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Barron K, Blaivas M, Blaivas L, Sadler J, Deal I. Bedside Ultrasound to Identify and Predict Severity of Dysphagia Following Ischemic Stroke: Human Versus Artificial Intelligence. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:99-104. [PMID: 37858370 DOI: 10.1016/j.ultrasmedbio.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Dysphagia is a significant ischemic stroke complication that can lead to aspiration. Identification of at-risk patients can be logistically difficult and costly. Researchers investigated whether quantitative ultrasound assessment of hyoid bone movement during induced swallowing would predict failure of videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing (FEES), as determined by a penetration-aspiration scale (PAS) score. Additionally, ability of a machine learning (ML) algorithm to predict PAS success or failure from real-time ultrasound video recordings was assessed. METHODS A prospective, single-blinded, observational pilot study was conducted from June 2019 through March 2020 at a comprehensive stroke center on a convenience sample of patients admitted with diagnosis of acute ischemic stroke undergoing VFS or FEES as part of dysphagia assessment. Researchers performed a midsagittal airway ultrasound during swallowing in patients receiving an objective swallowing assessment by speech language pathologists who were blinded to ultrasound results. Sonologists measured hyoid bone movement, and researchers then constructed an ML algorithm designed for real-time video analysis using a long short-term memory network with an embedded VGG16 convolutional neural network. RESULTS Videos from 69 patients were obtained with their respective PAS results. In total, 90% of available videos were used for algorithm training. After training, the ML algorithm was challenged with the 10% previously unseen videos and then compared with PAS outcomes. Statistical analysis included logistic regression and correlation matrix testing on human ultrasound measurements. Cohen's κ was calculated to compare deep learning algorithm prediction with PAS results. Measurement of hyoid bone elevation, forward displacement, total displacement and mandible length was unable to predict PAS assessment outcome (p values = 0.36, 0.13, 0.11 and 0.32, respectively). The ML algorithm showed substantial agreement with PAS testing results for predicting test outcome (κ = 0.79; 95% confidence interval: 0.52-1.0) CONCLUSION: Manual ultrasound measurement of hyoid movement during swallowing in stroke patients failed to predict PAS swallowing results. However, an ML algorithm showed substantial agreement with PAS results despite a small data set, which could greatly improve access to dysphagia assessment in the future.
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Affiliation(s)
- Keith Barron
- Prisma Health Midlands/Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
| | - Michael Blaivas
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Laura Blaivas
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - John Sadler
- Department of Medicine, VCU Health, Richmond, VA, USA
| | - Isadora Deal
- University of South Carolina School of Medicine, Columbia, SC, USA
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Isokuortti H, Virta JJ, Curtze S, Tiainen M. One-Year Survival of Ischemic Stroke Patients Requiring Mechanical Ventilation. Neurocrit Care 2023; 39:348-356. [PMID: 36759419 PMCID: PMC10541824 DOI: 10.1007/s12028-023-01674-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The outcome of patients with acute ischemic stroke who require mechanical ventilation has been poor. Intubation due to a reversible condition could be associated with better 1-year survival. METHODS All adult patients treated in Helsinki University Hospital in 2016-2020 who were admitted because of an ischemic stroke (either stroke or thrombosis seen on imaging) and needed mechanical ventilation were included in this retrospective cohort study. Data on demographics, medical history, index stroke, and indication for intubation were collected. The primary outcome was 1-year mortality. Secondary outcomes were modified Rankin Scale (mRS) score at 3 months and living arrangements at 1 year. RESULTS The mean age of the cohort (N = 121) was 66 ± 11 (mean ± SD) years, and the mean admission National Institutes of Health Stroke Scale score was 17 ± 10. Forty-four (36%) patients were male. The most common indication for intubation was unconsciousness (51%), followed by respiratory failure or airway compromise (28%). One-year mortality was 55%. Three-month mRS scores were available for 114 (94%) patients, with the following distribution: 0-2, 18%; 3-5, 28%; and 6 (dead), 54%. Of the 1-year survivors, 72% were living at home. In the multivariate analysis, only age over 75 years and intubation due to unconsciousness, respiratory failure, or cardiac arrest remained significantly associated with mortality. CONCLUSIONS The indication for intubation seems to significantly affect outcome. Functional outcome at 3 months is often poor, but a great majority of 1-year survivors are able to live at home.
