Dear Readers,

Welcome to NeuroAiD's September 2009 Newsletter. The idea of this monthly release is to share vital information for stroke patients and their families, and help them deal successfully with the common challenges life presents after a stroke.

This month, we are going to present you a detailed description of falls after stroke – of which you may be very afraid. You will know much more about falls after reading the newsletter from which you may learn how to avoid them afterwards. Secondly, we focus on the Adaptive Physical Activity after a stroke and you may consider go back to gym with your physiotherapist. At last, a special attention dedicated to women, we introduce the result of a recent study, about your sleeping duration and the risk of stroke.

We want this to be more than a one-way communication, and would be most happy to hear back from you. What you have experienced and learned will be very valuable to others and we will make sure it reaches as many people in our community as possible. Do also let us know what topics you wish to read in future issues of your NeuroAiD's newsletter.

We would like to assist you in your return to daily life while recovering from stroke. As you are probably already aware, making the best use of time is of vital importance in your stroke recovery. Therefore, please allow us to call you at a number, day and time of your convenience, to hear your questions and explain our answers. If you agree, kindly email us the table below at info@neuroaid.com :

• Number :
• Date :
• Location / time zone :
• Person to ask for :

If you choose to contact us yourself instead, call us on our US toll free number:
1-800-882-4046 / +65-6478-9430 or email us at info@neuroaid.com

The NeuroAiD™ Team at Moleac

After acute stroke, one of the most common medical complications is unexpected falls. Furthermore, the high fall risk remains a considerable health concern throughout the post stroke life span. Unfortunately, most of the stroke patients are aged people and social impact is growing. Stroke survivors are much more likely to sustain a hip fracture due to a fall than people without stroke; they often more easily lose independent mobility or even face more severe consequences. Preventing falls is an important issue for every person involved in stroke care and in any of the post-stroke stages.

Rates:

In the general population of elderly people, one out of three falls at least once a year, one out of six falls twice or more. However, this probability is much higher in patients with stroke. This makes falls the most frequent medical complication during hospitalization after stroke. Often falling can become repetitive.

Circumstances:

Circumstances vary in inpatient falls and community stroke survivor falls. The observation showed that most falls occurred during the day and in the patient’s room, toilet or bathroom. Transfers are the most common activity leading to a fall, whereas only a few falls involve walking or exercising. Therefore, despite of exploring the patient’s limits of balance and gait abilities, physiotherapy to improve these motor capacities appears to be very safe. In fact, almost 60% of the falls occur when people act against instructions: when he or she is transferred or walked without the recommended supervision or aids during inpatient rehabilitation, especially when the patient has cognitive deficits and can’t be instructed properly. In community stroke survivors, transfers are still a problem, but falls more often occur during walking indoors than outdoors.

Risk factors:

For inpatient and community patients, the risk factors are generally similar, however the transfer ability is more pronounced for inpatients.

Doctors and researchers often use a scale called Activities of Daily Living (ADL) in order to assess the dependence of a stroke survivor. Fallers are more dependent than non fallers, especially in gait and balance.

Disease-related mental factors like depression, cognitive deficits and sensory deficits also likely contribute to increase fall risk in patients with stroke, as fallers are more often unable to walk and talk at the same time, or slow down when performing another mental task.

What are the consequences?

Falls should be seriously considered because of their consequences, both physically and psychosocially. As you can imagine, elders fall, but a large proportion of fractures in persons with stroke involve the hip, as the loss of bone mineral density is a common long-term complication post-stroke, and the affected arm cannot be stretched to break the fall.

Patients with stroke have not only an increased risk for hip fractures but also more severe consequences. After a hip fracture, the regain of independent mobility is very rare. Psychosocial consequences can be significant as well. Out of 5 individuals with stroke who have fallen, 4 of them develop a fear of falling. This fear not only leads to reduced physical activity and deconditioning but also makes the person less socially active then before these falls. Furthermore, depression not only is a risk factor for falls, it can also be a consequence of falling.

What should you do?       

During inpatient rehabilitation, nurses are suggested to adequately supervising your training of strength, balance, and cognition; to take care of you during the transfer. Afterwards, when you are discharged from inpatient rehabilitation and here comes the chronic post-stroke stage, pay much more attention while walk – falls are most frequently related to loss of balance during walking.

You may consider physiotherapy treatment which is one of the solutions; however it might not be sufficient. A task-specific training program is recommended. It targets various domains of balance and gait abilities like balancing on various support surfaces, weight-shifting, side-stepping and walking over obstacle etc.

