Transcript L8a-Assessment-procedures-for-the-Exercise

EXERCISE AFTER STROKE
Specialist Instructor Training Course
L8a
The role of the Specialist Exercise
Instructor
Assessment Procedures
J Dennis/S Wicebloom Paul / S Dinan Young
Bex Townley
Content
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Criteria for inclusion
Contra-indications to exercise
Instructor Assessment of participant
Referral back to healthcare
Learning Outcomes
At the end of this session, you should be able to:
• List/ describe assessment process
• Explain/ demonstrate understanding of
assessment process and clinical risk
• Apply knowledge to exercise class and each
planned exercise
• Discuss risks and procedures should anything be
outside expected parameters
Essential Reading
Further detail about the topics discussed
in this session can be found in section
[L8] of the course manual
Patient Inclusion criteria
• Must have GP / other “permission”=
agreed referral path
• Passport/ Referral must be fully
completed
• Participant’s own responsibility is clear
• Readiness to exercise
Contra-indications -absolute
– Recent electrocardiogram changes or recent myocardial infarction
 Systolic blood pressure >180mm Hg
 Diastolic blood pressure >100mm Hg
– severe stenotic or regurgitant valvular heart disease
– Uncontrolled arrhythmia hypertension and/or diabetes
– Unstable angina
– Third degree heart block or Acute progressive heart failure.
– Acute aortic dissection
– Acute myocarditis or pericarditis
– Acute pulmonary embolus or pulmonary infarction --Deep venous thrombosis
– Extreme obesity, with weight exceeding the recommendations or the
equipment capacity (usually >159kg [350 lb.])
–
Severe mental or physical disabilities
The risk of a cardiovascular incident occurring is low!
(Quittian M 1994, Mead G 2005,ACSM 2001 Rimmer J, 2005)
Relative Contraindications – cautions
 Cardiomyopathy
 Moderate stenotic valvular heart disease
 Complex ventricular ectopy
 Uncontrolled metabolic disease.
 Left main coronary artery stenosis
 Electrolyte imbalance
 Tachyarrhythmias or bradyarrhythmias
 High degree atrioventricular block
 Mental or physical impairment leading to inability to
exercise adequately
(Quittian 1994, Mead 2005,ACSM 2001 Rimmer 2005)
Assessment by Specialist Exercise Instructor
1. What do you want to know about the participant?
2. What documents will you need in place to record
information?
3. Who can tell you what you need to know?
Assessment – Agreeing Goals
Confirming participant expectations and outcomes from
exercise programme:
• Agreeing initial participant centred SMART goals
• Form long-term SMART goals
• Give specific safety & cautions / exclusions
• Give self monitoring safety guidelines
Assessment Tools for Specialist Instructors
What tools do you use to assess/measure progress?
Assessment Tools and Outcome Measures
• 10 metre walk
• 6 min walk
• Timed Balances – Tandem & SLS
• Timed up & Go
• Tinetti Balance & Gait (Falls Risk)
• Stroke Impact Scale
• Postural map
Triggers Back to Referrer/Medical Review
Essential that if any of the following are noticed the patient is
reviewed by the physiotherapist/referred back via pathway
protocols:
• Repeated Falls reported
• Increase in slowness of movement execution
• Increase in weakness and / or deterioration in co-ordination
• Changes in speech or facial looks
• Unexpected deterioration in performance of planned
exercise programme
If the unthinkable happens...
• Is it 999 - usual first aid & resuscitation?
• If no, tell client to report ASAP to GP
• Inform Site manager
• Complete relevant section of incident report form
• Inform referring party.
• No return until GP agrees or re-referred