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Affiliation(s)
- Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Jyri J Virta
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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3
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Boz K, Saka S, Çetinkaya İ. The relationship of respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in post‐stroke hemiplegic patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 28:e1985. [PMID: 36408866 DOI: 10.1002/pri.1985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/30/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiorespiratory system involvement and early fatigue observed in stroke patients complicate the rehabilitation process and affect their ability to perform daily activities and functional independence. AIM It was aimed to determine the relationship between respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in hemiplegic patients after stroke. MATERIALS AND METHODS Twenty-five volunteers who were diagnosed with post-stroke hemiplegia were included in the study. Sociodemographic and physical characteristics were recorded. Pulmonary function test (PFT), respiratory muscle strength, Trunk Impairment Scale (TIS), Timed-Up and Go Test (TUG), and Barthel Index (BI) were applied. RESULTS There was a moderate negative correlation between TUG scores and PFT results (r = 0.413-0.502; p = 0.011-0.04), except for PEF (%) and FEV1/FVC. Also, there were statistically significant correlation between TIS scores and FEV1(%) (r = 0.505; p = 0.012), FVC(%) (r = 0.449; p = 0.024). On the other hand, there was no statistically significant relationship between BI results and any parameter of the PFT (p > 0.05). There was no statistically significant correlation between respiratory muscle strength and TUG, TIS, BI (p > 0.05). CONCLUSION It has been shown that respiratory functions are associated with functional capacity and trunk control. However, it was found that there was no relationship between respiratory muscle strength and functional capacity, trunk control, and functional independence. It is thought that considering these parameters in the assessment of patients will contribute to the creation of individual and effective rehabilitation programs. The respiratory system should be systematically assessed in stroke rehabilitation and considered as part of a holistic approach. CLINICAL TRIAL REGISTRATION NCT05290649 (retrospectively registered) (clinicaltrials.gov).
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Affiliation(s)
- Kübra Boz
- Physiotherapy Rehabilitation Department Institute for Graduate Studies Haliç University Istanbul Turkey
| | - Seda Saka
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Halic University Istanbul Turkey
| | - İrem Çetinkaya
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Halic University Istanbul Turkey
- Physiotherapy Rehabilitation Department Institute for Graduate Studies Marmara University Istanbul Turkey
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Perin C, Mazzucchelli M, Piscitelli D, Braghetto G, Meroni R, Cornaggia CM, Cerri CG. Feasibility of a standardized protocol for respiratory training with intermitted positive pressure breathing ventilator application in dysphonia and dysarthria. Eur J Phys Rehabil Med 2022; 58:218-224. [PMID: 34652084 PMCID: PMC9980488 DOI: 10.23736/s1973-9087.21.06946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Brain damage can affect several functions related to speech production leading to dysphonia and dysarthria. Most rehabilitation treatments focus on articulation training rather than on pneumophonic coordination and respiratory muscle strength. Respiratory training using an intermitted positive pressure breathing (IPPB) ventilator can be used for this last purpose; no agreement on a standard protocol has been reached to date. AIM To evaluate the feasibility and the effectiveness of a standardized incremental protocol of respiratory training using IPPB to treat dysphonia and dysarthria. DESIGN Case series study. SETTING Neuropsychological Rehabilitation Unit in an Italian Neurorehabilitation Division. POPULATION Thirty-two subjects with dysphonia and dysarthria resulting from neurological lesion. METHODS Participants were assessed using clinical evaluation scales (GIRBAS scale of dysphonia, Robertson dysarthria profile), respiratory function test, and arterial blood gas analysis in air. The evaluations were performed at baseline and after 20 sessions of respiratory training with IPPB. The protocol provided a default increment of ventilator parameters. All subjects also underwent a standard speech and language therapy treatment. A satisfaction survey to assess acceptability and the Goal Attainment Scale were