by age- and gender-matched individuals without a history of stroke (Pearson, 2002, 388-391). Such intolerance is likely due to several factors, including bed-rest-induced deconditioning, concomitant left ventricular dysfunction, the associated severity of neurological involvement (e.g., flaccidity or developing spasticity of the lower extremity and/or impairment of the sensory function of the involved side, impaired trunk balance, spasticity or weakness of the afflicted upper or lower extremity, receptive aphasia, and mental confusion), and the increased aerobic requirements of walking (Smith, 2001, 1577-1579).

Energy expenditure during gait in hemiplegic patients varies with the degree of weakness, spasticity, training, and bracing, but in general, the oxygen cost of walking (ie, oxygen consumption expressed in either absolute [L · min-1] or relative [mL · kg-1 · min-1] terms) is elevated in hemiplegic patients compared with that of able-bodied subjects of comparable body weight. Indeed, in some cases, the debilitating motor effects of a stroke can markedly reduce mechanical efficiency and increase the energy cost of walking up to 2 times that of able-bodied persons. Even common household tasks, such as bed making and vacuuming, are associated with considerably greater energy requirements among poststroke women than among their healthy counterparts (Pearson, 2002, ...