Evaluation and Feasibility of a Head Positioning Intervention in Patients with Intraparenchymal Hemorrhage

2021 ◽  
Author(s):  
◽  
Wendy Dusenbury ◽  
Keyword(s):  
Assessment Tool ◽  
Venous Blood ◽  
Internal Validity ◽  
Head Position ◽  
Intraparenchymal Hemorrhage ◽  
Stroke Patients ◽  
Subacute Stroke ◽  
Head Positioning ◽  
The Brain ◽  
Clinical Stability

Stroke caused by intraparenchymal hemorrhage (IPH) is most commonly the result of hypertension-induced blood vessel rupture in the brain and is associated with devastating disability and high rates of death. To date, no intervention has improved outcomes in IPH stroke patients; however, head elevation may be one of the most important first steps to promote clinical stability in the hyperacute stage of IPH stroke because of the risk of increased intracranial pressure (ICP) in these patients. Nursing research completed in the late 1970s and early 1980s in patients with increased ICP due to traumatic brain injury showed that elevating the head of bed (HOB) increased gravity drainage of venous blood and cerebrospinal fluid, lowering ICP, However, no study has yet been completed in a generalizable sample of hyperacute IPH stroke patients to examine serial changes in clinical stability in relation to HOB positioning. Recently, the Head Position in Stroke Trial (HeadPoST), which enrolled a highly heterogeneous sample of subacute stroke patients, found that head position does not affect 3-month outcome; however, the study was heavily criticized by international stroke experts due to significant internal validity concerns. HeadPoST findings have created significant confusion within the acute stroke practice community about whether there is a role for head positioning in hyperacute IPH stroke management. The focus of our research was to build knowledge of key clinical methods that will support future definitive HOB research in hyperacute IPH stroke patients. We established 1) the clinical knowledge and skill set supporting nurses’ ability to localize stroke disability within vascular territories in the brain and 2) use of the National Institutes of Health Stroke Scale as a valid assessment tool for serial monitoring of clinical change in hyperacute IPH patients. We also 3) examined the degree of acceptance of HeadPoST findings internationally among nurse and physician clinicians caring for IPH stroke patients and 4) evaluated elements tied to the feasibility of conducting hyperacute IPH HOB research at a large, comprehensive stroke center in the Midsouth. Collectively, the chapters in this dissertation create a foundation for future IPH head-positioning research, providing direction for our next steps in understanding the contribution of HOB positioning to hyperacute IPH patient management. Patients with hypertensive IPH stroke suffer significantly higher rates of disability and death compared to other forms of stroke, yet despite a great deal of inquiry into interventions to improve outcomes, none have been successful. Positioning the patient’s HOB at 30-degrees may be one of the most important early interventions that nurses can employ to impart stability in hypertensive IPH patients. Our research and conclusions position nurse scientists to further their examination of the effect of this simple HOB-positioning intervention in this highly vulnerable patient population.

scholarly journals The Effects of Gradual Change in Head Positioning on the Relationship between Systemic and Cerebral Haemodynamic Parameters in Healthy Controls and Acute Ischaemic Stroke Patients

2020 ◽  
Vol 10 (9) ◽  
pp. 582
Author(s):  
Eloise Sands ◽  
Louvinia Wong ◽  
Man Y. Lam ◽  
Ronney B. Panerai ◽  
Thompson G. Robinson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Blood Pressure Variability ◽  
Head Position ◽  
Gradual Change ◽  
Healthy Controls ◽  
Stroke Patients ◽  
Head Positioning ◽  
The Relationship

(1) Background: Larger blood pressure variability (BPv) in the first 3 h post-stroke onset increases pathophysiological effects such as infarct size, and leads to greater risk of disability, comorbidities and mortality at 90 days. However, there is limited information on the relationship between systemic and cerebral haemodynamic and variability parameters. (2) Objectives: This study determined the effect of a gradual change in head position (GHP) on cerebral blood flow velocity variability (CBFVv) and mean arterial blood pressure variability (MABPv), in healthy controls and acute ischaemic stroke (AIS) patients. Methods: CBFVv and MABPv were expressed as standard deviation (SD) and coefficient of variation. A total of 16 healthy controls (mean age 57 ± 16 years) were assessed over two visits, 12 ± 8 days apart, and 15 AIS patients (mean age 69 ± 8.5 years) were assessed over three visits (V1: 13.3 ± 6.9 h, V2: 4.9 ± 3.2 days and V3: 93.9 ± 11.5 days post-stroke). (3) Results: In response to GHP, MABPv does not initially increase, but over time MABPv showed a significant increase in response to GHP in AIS (visits 2 and 3) and controls (visit 2). Additionally, in response to GHP in AIS, CBFVv increased in the affected hemisphere. Lastly, in AIS, a significant correlation between CBFVv and MABPv, assessed by SD, was seen in the unaffected hemisphere, whereas this relationship was not demonstrated in the affected hemisphere. (4) Conclusions: To our knowledge, this is the first study to analyse the relationship between CBFVv and MABPv. Shedding light on the effect of head position on the relationship between cerebral blood flow and blood pressure is important to improve our understanding of the underlying effects of cerebral autoregulation impairment. This early mechanistic study provides evidence supporting supine head positioning in healthy controls and stroke patients, through demonstration of a reduction of MABPv and increase in CBFVv.