applied. RESULTS All participants fulfilled the protocol. No complications or discomfort were reported. Subjects' satisfaction at survey was 97.7%. After respiratory training, all respiratory function parameters increased, but only maximal voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were statistically significant (P<0.05). Clinical evaluation scales significantly improved (P<0.05). Correlation between respiratory function parameters and clinical evaluation scales showed a moderate correlation between MVV, MEP, MIP, and Robertson dysarthria profile (P<0.01). A weak correlation was found between MIP, MVV, and GIRBAS scale (P<0.05). CONCLUSIONS Our protocol showed to be practical and well-tolerated. After respiratory training, MVV, MIP and MEP improved in significantly. Clinical scale scores improved in all participants. CLINICAL REHABILITATION IMPACT Respiratory training using IPPB ventilator can be useful in implementing speech and language treatments in subjects with dysphonia and dysarthria linked to brain injury.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy - .,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Giacomo Braghetto
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy
| | - Roberto Meroni
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy.,Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Cesare M Cornaggia
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Cesare G Cerri
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
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Barnett HM, Davis AP, Khot SP. Stroke and breathing. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:201-222. [PMID: 36031305 DOI: 10.1016/b978-0-323-91532-8.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Stroke remains a leading cause of neurologic disability with wide ranging effects, including a variety of respiratory abnormalities. Stroke may influence the central control of the respiratory drive and breathing pattern, airway protection and maintenance, and the respiratory mechanics of inspiration and expiration. In the acute phase of stroke, the central control of breathing is affected by changes in consciousness, cerebral edema, and direct damage to brainstem respiratory centers, resulting in abnormalities in respiratory pattern and loss of airway protection. Common acute complications related to respiratory dysfunction include dysphagia, aspiration, and pneumonia. Respiratory control centers are located in the brainstem, and brainstem stroke causes specific patterns of respiratory dysfunction. Depending on the exact location and extent of stroke, respiratory failure may occur. While major respiratory abnormalities often improve over time, sleep-disordered breathing remains common in the subacute and chronic phases and worsens outcomes. Respiratory mechanics are impaired in hemiplegic or hemiparetic stroke, contributing to worse cardiopulmonary health in stroke survivors. Interventions to address the respiratory complications are under researched, and further investigation in this area is critical to improving outcomes among stroke survivors.
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Affiliation(s)
- Heather M Barnett
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Arielle P Davis
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Sandeep P Khot
- Department of Neurology, University of Washington, Seattle, WA, United States.
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Nair SP, Gardas SS, Mithaiwala R. Efficacy of chest expansion resistance exercise on respiratory function, trunk control and dynamic balance in patients with chronic stroke: A Comparative study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Motor impairments caused by stroke result in impaired diaphragmatic and respiratory muscle function, changes in thoracic biomechanics on the hemiparetic side ultimately resulting in decreased efficiency of lung ventilation. This study aimed to examine the efficacy of chest expansion resistance exercise (CERE) on respiratory function, trunk control ability, and balance in patients with chronic stoke. Following a purposive sampling, thirty-five patients with chronic stroke were randomly allocated into two groups, i.e., the experimental group receiving CERE with conventional therapy and the control group receiving conventional therapy alone. Both the groups received therapy four times per week for a period of four weeks (total 16 sessions). Following assessments were done before and after treatment in both the groups: chest expansion ( axillary, nipple, xiphisternal levels) using measure tape, respiratory muscle strength using micro-respiratory pressure meter, trunk control using the Trunk Impairment Scale, and balance using mini-Balance Evaluation Systems Test.
