BB Therapy Research Articles

Is Bobath-based therapy used by physiotherapists in the care of stroke patients?

The aim of this study was to investigate if physiotherapists had knowledge and skills in applying Bobath-based therapy (BB), also referred to as Neurodevelopmental Treatment, in the care of stroke patients and if they generally used the therapy in daily practice. This is because of the important emphasis placed on documenting the extent of the therapy given to the client groups compared in outcome studies measuring the efficacy of therapeutic interventions. The study took place as an intervention check for a large outcome study measuring the effects of BB therapy. BB therapy had been implemented on six wards, whereas six other wards did not use this approach. The physiotherapist's (n=38) knowledge and skills in making decisions about applying the BB principles in all wards was measured in two steps. In step 1, the physiotherapists received a questionnaire focusing on their physiotherapy strategy, and Bobath education. In step 2, they received a case vignette describing a stroke patient and questions conce...

Predicting maximum heart rate among patients with coronary heart disease receiving β-adrenergic blockade therapy

Background The use of β-adrenergic blockade (BB) therapy is common among patients with coronary heart disease (CHD), and as a result, these patients often undergo exercise testing while taking these medications. However, evaluation of maximal voluntary effort during exercise testing is often in question because current equations to predict maximum heart rate (HR max; eg, 220 − age) are based on subjects without heart disease or BB therapy. The purpose of this study was to develop and validate an age-specific equation to predict HR max in patients with CHD who are receiving BB therapy. Methods We queried the Henry Ford Preventive Cardiology Outcomes database for patients with a history of myocardial infarction or revascularization procedure; preserved left ventricular function; age, 40 to 80 years; sinus rhythm; and a graded treadmill test with a respiratory exchange ratio ≥1.10. Data were split, based on date, such that tests performed between November 1996 and April 2001 were used as the BB prediction equation development group (n = 334; 73% men) and those performed between May 2001 and April 2002 were used as the BB cross-validation group (n = 94; 84% men). Linear regression was used to develop the equation to predict HR max, based on age, and to calculate the correlation coefficient of the prediction equation among the cross-validation group. Results The resultant prediction equation was HR max = 164 − 0.7 × age ( r 2 = 0.13), with a standard error of the estimate of 18 per minute. Among the cross-validation group, mean predicted HR max was not significantly different from mean measured HR max ( P = .7). The mean error of prediction was −0.4 ± 2.0 per minute (mean ± SEM), and the correlation was r = 0.38. Conclusions This new equation provides a better estimate of HR max for patients with CHD receiving BB therapy than previously reported equations. Additional variables may improve the equation but may not be as convenient to use.

Comparison of mortality in mexican-american females and mexican american males following acute myocardial infarction

Acute myocardial infarction results in 7.2 million deaths per year world-wide.The treatment of AMI in the post-myocardial infarction period differs among the races and genders. This study investigated differences in mortality between Mexican American (MA) males and females, post-AMI who received BB therapy and those who did not receive BB therapy.Findings from this secondary analysis indicate that MA females experienced a higher mortality post-AMI compared to MA males. However, MA females taking BB therapy post-AMI had a reduced odds of mortality compared to MA males taking BB post-AMI. Interestingly, MA females were less likely to have received BB therapy post-AMI compared to MA males, despite its apparent benefit.

Partial reversal of Cachexia by β-adrenergic receptor blocker therapy in patients with chronic heart failure

BackgroundCachexia is a common problem in chronic heart failure (CHF) that may be partly mediated by activation of the sympathetic nervous system. The effects of β-adrenergic receptor blocker (BB) therapy on body weight in cachectic and noncachectic subjects with CHF has not been previously reported. Methods and resultsBody weight and plasma norepinephrine, leptin, and insulin levels were measured in 27 subjects with CHF before and after 6 months of β-adrenergic receptor blockade with carvedilol or long-acting metoprolol. Before BB therapy, baseline weight, plasma leptin, and plasma insulin levels did not differ between cachectic and noncachectic subjects. Baseline plasma norepinephrine levels were increased in cachectic subjects when compared with noncachectic subjects (930±248 pg/mL versus 503±109 pg/mL, P=.063). After 6 months of BB therapy, subjects with baseline cachexia demonstrated significantly greater weight gain (+5.2±9.6 versus +0.8±5.0 kg, P=.027), greater increase in plasma leptin levels (+3.7±3.9 versus +1.2±4.3 ng/mL, P=.030), and greater decrease in plasma norepinephrine levels (–374±261 versus –41±122 pg/mL, P=.012) when compared with noncachectic subjects. ConclusionsSix months of BB therapy with carvedilol or long-acting metoprolol is associated with differential effects on body weight and hormonal levels in cachectic and noncachectic subjects with CHF. Further work is needed to determine the role the sympathetic nervous system in the pathogenesis of cachexia in patients with CHF.

