Factors influencing home modification of stroke patients.

BACKGROUND: Home modification for stroke victims is often necessary to prevent falls and enable them to have a better quality of life. Up-to-date relationship between personal factors and home modifications in post-stroke patients has not been investigated. OBJECTIVE: To identify significant personal factors influencing the requirement for home modification in post-stroke patients. STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Two hundred eighty one post-stroke patients were recruited from nine tertiary rehabilitation centers in Thailand. All patients received inpatient rehabilitation programs until either they reached the rehabilitation goals or registered two consecutive stable weeks as measured by their Barthel index score. Personal factors related to home modification were assessed at study entry, during hospital stay and at discharge. The correlation between personal factors and necessities of home modification in post-stroke patients were reported through univariate and multivariate modeling. RESULTS: The results of univariate analysis showed that a low Barthel index score (< or = 14/20) (at baseline and discharge), low Brunnstrom stage of arm or leg (< or = IV/VI) at baseline, and intolerance to intensive rehabilitation programs (< 3 hr/day) indicated a necessity for modifications in the patient's home (p < 0.05). The results of multivariate modeling showed that a low Barthel index score (at baseline and discharge), and intolerance to intensive rehabilitation were significant predictors of a requirement for home modification (p < 0.05). CONCLUSION: A low level of physical functioning and intolerance to intensive rehabilitation are significant predictors for the necessity of home modifications in stroke victims.

Experiencia con el tratamiento endovascular de los aneurismas del tope de la arteria basilar / Experience with the endovascular treatment of vasilar tip aneurysms

Objetivo. Describir los resultados inmediatos obtenidos en una serie de pacientes con aneurismas del tope de la arteria basilar tratados por vía endovascular en relación con el tamaño del cuello y saco del aneurisma, la presencia o no de ruptura aneurísmática y la gravedad clínica. Método. Se realizó un estudio descriptivo en una cohorte retrospectiva de 37 pacientes adultos de ambos sexos con aneurismas del tope de la arteria basilar tratados por vía endovascular (período 1993-2006). Los pacientes fueron clasificados con la escala de Hunt-Hess. Los aneurismas fueron clasificados según su tamaño y ancho del cuello. El grado de oclusión se clasificó en 4 categorías: A(100), B(>95), C(>90), D(<90). Resultados. En el 68 se logró una oclusión grado A y en el 1 se logró una oclusión grado B. La morbilidad fue del 7 en el subgrupo sin HSA y del 28 en el subgrupo con HSA. Se encontró una morbilidad del 9 en el grado HH 0; 12,5 en el grado HH 1-2; 58 en el grado HH 3 y 50 en el grado HH 4-5. La oclusión fue grado A en el 75 de los aneurismas con saco pequeño y cuello angosto y en el 55 de los aneurismas con saco grande y cuello ancho. La morbilidad global fue del 24 y la mortalidad global fue del 5,4. Conclusión. En base a los resultados descriptos la vía endovascular fue una buena alternativa para el tratamiento en agudo de los aneurismas rotos e incidentales del tope de la basilar, sobre todo cuando tenían un saco pequeño y cuello angosto y presentaban una menor gravedad clínica. Palabras clave: aneurisma cerebral, tope de basilar, tratamiento endovascular.

Objective. We describe the early results obtained in a series of cases with basilar tip aneurysms treated by endovascular surgery with detachable coils. The results are compared according to the size of the neck and the sac of the aneurysms, the history of aneurysms rupture and neurological state. Method: A retrospective descriptive study was made in a cohort of 37 adults patients of both sexes with basilar tip aneurysms treated by endovascular surgery (period 1993-2006). Hunt-Hess scale was usedfor patients classification. The aneurysms were classified according to their size and the wide of the neck. The occlusion grade was classified in 4 categories: A(100), B(>95), C(>90), D(<90). Results: Occlusion grade A was obtained un 68 of patients and occlusion grade B was obtained in 18 of patients. The morbidity was 7 in the non-SHA group and 28 in the SAH group. Morbidity was 9 in HH 0, 12,5 in grade HH 1-2, 58 in grade HH 3 and 50 in grade HH 4-5. Occlusion was grade A in 75 of the aneurysms with small sac and narrow neck and in 55 fo the aneurysms with a huge sac an broad neck. Global morbidity was 24 and global mortality was 5.4. Conclusion: According with our results, endovascular surgery was a good alternative for acute ruptured basilar tip aneurysms and incidental ones too, mainly when they had smaller sacs, narrower necks and a better neurological state. Key words: basilar tip aneurysm - cerebral aneurysm - endovascular treatment.