Results
Both groups had 17 participants each (n = 34, drop-outs = 1) consisting of 12 males and 5 females having a mean age of 56.5 ± 12.98 years and 59.7 ± 10.2 years, respectively. Intra-group analysis showed a statistically significant increase in mean values of chest expansion, respiratory muscle strength, trunk control ability, and balance in the experimental group whereas the control group showed improvement only in trunk control ability and balance. Inter-group comparison revealed a better improvement in all the outcome variables in experimental group compared to the control group.
Conclusions
Based on these results, this study proved that CERE was more effective in improving respiratory function, trunk control, and balance in patients with chronic stroke.
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Kim NH, Choi YH, Choi YR, Ryu JN, Oh SJ, Cha YJ. Comparison of training effects between underwater treadmill gait training and overground gait training on the walking ability and respiratory function in patients with chronic severe hemiplegic stroke: A randomized, controlled, preliminary trial. Top Stroke Rehabil 2021; 29:83-91. [PMID: 33620021 DOI: 10.1080/10749357.2021.1886638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The need to develop a more effective intervention to obtain a functional recovery of stroke patients who are unable to perform land-based treadmill gait training has been widely reported. Thus, this pilot study aimed to identify a gait training type that could lead to improved gait and respiratory functioning in adult patients with chronic severe hemiplegic stroke.Objectives: To examine whether underwater treadmill or/and overground gait training could be more effective in stroke patients.Methods: In this single-blinded, randomized, controlled, comparative study, 22 patients with severe hemiplegic stroke in a rehabilitation hospital were randomly assigned to the experimental (underwater treadmill gait training) or control group (overground gait training). All participants performed a 60-min neurodevelopmental treatment (five times/week for 12 weeks). Each group performed 30-min underwater or overground gait training (two times/week for 12 weeks). Gait and respiratory function were measured before and after the 12-week training.Results: For the walking variables, step-time difference changes post-training showed significant differences between the groups (-.06 vs. +.04 s, p < .05). Both groups showed significant increases in the maximal voluntary volume (MVV) at post compared to pre training (p < .05). The post-training MVV values were significantly different between the two groups (+23.35 vs. +4.76 L, p < .05).Conclusions: In severe stroke patients, underwater treadmill gait training can be more effective in improving gait and respiratory function than overground gait training and could be an effective clinical intervention tool for the training of such patients.
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Affiliation(s)
- Nan-Hyang Kim
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
| | - Yoon-Hee Choi
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
| | - Yu-Ran Choi
- Department of Physical Therapy, Cheonan Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Jun-Nam Ryu
- Department of Physical Therapy, Yeoju University, Yeoju, Republic of Korea
| | - Se-Jung Oh
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
| | - Yong-Jun Cha
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
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Farr E, Altonji K, Harvey RL. Locked-In Syndrome: Practical Rehabilitation Management. PM R 2021; 13:1418-1428. [PMID: 33465298 DOI: 10.1002/pmrj.12555] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022]
Abstract
Locked-in syndrome is a rare and devastating condition that results in tetraplegia, lower cranial nerve paralysis, and anarthria with preserved cognition, vertical gaze, and upper eyelid movements. Although acute management is much like that of any severe stroke, rehabilitation and recovery of these patients have not been previously described. Challenges relevant to this population include blood pressure management and orthostasis, timing and appropriateness of reinstating oral feeding, ventilatory support, decannulation after tracheostomy, bowel and bladder management, vestibular dysfunction, and eye care. Targeted rehabilitation of head, neck, and trunk stability to improve function, and proper fit in an appropriate wheelchair are essential to assist with mobility. Rehabilitation interventions should include a focus on distal motor control and upright tolerance training followed by balance and mobility exercises. In addition, special considerations must be given to developing early methods of communication through use of augmentative systems to call for help and express needs. These systems along with additional technology provide the basis to promote connectivity to family and friends through the use of social media and the internet. Establishment of communication, mobility, and connectivity is essential in promoting independence, autonomy, and improving quality of life. Overall, with specialized rehabilitative care and access to the proper equipment, long-term outcomes and quality of life in these patients can be favorable.