534 The Norris coronary prognostic index predicts increased post-infarction myocardial apoptosis at post-mortem examination in humans

11±3 ml/k/min, p 120 mg%, respectively (p=0.015), 95% vs. 75% in the patents with RAP 8 mHg (p=0.002), 93% vs. 73% in those with peak exercise SBP > and 37, respectively (p=0.001). The 2and 3-years survival rates were, respectively, of only 59% and 47% in the patients with a RAP > 8 mHg and a peak exSBP 8 mHg and a VE/VCO2slope > 37. In conclusion, simple hemodynamic parameters, which may be assessed also noninvasively, and the ventilatory response to ex may identify subgroups of patients with chronic HF at high risk of subsequent events despite long-term BB therapy.

Comparison of the beta blocker bucindolol in younger versus older patients with heart failure

E evidence and clinical trials have shown the beneficial effects of -adrenergic blockers (BBs) in patients with heart failure (HF). A large database supports the contention that BB therapy improves survival, reduces the rate of hospitalization, delays the progression of HF, and improves cardiac function. However, there is little information regarding how elderly patients with HF tolerate and respond to BBs. To test the hypothesis that BB therapy can be safely administered to, and improves cardiac function in elderly patients with HF, we analyzed, according to age, patients who were randomized to receive the BB bucindolol or placebo in the Beta-Blocker Evaluation of Survival Trial (BEST).

Plasma brain natriuretic peptide as a novel therapeutic indicator in idiopathic dilated cardiomyopathy during β-blocker therapy: A potential of hormone-guided treatment

Background Plasma brain natriuretic peptide (BNP) is a sensitive and specific marker of left ventricular (LV) function. In the treatment of heart failure, especially in idiopathic dilated cardiomyopathy (IDC), β-blocker (BB) therapy has been established as a powerful strategy. The purpose of this study was to analyze relationships between changes in BNP level and LV function during BB therapy in patients with IDC. Methods In 30 patients with IDC who had already received conventional therapy, measurement for plasma BNP and norepinephrine levels and echocardiographic indices were evaluated before and 2 and 6 months after carvedilol in 21 patients and at baseline and after 6 months in 9 patients who did not receive carvedilol. Results After 6 months carvedilol treatment significantly improved LV end-diastolic dimension (LVEDD) (65 ± 8 to 61 ± 8 mm) and LV ejection fraction (LVEF) (34% ± 13% to 43% ± 12%) with intergroup differences; it significantly decreased BNP (127 ± 113 to 69 ± 92 pg/mL) with no intergroup difference; however, it did not decrease norepinephrine. BNP correlated strongly with LVEDD, LVEF, and LV mass index in carvedilol-treated patients. The degree of change in BNP correlated with that in LVEDD or LVEF 6 months after carvedilol. All 14 patients with decreased or unchanged BNP levels showed an increase in LVEF, and 4 of 7 with a rise in BNP had decreased or unchanged LVEF. According to receiver operating characteristic analysis, the optimal BNP levels for detecting LVEF <35% before and after carvedilol were 75.5 and 69 pg/mL, respectively. Conclusion: Plasma BNP levels may accurately reflect alteration in LV function and structure and can be used as a therapeutic indicator for risk stratification in patients with IDC during BB therapy. (Am Heart J 2001;141:925-32.)

Nadolol treat aggression and psychiatric symptomatology in chronic psychiatric inpatients

β-Blockers (BBs) are a widely used class of medications with a number of medical indications. Their ability to suppress the adrenergic response has made them a target of investigation for treating a variety of psychiatric symptoms.The aim of this review is to identify evidence regarding the use of BBs for various psychiatric disorders including anxiety disorders, mood disorders, psychosis, and posttraumatic stress disorder. We also review the evidence for use for aggression and agitation and for extrapyramidal side effects of psychiatric medications.A search of PubMed and Google Scholar was conducted with search terms relevant to the use of BBs for psychiatric conditions. Studies were selected based on relevance to the review objective, focusing on systematic reviews and meta-analyses. Case reports were included and are clearly identified when referenced in this review.A total of 44 publications were included that examined the use of BBs as treatment for the following psychiatric symptoms and conditions: anxiety disorders, depression and mood disorders, acute stress disorder and postraumatic stress disorder, psychotic disorders and extrapyramidal symptoms, as well as aggression and agitation. Additionally, adverse effects and drug-drug interactions were reviewed.Well-characterized psychiatric uses of BBs include treating symptoms of performance anxiety and akathisia. Some positive evidence exists for BB therapy in other disorders such as specific phobia, panic disorder, and for aggression in patients with psychosis, acquired brain injury, or intellectual disability. Most of the evidence on the role of BBs in psychiatry is as adjunctive treatment for management of somatic symptoms rather than as monotherapy. Outside of performance anxiety and akathisia, the role of BBs in psychiatry has not been subjected to careful study, and further investigative trials are needed.