Effects of mirror therapy vs modified constraint induced movement therapy on upper extremity in subacute stroke patients

2021 ◽  
Vol 20 (2) ◽  
pp. 323-329
Author(s):  
Kamatchi Kaviraja ◽  
G Tharani ◽  
G Yuvarani ◽  
N Kaviraja ◽  
Jenifer Augustina S ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Movement Therapy ◽  
Systemic Hypertension ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Functional Index ◽  
Constraint Induced Movement Therapy ◽  
Subacute Stroke ◽  
The Brain

Objective: To compare and to examine the effectiveness of mirror therapy and modified constraint induced movement therapy (mCIMT) on upper extremity in subacute stroke patients. Background: Stroke or cerebral vascular accident is sudden dead of the brain cells due to inadequate blood flow. The WHO defines stroke as rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting for 24hrs or longer or leading to death, with no apparent cause other than of vascular origin. The most common consequence of stroke is loss of upper limb function. The protocol planned for improving the function of upper limb are mirror therapy and modified constraint induced movement therapy (mCIMT). Mirror therapy is a simple and inexpensive treatment which uses the visual information activating the premotor and motor cortex of the brain. This is explained by activation of so called mirrorneuron system. Whereas mCIMT utilises the redundant pathway in brain through neuro plasticity. Methodology: A total of 30 participants with subacute stroke were selected. The inclusion criteria are both gender of age 55-70 years and duration of 2-12 months of post stroke. Participants with mini mental state examination score<24, uncontrolled systemic hypertension, severe shoulder subluxation, previous stroke and severe cardiac failure were excluded. The outcome measures were measured using Upper Extremity Functional Index (UEFI) and Fugl Meyer Upper Extremity Scale. Procedure: All 30 participants with sub-acute stroke were divided into two groups. Both the group individuals were assessed for pre test using Fugl Meyer Upper Extremity Scale and Upper Extremity Functional Index Scale. Group A (15) was assigned to mirror therapy for 5 days a week, for 4 weeks and rest intervals was given. Similarly group B (15) was assigned to modified constraint induced movement therapy for 5 days a week, for 4 weeks. Both the groups were given conventional therapy for 20 mins. At the end of study subjects were assessed for post test using UEFI and Fugl Meyer upper extremity scale. Results: The Modified Constraint Induced Movement (mCIMT) is more effective than Mirror Therapy in improving the hemiparetic upper extremity in subacute stroke patients. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.323-329

Platelet Hyperaggregability in Ischemic Cerebrovascular Disease and Effects of Aspirin

1982 ◽  
Vol 48 (02) ◽  
pp. 117-119 ◽  
Author(s):  
M Kusunoki ◽  
K Kimura ◽  
K Nagatsuka ◽  
Y Isaka ◽  
O Uyama ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Venous Blood ◽  
Second Phase ◽  
Cerebral Angiogram ◽  
Peripheral Venous Blood ◽  
Chronic Stage ◽  
Ischemic Cerebrovascular Disease ◽  
Carotid Arterial ◽  
Platelet Hyperaggregability ◽  
The Brain

SummaryPlatelet aggregation was studied in 24 patients in the chronic stage of ischemic cerebrovascular disease (CVD), with cerebral affluent and effluent blood, i.e., carotid arterial and internal jugular venous blood, and also with peripheral venous blood. Aggregation tests were performed at various final concentrations of sodium arachidonate (A.A.) and ADP. In 17 patients, not taking aspirin, platelet aggregability in jugular venous blood was significantly accentuated compared with that in arterial and peripheral venous blood. This tendency was more marked in the patients with cerebral artery stenosis and/or occlusion than in those with normal cerebral angiogram. In 7 patients taking 500 mg or more oral aspirin, aggregation differences across the brain were not observed and A.A. aggregation and the second phase of ADP aggregation were completely suppressed. These results suggest that a prophylactic administration of aspirin may be beneficial for patients in chronic stage of CVD.