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Affiliation(s)
- Ellen Farr
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn Altonji
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard L Harvey
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Slim M, Westmacott R, Toutounji S, Singh J, Narang I, Weiss S, Krishnan P, Grbac E, Surmava AM, Andres K, MacGregor D, deVeber G, Moharir M, Dlamini N. Obstructive sleep apnea syndrome and neuropsychological function in pediatric stroke. Eur J Paediatr Neurol 2020; 25:82-89. [PMID: 31787553 DOI: 10.1016/j.ejpn.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/04/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the prevalence of obstructive sleep apnea syndrome (OSAS) in children with arterial ischemic stroke (AIS) and to evaluate its association with neuropsychological outcomes. METHODS We conducted a cross-sectional study of sleep health and neuropsychological outcome in children with AIS. A consecutive cohort of children attending a stroke clinic were assessed using a standardized pediatric sleep questionnaire (PSQ) and standardized measures of pediatric stroke outcome and intellectual, executive and adaptive function. High risk for OSAS was defined as PSQ score ≥0.33. RESULTS Overall, 102 children were included (55% males, median age: 9 years [interquartile-range [IQR]: 6-14]). The prevalence of OSAS in children with AIS was significantly higher compared to published normative prevalence rate (25.5% vs 5%, p < 0.001). Children with OSAS were more likely to have infarcts affecting both the anterior and posterior circulation (37.5% vs 9.5%, p = 0.021). In addition, children with OSAS had significantly higher median Pediatric Stroke Outcome Measure (PSOM) scores (2 [IQR: 0-2] vs 1 [IQR: 1-3.5], p = 0.01) and were more likely to be prescribed concomitant medications affecting sleep architecture (50% vs 22.4%, p = 0.007). OSAS was associated with significantly lower scores on intellectual, memory, cognitive, behavioral, attention, executive and adaptive function scales. The association between PSQ and intellectual ability and working memory remained statistically significant upon controlling for potential confounding factors including stroke related characteristics (neurologic impairment and arterial territory). CONCLUSIONS The prevalence of OSAS in children with AIS compared to healthy controls is significantly elevated and is associated with poor neuropsychological outcomes. We highlight the importance of regular screening for OSAS - a modifiable risk factor - in children with AIS. The specific risk factors for OSAS and the potential benefits of therapeutic interventions in this patient population warrant further investigation.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Sandra Toutounji
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Jaspal Singh
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Shelly Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Pradeep Krishnan
- Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Elena Grbac
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Ann-Marie Surmava
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Kathleen Andres
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Daune MacGregor
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Gabrielle deVeber
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
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Valenza MC, Prados-Román E, Granados-Santiago M, Torres-Sanchez I, Lopez-Lopez L, Cabrera-Martos I. Respiratory repercussions of neurological diseases and how best to manage them. Expert Rev Respir Med 2019; 14:89-102. [PMID: 31679407 DOI: 10.1080/17476348.2020.1689124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The high incidence of respiratory impairments in patients with neurological diseases is recognized, but the design, dosage, and effectiveness of interventions to manage them are seen as an ongoing challenge.Areas covered: This article summarizes the evidence regarding the respiratory impairments in major neurological diseases, and how to best manage them.Expert opinion: On the balance of available evidence, respiratory impairments are part of the clinical profile of neurological diseases including Multiple Sclerosis, Stroke, and Parkinson's Disease, acquiring more importance as the pathologies progress. It is recognized that knowledge gaps remain in some areas of relevance related to respiratory function and further research is required. When considering the therapeutic options, the respiratory training emerges as the approach with most evidence. However, important questions remain unsolved: what kind, how much, and how to best include respiratory interventions is uncertain. At present, respiratory programs also fail to include clinically relevant factors such as ambulation and trunk stability.
