Post-cerebrovascular Accident Research Articles

Body weight supported treadmill and overground training in a patient post cerebrovascular accident

This study was designed to consider the feasibility and effectiveness of combined body weight support (BWS) treadmill and overground training for a 71-year-old woman 19 months post left embolic middle cerebral artery stroke. The study used a modified single subject withdrawal design (ABAA). Initial baseline performance (A1) was established using a set of functional assessment tools for balance, mobility and gait. Intervention (B) was introduced and removed, and a second baseline performance (A2) was recorded. After a one-month delay, final baseline performance was established. During intervention, the participant was involved in combined BWS training three times/week for eight weeks. Single subject analyses and pre/posttest analyses were conducted. Results revealed that 17 of 20 indicators (85%) nine indicators (89%) performance one-month post intervention. Combined BWS training was feasible and effective in improving and maintaining functional performance in this participant.

Complications and outcome of percutaneous endoscopic gastrostomy in different patient groups.

A retrospective study of percutaneous endoscopic gastrostomy (PEG) was performed to evaluate the complications of PEG and determine the role of prophylactic antibiotics in preventing early wound infection and to evaluate the outcome of patients in different groups (neurological disease, head injury, AIDS). Percutaneous endoscopic gastrostomy was performed on 50 patients between March 1991 and November 1993 and the survey was completed in July 1994. The average time to PEG placement post-cerebrovascular accident or head injury was 5 weeks. No deaths were attributable to the procedure. Four of 50 (8%) patients died in the first 30 days (early mortality). Wound infection (early eight, late five) was the most common complication: two of 13 patients receiving prophylactic antibiotics and six of 37 not receiving antibiotics had early wound infection. At completion of follow-up 19 of 26 patients with neurological disease had died (median survival = 370 days), three resumed oral feeding and four continued PEG feeding. All head injury patients (n = 6) were alive and had resumed oral feeding; five returned home. All AIDS patients (n = 7) died within 12 months (median survival = 138 days), although improved nutritional state was found after gastrostomy feeding. In conclusion, PEG placement is a useful procedure to assist feeding in multiple patient groups. Wound infection is a common but not life threatening complication. The need for prophylactic antibiotics to prevent early wound infection has not been proven. The 5 week delay in PEG insertion may contribute to lower early mortality. The 100% survival rate in head injury patients may reflect their young age and absence of underlying medical illness. In AIDS patients, improved nutritional state is not known to translate into better quality of life or prolonged survival.

Effects of Continuous Passive Motion on the Edematous Hands of Two Persons With Flaccid Hemiplegia

This study evaluated the effect of the use of a continuous passive motion device for the edematous hands of two persons with flaccid hemiplegia. The subjects were both 1 month post-cerebrovascular accident with left-sided hemiplegia. Each subject's routine therapy program was maintained throughout this ABA design study. During the first week, baseline data were gathered, during the second week the intervention was provided (2 hr of continuous passive motion device use), and during the third week data were gathered with treatment withdrawn. Edema was measured with a hand volumeter and finger circumference. The continuous passive motion device had an effect in reducing edema in the hands of the two subjects. The continuous passive motion device is a readily available tool that could enhance the treatment of edematous hands of persons with flaccid hemiplegia by offering a contribution to already established treatment protocols. Further research is needed, however, to establish guidelines for use.

Orthotic Management of the Flaccid Upper Limb in Hemiplegia: Two Case Studies

There is little documented evidence pertaining to the effects of orthotic management of the flaccid upper limb in hemiplegia. Two adult hemiplegics with flaccid upper limbs post cerebrovascular accident volunteered to participate in an investigation examining the effects of a wrist hand orthosis of the resting type on variables such as sensation, passive range of motion, oedema, arm placement, hand function, muscle tone and cosmetic appearance. One subject was fitted with the orthosis, the other was not. All variables were measured over an eight week period. Results for the splinted subject indicated no negative effects for any of the measured variables whilst the limb was splinted. The unsplinted subject developed some oedema and range restrictions during the eight weeks. Due to the limited number of subjects and the length of the study, generalised conclusive and long‐term effects of orthotic management could not be stated. The short‐term results however, suggest possible benefits from the use of orthoses in flaccid hemiplegia and further emphasise the need for continued research in this field.

Case Studies: Use of the Cybex®Trunk Extension Flexion Unit in the Rehabilitation of Back Patients

This article presents the case histories of two back patients, one who had undergone three separate spinal surgeries and one who was status post-cerebrovascular accident, that were successfully rehabilitated using the Cybex® Trunk Extension/Flexion Isokinetic System.

Effects of a Wrapping Technique on Passive Range of Motion in a Spastic Upper Extremity

Limited range of motion (ROM) and subsequent soft tissue contractures resulting from spasticity are common developments in patients with acquired hemiplegia from cerebrovascular accidents. The purpose of this study was to examine the effects of a wrapping technique on ROM in patients with a spastic upper extremity. Four adult patients, postcerebrovascular accident of less than one year, received wrapping of the upper extremity for three hours, three times a week on alternating days for a total of two to four weeks. Baseline passive range-of-motion (PROM) measurements were established for shoulder flexion, shoulder abduction, shoulder external rotation, and wrist extension; these movements were commonly limited in all patients. The PROM was recorded after each wrapping session. The results showed a significant change in PROM for all motions in all patients (p = less than .01). In addition, all patients reported a decrease in pain in the upper extremity. Comparisons of videotapes of two patients at baseline and after 12 wrappings revealed an increase in ROM and a decrease in spasticity in the upper extremity during ambulation. These findings should encourage clinicians to experiment further with the wrapping technique and to report their findings.

Pragmatic and behavioral aspects of computerized tomographic scanning in epileptic patients.

The computerized tomographic scan (CT) is a valuable method for screening the epileptic population. From the pragmatic standpoint, it is safe and nonpainful, and the cost is offset by its usefulness in uncovering and treating unexpected lesions such as brain tumors. In patients with brain tumors, CT scans are valuable for posttherapy follow-up and for determining the time for appropriate therapy in patients with minimal or no neurological deficits. The CT scan is far superior to routine skull x-ray and nuclear scan studies. Electroencephalography, the prime laboratory method for investigating epilepsy, is not as useful as the CT scan for demonstrating structural changes. In posttraumatic, postcerebrovascular accident and postinfectious patients, demonstration of the lesion is helpful from a behavioral standpoint, for understanding the patient’s psychological, emotional and cognitive difficulties. The psychological management of brain tumor patients is greatly aided by repeated CT scan studies.