Preditores de disfunção neurológica maior após cirurgia de revascularização miocárdica isolada / Predictors of major neurologic dysfunction after coronary bypass surgery

OBJETIVO: Avaliar a incidência e os fatores preditores de disfunção neurológica maior pós-operatória e a evolução clínica precoce em uma coorte não selecionada. MÉTODO: Um total de 1760 pacientes consecutivos submetidos a CRM isolada, no Hospital São Lucas da PUCRS, entre janeiro de 1997 e fevereiro de 2004, foram incluídos. Dados demográficos, informações do procedimento e desfechos perioperatórios foram coletados usando-se o protocolo do registro de dados da Unidade de Pós-Operatório de Cirurgia Cardíaca do nosso hospital. As variáveis consideradas estatisticamente significativas foram aquelas com p <0,05 e intervalo de confiança de 95 por cento. RESULTADOS: Na nossa amostra, 52 (3 por cento) pacientes evoluíram com disfunção neurológica maior (AVC). Na análise univariada, idade avançada, maior prevalência de doença pulmonar obstrutiva crônica (DPOC), doença cerebrovascular (DCV) prévia, média de fibrinogênio elevada, desenvolvimento de choque ou hipotensão grave, presença de taquicardia supraventricular (fibrilação atrial ou flutter), ocorrência de síndrome da resposta inflamatória sistêmica (SIRS) e ventilação mecânica prolongada estiveram associados ao desenvolvimento de AVC. Na análise multivariada, a história prévia de DCV e DPOC demonstraram ser preditores independentes para a ocorrência de disfunção neurológica maior. Ventilação mecânica prolongada também apresentou associação independente com o desfecho. Além disso, a ocorrência de AVC aumentou significativamente o tempo de internação hospitalar e a mortalidade intra-hospitalar. CONCLUSÃO: A disfunção neurológica permanece sendo relevante causa de morbidade hospitalar, no pós-operatório de CRM com circulação extracorpórea.

OBJECTIVE: The aim of this study was to evaluate the incidence and to identify possible predictors of major postoperative neurologic dysfunction (defined as stroke) and to evaluate early clinical outcome in a non-selected cohort. METHOD: A total of 1760 consecutive patients who underwent isolated CABG in the San Lucas Hospital -PUCRS, between January 1997 and February 2004, were enrolled. Demographic and laboratory data, informations regarding the procedure and perioperative endpoints were collected prospectively using a standard protocol of data register of the cardiac postoperative unit of our hospital. We considered statistically significant those variables with a p value no greater than 0.05 with a confidence interval of 95 percent. RESULTS: In this study, 52 (3 percent) patients presented with major neurologic dysfunction. On the univariable analysis advanced age, higher prevalence of obstructive pulmonary disease, previous cerebrovascular disease, higher mean value of fibrinogen, occurrence of shock or severe hypotension, presence of supraventricular tachycardia (atrial fibrillation or flutter), occurrence of the systemic inflammatory syndrome and prolonged mechanical ventilation were associated with stroke. On the multivariable analysis previous history of cerebrovascular disease and obstructive pulmonary disease presented as independent predictors for the occurrence of major neurologic dysfunction. Prolonged mechanical ventilation was also independently associated with the endpoint. Furthermore, the occurrence of stroke raised significantly the duration of hospital stay and in-hospital mortality. CONCLUSION: Neurological dysfunction is still a significant cause of morbidity after CABG.

Acciones de enfermería en pacientes con afecciones cerebrovasculares / Nursing actions in the care of patients with cerebrovascular diseases

Se realizó un estudio retrospectivo, descriptivo y transversal en el Servicio de Cerebrovascular del Hospital Clinicoquirúrgico Docente Provincial Dr. Ambrosio Grillo Portuondo de Santiago de Cuba durante 1996, cuyo universo estuvo constituido por 522 enfermos, de los cuales se tomó una muestra al azar de 200 casos, con el propósito de exponer la importancia de las acciones de enfermería en pacientes con enfermedades cerebrovasculares, entre otras variables de interés. Con esta finalidad se revisaron las historias clínicas de las que se obtuvo la información necesaria, que fue procesada de forma manual. Los pacientes más afectados se hallaban comprendidos entre los 56 y 65 años, con predominio del sexo femenino. Según la clasificación diagnóstica del accidentes vascular encefálico, la mayor frecuencia correspondió a los isquémicos, en los que también se registró la mortalidad más baja. La labor de la enfermera en estrecha coordinación con el equipo de salud resultó fundamental en los diferentes tipos de rehabilitación que se aplica a estos enfermos(AU)