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Affiliation(s)
- Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados-Román
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Irene Torres-Sanchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura Lopez-Lopez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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11
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Santos RSD, Dall'alba SCF, Forgiarini SGI, Rossato D, Dias AS, Forgiarini Junior LA. Relationship between pulmonary function, functional independence, and trunk control in patients with stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:387-392. [PMID: 31314840 DOI: 10.1590/0004-282x20190048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. METHODS This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. RESULTS Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). CONCLUSION The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.
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Affiliation(s)
| | | | | | - Daniele Rossato
- Hospital de Clínicas de Porto Alegre, Serviço de Fisioterapia, Porto Alegre, RS, Brasil
| | - Alexandre Simões Dias
- Hospital de Clínicas de Porto Alegre, Serviço de Fisioterapia, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programas de Pós-graduação em Ciências Pneumológicas e Ciências do Movimento Humano, Porto Alegre, RS, Brasil
| | - Luiz Alberto Forgiarini Junior
- Universidade La Salle, Curso de Fisioterapia e Programa de Pós-graduação em Saúde e Desenvolvimento Humano, Canoas RS, Brasil
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Chest wall volume and asynchrony in stroke and Parkinson's disease subjects: A case-control study. PLoS One 2019; 14:e0216641. [PMID: 31095580 PMCID: PMC6522099 DOI: 10.1371/journal.pone.0216641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/26/2019] [Indexed: 11/22/2022] Open
Abstract
Background The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals. Methods Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis. Results In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (VRCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). Conclusion Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.
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Cho J, Lee E, Lee S. Effectiveness of mid-thoracic spine mobilization versus therapeutic exercise in patients with subacute stroke: A randomized clinical trial. Technol Health Care 2019; 27:149-158. [PMID: 30664514 DOI: 10.3233/thc-181467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although commonly used in clinical settings, evidence regarding the beneficial effectiveness of joint mobilization and therapeutic exercise in patients with stroke is still lacking. OBJECTIVE This study aimed to investigate the effects of mid-thoracic spine mobilization and therapeutic exercise on dynamic balance and inspiratory function in patients with subacute stroke. METHODS The participants included 33 patients with subacute stroke. Participants were randomly allocated to 1 of 2 groups: (1) a group that received segmental mobilization (T4-8), and (2) a group that received foam roller exercises (T4-8). Outcome measure included the limits of stability (LOS), inspiratory function, and global rating of change (GRC). RESULTS The improvement in inspiratory function was statistically significant at 4 and 6 weeks after the initiation of the intervention and changes in the LOS were statistically significant at 6 weeks in the mobilization group (p< 0.05). In addition, 15 of 17 (88.2%) participants in the mobilization group, compared to 9 of 16 participants (56.2%) in the exercise group, indicated a GRC score of +4 or higher at the 4-week follow-up. CONCLUSIONS This study demonstrates that patients with subacute stroke who receive mid-thoracic spine mobilization demonstrate effective short-term improvements in LOS and GRC.
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Affiliation(s)
- Juchul Cho
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, Korea
| | - Eunsang Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Slupska L, Halski T, Żytkiewicz M, Ptaszkowski K, Dymarek R, Taradaj J, Paprocka-Borowicz M. Proprioceptive Neuromuscular Facilitation for Accessory Respiratory Muscles Training in Patients After Ischemic Stroke. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1160:81-91. [PMID: 30680643 DOI: 10.1007/5584_2018_325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study focused on how pulmonary function is affected by proprioceptive neuromuscular facilitation (PNF) of accessory respiratory muscles in the chronic post-stroke phase. The study involved patients who had had ischemic stroke 6 months or more before the PNF treatment investigated. The objective was to define the effect of PNF on bioelectrical resting and maximum activity of the accessory muscles. Patients were randomly assigned to PNF treatment and just positioning treatment as a reference for comparison; 30 patients each. Electromyography of accessory muscles was investigated before and after physiotherapeutic treatments. We found that there was a greater reduction in EMG activity in all muscles investigated after PNF compared to positioning treatment alone. A reduction of muscle activity due to PNF concerned both affected and unaffected body side, but it was greater on the affected side. We conclude that a reduction of the accessory respiratory muscle activity due to PNF treatment could be of benefit in chronic stoke patients in that it would help normalize breathing pattern and thereby prevent the development of hypoxia.
