Chapter 14: Cardiopulmonary Concerns in the Patient With Neurological Deficits: An Evidence-Based Approach

INTRODUCTION

Physical therapists are responsible for the exercise prescription and management of patients with neurological disorders. Physical therapists can best treat patients with neurological illnesses by focusing on neurological impairments, functional limitations, and participation outcomes while considering the cardiopulmonary system. The cardiopulmonary system plays an important role in functional activities because of its role in transporting oxygen to skeletal muscle. Abnormalities in the cardiopulmonary system can produce limitations in movement and thus functional outcomes.

Patients with neurological deficits have a particular problem of deconditioning due to hospitalization or inactivity as a result of their disease or illness. This deconditioning could mean the difference between independence and dependence in activities of daily living (ADL). Physical therapists are the first health care professionals to note the functional impact of cardiopulmonary limitations because of the way that their patients are challenged through exercises and position changes in the provision of physical therapy.

Furthermore, physical therapists can contribute to the prevention of cardiopulmonary complications of immobility, weakness, and exercise intolerance. Individuals with neurological injuries, who are within age ranges where cardiac risk factors are high, may be even more at risk during activity or exercise. In the existing health care environment, these neurological patients may be discharged from the acute care hospital in a fragile cardiopulmonary state. Therefore, significant focus must be placed on the cardiopulmonary status of patients with neurological illnesses who demonstrate activity and exercise risk factors.

It is ultimately the intent of this chapter to make the reader familiar with the Guide to Physical Therapist Practice (2nd editon) as it relates to evidence-based treatment of cardiopulmonary disorders for neurological patients. This chapter assumes that cardiopulmonary status is a primary focus of the intervention, and thus provides guidelines regarding the factors associated with activity and exercise that influence the exercise ability for patients with neurological impairments. This chapter also makes recommendations for common tests and measures used for exercise testing and describes the physiological responses to exercise, including the effect of medications. Finally, the intent is to make recommendations for exercise training interventions and identify other benefits of exercise for patients with neurological disorders.

NEUROLOGICAL DIAGNOSTIC CATEGORIES

Stroke

Stroke, or cerebrovascular accident (CVA), is the result of a thrombus or hemorrhage in the brain, producing an area of infarct. This region produces neurological impairments that may result in significant disability. Indeed, stroke is the leading cause of serious, long-term disability in the United States, where 15% to 30% of stroke survivors are permanently disabled¹ with $3.8 billion paid to Medicare beneficiaries.² According to the World Health Organization (2002), 15 million people suffer stroke worldwide each year.¹

There are nearly 4.7 million stroke survivors alive in the United States of which 2.3 million are men and 2.4 million are women. There are approximately 700,000 strokes annually where ...