A retrospective, descriptive and cross-sectional study was performed in the Cerebrovascular Service Department of Dr Ambrosio Grillo Portuondo provincial clinical, surgical and teaching hospital in 1996 in Santiago de Cuba province. The universe of study was made up of 522 patients,200 of which were included in the random sample. The objective of the study was to show the importance of nursing actions in taking care of patients with cerebrovascular diseases, among other variables of interest. To this end, medical histories were checked to obtain necessary data, which was manually processed. The most affected patients were 56-65 years-old, females prevailed. According to the diagnostic classification of encephalic vascular accidents, the higher frequency lies in ischemic events with the lowest mortality rates. The work of the nurse in close cooperation with the health care team was fundamental at the different rehabilitation types targeted to these patients(AU)

Fisioterapia em acidente vascular hemorragico putaminal direito: estudo de caso / Physical therapy approuch in right putaminal hemorrhagic stroke: case report

O objetivo do estudo foi caracterizar o quadro funcional de um paciente com diagnostico de acidente vascular cerebral hemorragico putaminal e verificar os efeitos da intervencao fisioterapica, utilizando os procedimentos da facilitacao neuromuscular proprioceptiva. Empregou-se o delineamento de sujeito unico, observando...

La rehabilitación precoz en el enfermo con dano vácculo-encefálico en el servicio terapia intermedia / The precocious rehabilitation of patients with brain-vascular damage in the intermediate service

Foi realizado um estudo retrospectivo longitudinal comparativo dos doentes que ingressaram no Serviço de Terapia Intermediária do Hospital Clínico-Cirúrgico Docente Amália Simoni de Camaguey no período compreendido entre junho - dezembro de 1996 e janeiro - junho de 1997, todos com diagnóstico de doenças vasculo-encefálicas. Estes doentes foram divididos em dois grupos comparativos: os que ingressaram no segundo semestre de 1996 näo se submeteram a uma reabilitaçäo postural precoce, enquanto os que ingressaram no primeiro semestre de 1997 foram submetidos a estas técnicas, alcançando-se a reduçäo de complicaçöes atribuíveis a paciente acamado de forma substancial. A incidência de infecçäo pulmonar diminui em 14,5 por cento, assim como a incidência de úlcera de decúbito diminui em 11,9 por cento o que demonstrou o valor da reabilitaçäo postural precoce para este tipo de doente.

Biofeedback eletromiografico na recuperacao do pe caido / Electromyographic biofeedback in recuperation of the foot-drop

Este resumo demonstra a utilizacao do biofeedback eletromiografico como tecnica adjunta na reabilitacao, suas indicacoes, efeitos e outros aspectos importantes a serem considerados nesta abordagem. Sequencialmente, relata um caso de pe caido por doenca cerebrovascular e polineuropatia periferica tratado com biofeedbeck eletromiografico. Os resultados indicaram ganhos significativos que repercutiram funcionalmente nas atividades de vida diaria do paciente

Cardiac rehabilitation in a young patient with severe left ventricular dysfunction and stroke: a case study

This is a case report of a 36 years old Puerto Rican female with dual disabilities: severe left ventricular dysfunction secondary to an extensive myocardial infarction and two stroke episodes, complicated with congestive heart failure, who underwent a comprehensive cardiac rehabilitation program which resulted in improvement. Strategies included a long term exercise program, with low increments, slow progression and close supervision; educational, nutritional and medical interventions, in addition to an orthotic device. This report discusses the health-related fitness and overall benefits that the patient obtained from this multifactorial program.