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Affiliation(s)
- Lucyna Slupska
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | - Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | | | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Malgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Joo S, Lee Y, Song CH. Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study. J Manipulative Physiol Ther 2018; 41:602-608. [PMID: 30121128 DOI: 10.1016/j.jmpt.2017.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/27/2017] [Accepted: 12/15/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the immediate effects of thoracic spinal manipulation (TSM) on pulmonary function in stroke patients. METHODS Thirty-six volunteers with stroke (20 men, 16 women) were recruited and randomized to a TSM group (n = 18) and a sham group (n = 18). All participants underwent initial pulmonary function test and then rested supine for 10 minutes before the intervention. Pulmonary function test was repeated immediately after the intervention. Forced vital capacity, forced expiratory volume at 1 second, maximum voluntary ventilation, and residual volume were measured by a spirometer in preintervention and post-intervention. RESULTS Significant between-group differences were observed in forced vital capacity and forced expiratory volume at 1 second in the TSM group (P < .05). No significant changes in dependent variables were seen in the sham group. CONCLUSION The pulmonary function values for patients in the TSM group were significantly enhanced with no significant improvement in maximum voluntary ventilation and residual volume. Mechanical factors may be responsible for the improved pulmonary function in the TSM group.
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Affiliation(s)
- Sunghee Joo
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
| | - Yongwoo Lee
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
| | - Chang-Ho Song
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea.
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Abstract
RATIONALE Pathophysiologic mechanisms of the central nervous system, such as stroke, can be associated with intractable hiccups. Intractable hiccups can be associated with potentially fatal consequences, thus requiring safe management in an inpatient rehabilitation facility (IRF) setting with a multidisciplinary team approach to optimize mobility and feeding. PATIENT CONCERNS A 49-year-old male presented to the emergency department with complaints of vomiting and dizziness. DIAGNOSES Head computed tomography revealed moderate acute inferior cerebellar infarct in the territory of the posterior inferior cerebellar artery. He required a percutaneous endoscopic gastrostomy tube for feeding and developed severe intractable hiccups which he rated 7/10 on the hiccup assessment instrument (HAI) on IRF admission. Functional independence measure (FIM) score for transfers was 2 (maximum assist), walking was 1 (total assist), stairs were not attempted on IRF admit due to safety concerns, and feeding (eating) was 1 (total assist). INTERVENTIONS Anterior and posterior diaphragm kinesio taping was applied on day 6 of IRF physical therapy in an attempt to inhibit diaphragm spasm and intractable hiccups given that pharmacologic interventions had not been effective up to that point (Table 3). OUTCOMES The HAI decreased from 7/10 on day 6 of IRF physical therapy to 0/10 on day 8. The taping was reapplied every 3 to 5 days. On IRF day 9, his diet was advanced to a regular consistency with extra moisture and thin liquids. On day 21, hiccup severity remained 0/10 on the HAI, while FIM score for transfers was 4 (minimal assist), walking was 4 (minimal assist), stairs was 4 (minimal assist), and feeding (eating) was 7 (independent). LESSONS Diaphragm kinesio taping is a very effective treatment at reducing hiccup severity in a patient after ischemic stroke, while at the same time reducing burden of care for caregivers per FIM score improvement and improving diet to that of regular consistency with extra moisture and thin liquids.
