Long-term efficiency of training program for patients with artificial heart valves to improve theadherence to treatment and quality of life

The prophylaxis of thromboembolism with oral anticoagulants and low dose heparin is established. However, bleeding episodes and other side effects may occur. Alternative compunds for further anticoagulation do not exist so far. We report, therefore, of the experiences of 66 outpatients who were treated with low molecular weight heparin up to nineteen months.All patients had major bleeding on conventional anticoagulants. Further anticoagulation was strongly indicated because of recurrent thromboembolism, artificial heart valves, dilative cardiomyopathy or heart valve diseases with artrial fibrillation. The dose ranged from 2.500 to 15.000 aXa units once daily subcutaneously. The LMW heparin Tedelparin (Kabi 2165) was used. The dose was chosen according to the risk ofbleeding or thromboembolism, and body weight of eachpatient. In patients with high bleeding risks (esophagiai varices) the average dose was 100 units/kg bodyweight and in patients with high risk of thromboembolism (artificial heart valves) the average dose was140 units/kg bodyweight. The dose was adjusted according to the aXa activity and aPTT inhibition: 2-4 hours after the s.c. administration 0,3 - 0,6 heparin units/ml or 0,6 - 1,0 units/ml in the above mentioned groups should be reached respectively, and the aPTT should be not more than 10 sec above the upper normal limit.Four of 66 patients experienced rethrombosis, 2 of them were non- compliant. Six of 66 patients had minor haemorrhages, 0 major or fatal bleeding occured. Bleeding was more frequent when the aXa activity increased to more than 1 unit/ml. With a dose reduction of 20 % no recurrence of bleeding was seen and antithrombotic effect was still maintained.The data demonstrate that LMW heparin can be safely and effectively used for long term anticoagulation in patients with major haemorrhage due to cönventional anticoagulants.

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Boxing Training for Patients With Parkinson Disease: A Case Series

Physical Therapy ◽

10.2522/ptj.20100142 ◽

2011 ◽

Vol 91 (1) ◽

pp. 132-142 ◽

Cited By ~ 45

Author(s):

Stephanie A. Combs ◽

M. Dyer Diehl ◽

William H. Staples ◽

Lindsay Conn ◽

Kendra Davis ◽

...

Keyword(s):

Quality Of Life ◽

Activities Of Daily Living ◽

Parkinson Disease ◽

Training Program ◽

Outcome Measures ◽

Daily Living ◽

Case Series ◽

Short Term

Background and PurposeA nontraditional form of exercise recently applied for patients with Parkinson disease (PD) is boxing training. The primary purpose of this case series is to describe the effects of disease severity and duration of boxing training (short term and long term) on changes in balance, mobility, and quality of life for patients with mild or moderate to severe PD. The feasibility and safety of the boxing training program also were assessed.Case DescriptionsSix patients with idiopathic PD attended 24 to 36 boxing training sessions for 12 weeks, with the option of continuing the training for an additional 24 weeks (a seventh patient attended sessions for only 4 weeks). The 90-minute sessions included boxing drills and traditional stretching, strengthening, and endurance exercises. Outcomes were tested at the baseline and after 12, 24, and 36 weeks of boxing sessions (12-, 24-, and 36-week tests). The outcome measures were the Functional Reach Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Timed “Up & Go” Test, Six-Minute Walk Test, gait speed, cadence, stride length, step width, activities of daily living and motor examination subscales of the Unified Parkinson Disease Rating Scale, and Parkinson Disease Quality of Life Scale.OutcomesSix patients completed all phases of the case series, showed improvements on at least 5 of the 12 outcome measures over the baseline at the 12-week test, and showed continued improvements at the 24- and 36-week tests. Patients with mild PD typically showed improvements earlier than those with moderate to severe PD.DiscussionDespite the progressive nature of PD, the patients in this case series showed short-term and long-term improvements in balance, gait, activities of daily living, and quality of life after the boxing training program. A longer duration of training was necessary for patients with moderate to severe PD to show maximal training outcomes. The boxing training program was feasible and safe for these patients with PD.

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Thinking Beyond Language: Intervention for Severe Aphasia

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld19.1.15 ◽

2009 ◽

Vol 19 (1) ◽

pp. 15-22 ◽

Cited By ~ 3

Author(s):

Nina Simmons-Mackie

Keyword(s):

Quality Of Life ◽

Communication Training ◽

Language Intervention ◽

Specific Training ◽

Environmental Support ◽

Total Communication ◽

Communication Partners

Abstract Purpose: This article addresses several intervention approaches that aim to improve life for individuals with severe aphasia. Because severe aphasia significantly compromises language, often for the long term, recommended approaches focus on additional domains that affect quality of life. Treatments are discussed that involve increasing participation in personally relevant life situations, enhancing environmental support for communication and participation, and improving communicative confidence. Methods: Interventions that have been suggested in the aphasia literature as particularly appropriate for people with severe aphasia include training in total communication, training of communication partners, and activity specific training. Conclusion: Several intervention approaches can be implemented to enhance life with severe aphasia.

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