Depresión en ancianos con y sin apoplejía(s) cerebral(es) o amputación(es) que reciben tratamiento de rehabilitación fisica: un estudio piloto en Puerto Rico / Depression among elderly patients with and without apoplexy or amputations, who receive physical rehabilitation treatment: a pilot study in Puerto Rico

The purpose of this study is to see if these are significant statistical differences in the levels of depression in elderly with and without stroke or amputation that receive physical rehabilitation treatment. The total number of participants were 104 elderly distributed in four (4) groups (52 women and 52 men). All participants were presented with the Beck's Depression Questionnaire to measure the level of depression. Responses were analyzed by means of using the Variations Analysis. Significant differences in depression were evident within the stroke(s) and amputation elderly population. The group of higher depression level is that of elderly with strokes that received physical rehabilitation

Dynamic posturography findings in stroke patients

To evaluate the role of sensory functions on balance deficits in hemiplegic patients using computerized dynamic posturography. Cornell Medical Center at Burke Rehabilitation Hospital, New York. Fifty stroke patients who met the study criteria were selected for this study. Twenty five age-matched were tested and used as a control group. Sensory organization was evaluated in quiet standing with standard Equi-Test procedure consisting of six test conditions. Patients were exposed to three consecutive 20-second trials for each condition. Sensory condition characteristics in stroke patients were significantly different in all six conditions from those of the age-matched normal subjects. Most of the patients studied had great difficultry standing on four out of six conditions. Significant differences were seen in proprioception, visual and vestibular sensory analysis between stroke patients and the age-matched normal group. The result of this study may be used for monitoring the rehabilitation process by providing objective Information to overcome the huge difficulties inherent in the clinical and functional assessment

Inhabilidad

La presencia de enfermedad cerebrovascular en un paciente implica, no sólo la evaluación inmediata encaminada a establecer la etiología y localización de la lesión sino que también debe tratar en lo posible de establecer parámetros que indiquen la posibilidad de que este paciente vuelvas a tener una actividad diaria lo más similar posible a la que llevaba antes del ataque. Existen diferentes escalas que pueden ser usadas a fin de tratar de establecer las posibilidades de recuperación de estos pacientes, como la escala de Barthel, la escala de Rankin y la escala neurológica canadiens. En el presente artículo se revisan algunas de ellas y su utilidad para la evaluación de pacientes con ataque cerebral agudo

Enfoque sobre pesquisa prospectiva no AVC / Focal point about prospect investigation on CVA

Este artigo traz revisäo de trabalhos prospectivos analisando epidemiologia, fatores de risco, complicaçöes e capacidade de recuperaçäo de pacientes com Acidente Vascular Cerebral (AVC). AVC é a maior causa de incapacitaçäo da populaçäo adulta e a terceira maior causa de morte nos E.U.A. Dentre os fatores de risco comprovados, a Hipertensäo Arterial é o mais correlacionado com AVC. O estudo das complicaçöes procura alertar para sua prevençäo e tratamento. Uma equipe de reabilitaçäo especializada reduz o tempo de internaçäo e aumenta o índice de independência dos pacientes. O encaminhamento precoce e o tratamento especialziado säo um importante fator para a melhor recuperaçäo do paciente

Revascularización de las secuelas cerebrovasculares de tipo oclusivo con el epiplón / Revascularization of the cerebrovascular secuela of the oclusive type with the epiplon

Presentamos 25 pacientes con secuelas de enfermedad cerebro vascular de tipo oclusivo que recibieron transplante de epiplón al encéfalo. En el área de lesión se encontraron arterias con flujo sanguíneo residual centrípeta al área de infarto. La mejoría neurológica ocurrió dentro de los primeros días o semanas de la operación. Creemos que estos resultados son debidos a la revascularización y a la influencia de factores neurotróficos proporcionados por el omentum, que actuan sobre el tejido nervioso residual.

Rehabilitación de la marcha del paciente hemipléjico / Gait rehabilitation in hemiplejic patients

Se presentaron 15 pacientes con hemiplejia izquierda para recibir rehabilitación de la marcha. Todos los pacientes recibieron tratamiento kinésico, aplicando las técnicas de Bobath para su rehabilitación y se evaluaron sus etapas usando el Test de valoración de la hemiplejia de Brunstroomn. Los resultados fueron los siguientes: el 53.3 por ciento de los pacientes logró vencer el patrón de extensión y caminar sin circunducción y llegaron a la etapa 5 de la hemiplejia. Un 33,3 por ciento permaneció con algún grado de circunducción, mejorando bastante la marcha con el uso de bastón; estos pacientes lograron llegar a la etapa 4. Un 13,3 por ciento de los pacientes quedó con una marcha de Todd, incluso sin lograr salir de la fase 3 de la hemiplejia