ASSECSSING MOCA TEST IN SUBACUTE STROKE PATIENTS AND COMPARE MOCA VERSUS MMSE

2016 ◽  
pp. 120-127
Author(s):  
Dinh Toan Nguyen
Keyword(s):  
Human Life ◽  
Statistical Significance ◽  
High Sensitivity ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Female Age ◽  
Subacute Stroke ◽  
Duration Of Illness ◽  
Dsm Iv

Background: Dementia after stroke, particularly subacute period is often overlooked. Today the quality of human life is increasingly high, finding scales that have high value for detection of dementia in patients with stroke is increasingly interested. MoCA test is high sensitivity with mild dementia and identify more abnormalities of awareness caused by vascular, but MoCA have not been studied much in Vietnam. Objective: Assessing MoCA test in subacute stroke patients and compare MoCA versus MMSE in these patients. Subjects: 90 patients with subacute stroke period, these people are being treated at Department of cardiovascular internal medicine at Hue Central Hospital, from 7/2014 - 7/2015. Methods: cross-sectional description and analysis. Results: The mean age is 65.57 ± 13.38, accounting for 54.4% male and 45.6% female. Age, duration of illness has weak correlation with MoCA. The risk factors: hypertension, stroke ischemic transient, alcoholism, smoking, heart disease, diabetes, dyslipidemia related no statistical significance with MoCA. The proportion of dementia in subacute stroke according MoCA is 82.2%. The concordance between MoCA and MMSE was good (kappa = 0.684). Using DSM-IV criteria as the gold standard we found MoCA more valuable in the dementia diagnosis than MMSE (AUC 0.864 versus 0.774, p <0.05). Conclusion: The rate of dementia in stroke subacute period according MoCA is quite high. MoCA is valuable than MMSE in detecting dementia in patients with stroke subacute period, this scale is short, easy to implement so should put into using widely in clinical practice. Key words: MoCA test, subacute stroke, dementia

scholarly journals Cross-Modal Effect of Presenting Visual and Force Feedback That Create the Illusion of Stair-Climbing

2021 ◽  
Vol 11 (7) ◽  
pp. 2987
Author(s):  
Takumi Okumura ◽  
Yuichi Kurita
Keyword(s):  
Visual Information ◽  
Force Feedback ◽  
Activity Level ◽  
Experimental Results ◽  
Stair Climbing ◽  
Mirror Therapy ◽  
Visual Condition ◽  
Stroke Patients ◽  
Head Mount Display ◽  
The Brain

Image therapy, which creates illusions with a mirror and a head mount display, assists movement relearning in stroke patients. Mirror therapy presents the movement of the unaffected limb in a mirror, creating the illusion of movement of the affected limb. As the visual information of images cannot create a fully immersive experience, we propose a cross-modal strategy that supplements the image with sensual information. By interacting with the stimuli received from multiple sensory organs, the brain complements missing senses, and the patient experiences a different sense of motion. Our system generates the sense of stair-climbing in a subject walking on a level floor. The force sensation is presented by a pneumatic gel muscle (PGM). Based on motion analysis in a human lower-limb model and the characteristics of the force exerted by the PGM, we set the appropriate air pressure of the PGM. The effectiveness of the proposed system was evaluated by surface electromyography and a questionnaire. The experimental results showed that by synchronizing the force sensation with visual information, we could match the motor and perceived sensations at the muscle-activity level, enhancing the sense of stair-climbing. The experimental results showed that the visual condition significantly improved the illusion intensity during stair-climbing.

scholarly journals Postural Control Disturbances Induced by Virtual Reality in Stroke Patients

2021 ◽  
Vol 11 (4) ◽  
pp. 1510
Author(s):  
Charles Morizio ◽  
Maxime Billot ◽  
Jean-Christophe Daviet ◽  
Stéphane Baudry ◽  
Christophe Barbanchon ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Postural Control ◽  
Virtual Environments ◽  
Center Of Pressure ◽  
Dynamic Condition ◽  
Static Condition ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

People who survive a stroke are often left with long-term neurologic deficits that induce, among other impairments, balance disorders. While virtual reality (VR) is growing in popularity for postural control rehabilitation in post-stroke patients, studies on the effect of challenging virtual environments, simulating common daily situations on postural control in post-stroke patients, are scarce. This study is a first step to document the postural response of stroke patients to different challenging virtual environments. Five subacute stroke patients and fifteen age-matched healthy adults were included. All participants underwent posturographic tests in control conditions (open and closed eyes) and virtual environment without (one static condition) and with avatars (four dynamic conditions) using a head-mounted device for VR. In dynamic environments, we modulated the density of the virtual crowd (dense and light crowd) and the avoidance space with the avatars (near or far). Center of pressure velocity was collected by trial throughout randomized 30-s periods. Results showed that more challenging conditions (dynamic condition) induced greater postural disturbances in stroke patients than in healthy counterparts. Our study suggests that virtual reality environments should be adjusted in light of obtaining more or less challenging conditions.

EP 4. Recruitment of premotor cortices in subacute stroke patients – A longitudinal fMRI study

2016 ◽  
Vol 127 (9) ◽  
pp. e233-e234
Author(s):  
U. Horn ◽  
S. Roschka ◽  
K. Eyme ◽  
A.D. Walz ◽  
T. Platz ◽  
...  
Keyword(s):  
Stroke Patients ◽  
Subacute Stroke ◽  
Fmri Study
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