Active Balance and Cardio Care Intervention on Physical and Cardiovascular Health in People With Chronic Stroke

Other illness

• Cognitive or communicative impairment indicated by a score of \> 26 on Montreal cognitive assessment and a score of \<25 on Mini Mental State Exam Score;
• active or untreated infection,
• thromboembolic disease,
• known history of peripheral nerve injury in the lower legs,
• history of cardiovascular or pulmonary complications, or with pacemakers and history of metabolic (endocrine, hepatic) or renal dysfunction, uncontrolled seizures (Self-report).
• History of any acute and significant cardiopulmonary, musculoskeletal or systemic diagnosis in the past 6 months or history of a recent major surgery (\<6months) or hospitalization (\<3months) and on any sedative drugs.
• Uncontrolled hypertension (systolic blood pressure (SBP) \> 165 mmHg and/or diastolic blood pressure (DBP) \> 110 mmHg during resting).

Lab values

• Severe cardiac disease (New York Heart Association classification of IIIV) \[1\]. Exclusion Criteria for Laboratory Slip test.

Age

• Resting hear rate (HR) \> 85% of age-predicted maximal heart rate (HRmax) (HRmax = 220 - age) \[3\].

Other

• aphasia \<71% on Mississippi Aphasia Screening Test
• \>15 on Geriatric Depression Scale.
• unhealed pressure sores,
• severe contractures,
• active heterotrophic ossification in the lower extremities,
• lower limb fractures,
• Partcipants unavailable for 12 weeks of participation,
• Current participation in other treatment (i.e.- Botox) or other research studies during the phase of the study.
• Pregnancy.
• Uncontrolled pain \>3/10 on VAS.
• Complains of shortness of breath
• Oxygen saturation (measured by pulse oximeter) during resting \< 95%.
• T score of \< -2 on the Bone density, measured through via the heel ultrasound machine.

• 45 to 90 years of age.
• Able to follow instructions provided in English.
• History of neurological impairment (Stroke) for at least 6 months prior to evaluation (self-report, confirmed by participant's physician).
• Able to stand and walk with or without assistive device or braces as part of their activities of daily living (self-report).
• Cognitive skills to actively participate (score of \< 26 on Montreal cognitive assessment indicates cognitive impairment).
• Stroke - a) Upper extremity limb function (score of at least 25 on the Fugyl Myer Upper extremity test and Muscle performance grade on deltoid, pec major and and triceps of \> or = 2/5).