Start by asking for doctors if you want to take these task-oriented exercise programs. Don’t be afraid of falling if you have already experienced but try to get over of it. Use an assistive device like walking aids while walking.

Sources:
Journal of Rehabilitation Research & Development

Many stroke survivors have chronic deficits which will limit physical activity and cause subsequent physical deconditioning, which not only propagates disability but also worsens cardiovascular disease risk. Several years ago, scientists have stated that exercise can improve walking function and fitness even years after stroke. However, even doctors have few ideas about how the exercises should be designed. There are numerous behaviorial and psychosocial issues associated with chronic disability, considering as well the aging influence, the exercises setting of and strategies that are optimal for improving mobility and quality of life (QOL) outcomes are unknown.

Last year, a group of European scientists have developed a structure adaptive physical activity (APA), based on task-oriented exercise and social learning models in older adults. This APA program includes both gymnasium and home components for chronic stroke survivors. Group exercises targeting improved gait and balance were used in order to enhance social support, with a home exercises regimen in parallel to build self-efficacy of usual physical activities that enhance daily function and QOL.

The APA consists of 2 months of twice weekly, with one hour sessions of group mobility, balance, and stretching exercises at the hospital gymnasium. Mobility training includes a walk of 12 minutes on a course with parallel bars to practice stepping over 10 cm-high boards, traversing 3 steps and walking laterally, all with support. Exercises at the parallel bars included weight shift from leg to leg, turn in place, leg-trunk flexion and extension exercises of eight repetitions of each. Seated upper- and lower-limb stretching exercises focused on range of motion including trunk mobility. At the same time, participants performed a similar home regimen three times a week that included walking, stair climbing and stretching exercises.

20 patients have participated into the trial and the results showed that APA reduced stroke impairments and improved all mobility outcomes in patients with chronic stroke. These findings provide evidence that a group exercises class combined with a home program is effective in reducing stroke impairments and improving mobility function and QOL- related outcomes for older chronic stroke survivors.

Recent studies have focused on group exercise models for chronic stroke that may be administered in a variable ways, in more cost-effective manner at the community level. A number of training programs (certainly under the instruction of a physical therapist) are proven in randomized studies to increase fitness levels and selected functional outcomes, like water aerobics, lower-limb group exercises, treadmill etc.

In conclusions, APA has the potential to improve function and QOL for many individuals who are aging with the chronic disability of stroke. Before starting the APA experience, you have to first of all ask your doctor for confirmation, and follow exclusively a physical therapist. Don’t forget to join into a group so that your APA will be more enjoyable. For more information, you can visit the International Federation of APA website.

Sources:
Journal of Rehabilitation Research & Development

Almost everybody of us has ever heard once from friends or relatives that one should sleep at least 8 hours per night to stay healthy. Is this a justified statement? Keeping a good sleep rhythm is important. Does it mean that we should sleep as long as we can?

In reality, “the more is better” may not be true, at least not for the sleep duration. Getting too much sleep may be a serious sign of stroke risk than not getting enough sleep, especially among older women, according to a recent study published in Stroke: Journal of the American Heart Association. Researchers compared sleeping patterns and stroke risk among nearly ten thousands women aged from 50 to 90 years.

In this study, researchers accounted for known stroke risk factors in analyzing the link between sleep and stroke risk and found an increased risk among those who slept more or less than seven hours per night.

There have been more than one thousand cases of ischemic stroke over the course of the study with an average follow-up of nearly 8 years. The lowest risk of stroke was observed in women who slept seven hours per night compared to those who slept much (over nine hours) or little (less than six hours). Moreover in this study, researchers categorized women who reported both frequent snoring and sleepiness, they found that women with 10 or more hours of sleep had the highest prevalence of SDB-related (sleep-disordered breathing) symptoms, and the risk of ischemic stroke was increased in women with frequent snoring/sleepiness.

Why is long sleep associated with increased risk of ischemic stroke? Since long sleep is an independent neurobehavioral risk factor for ischemic stroke in postmenopausal women, the causes are not clear. It may be associated with long duration of recumbent position which might increase the period with high pressure, or either long duration of sleep may have impact on some unmeasured socio-behavioural attributes, environmental factors, which can be causes of stroke.

These data do not suggest that if long-sleepers cut their sleep hours, their risk would decrease. The observed increase in stroke risk in long sleepers may be caused by unmeasured factors, such as undiagnosed sleep disorders. And the study focused only in women. However, it’s still better to pay attention to your life rhythm. In case you suspect that you sleep too little or too much, don’t hesitate to see a doctor.

Sources:
Stroke
Reuters