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Siedlecki P, Sanzo P, Zerpa C, Newhouse I. End-tidal carbon dioxide levels in patients with post-concussion syndrome during neurocognitive and physical tasks compared to a normative control group. Brain Inj 2018; 32:1824-1833. [DOI: 10.1080/02699052.2018.1506945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Patrick Siedlecki
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
- School of Kinesiology, Western University, London, ON, Canada
| | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
| | - Carlos Zerpa
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
| | - Ian Newhouse
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
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Li H, Li G, Liu G, Zhang Y. Liuzijue Qigong vs traditional breathing training for patients with post-stroke dysarthria complicated with abnormal respiratory control: study protocol of a single center randomized controlled trial. Trials 2018; 19:335. [PMID: 29941037 PMCID: PMC6019506 DOI: 10.1186/s13063-018-2734-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke-induced dysarthria is caused by muscle weakness, sacral or muscular dystonia, and incoordination of the articulatory organ formed by organic lesions caused by cerebral vascular obstruction or sudden bursting of blood vessels in the brain, which may cause abnormal breathing patterns, pronunciation, resonance, rhythm, and unclear articulation. The Six Character Formula, or Liuzijue qigong (LQG), is an essential part of Chinese traditional exercises and focuses on breathing-speech synchronization. The purpose of the present study was to compare the effects of LQG with traditional breathing training (combined with basic articulation training in both groups) in patients with post-stroke dysarthria. METHODS/DESIGN The proposed study will be a single-center randomized controlled trial. A total of 100 patients, with a modified Frenchay Dysarthria Assessment (FDA) dysarthria assessment score < 27 and with a FDA speech breathing level ≥ b will be randomly divided into study (LQG, n = 50) and control (conventional breathing training, n = 50) groups. Basic articulation training will be conducted once a day, five times a week for 3 weeks. Data collection will be conducted at baseline, 1 week, and 2 weeks post-treatment initiation and after completion of the treatment (3 weeks). Comprehensive analyses will be conducted to measure and compare any differences in speech breathing dysfunction levels, comprehensive evaluation of dysarthria, maximum phonation time (MPT), maximal counting ability, signal-noise (S/Z) ratio, and loudness scales between the study and control groups. DISCUSSION This trial will provide evidence about the effectiveness of LQG for improvement of speech breathing function and speech ability in patients with post-stroke dysarthria complicated with abnormal breathing. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16010215. Registered 21 December 2016.
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Affiliation(s)
- Hongli Li
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Gaiyan Li
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Gongliang Liu
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.
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Popat C, Ruthirago D, Shehabeldin M, Yang S, Nugent K. Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation: Predictors of Mortality and Successful Extubation. Am J Med Sci 2018; 356:3-9. [PMID: 30049327 DOI: 10.1016/j.amjms.2018.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The majority of patients with acute stroke requiring mechanical ventilation have a poor prognosis and often present difficult decisions regarding extubation. The best criteria for planned extubation in these patients are uncertain. METHODS We reviewed the electronic medical records of patients hospitalized between 1/1/2010 and 12/15/2015 with acute stroke requiring mechanical ventilation to determine the mortality rate, the respiratory parameters recorded before planned extubation, and the reintubation rate. RESULTS This study included 226 patients. The mean age was 60.3 ± 14.3 years. The mean duration of mechanical ventilation was 6.5 ± 5.9 days. The overall in-hospital mortality rate was 56.6%. The best predictors of mortality were age and stroke volume calculated from radiographic images. One hundred and one patients had planned extubations; 9 patients (8.9%) required reintubation. There was no difference in respiratory parameters or Glasgow coma scale scores between those patients with successful extubation and those patients with failed extubation. CONCLUSIONS The in-hospital mortality rate of patients with acute stroke who require mechanical ventilation is quite high. The success rate with planned extubation is relatively good and comparable to rates in previous studies which largely involved patients with respiratory failure. There is no single weaning parameter or Glasgow coma scale score which identifies patients with high success rates.
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Affiliation(s)
- Chirag Popat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Doungporn Ruthirago
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mohamed Shehabeldin
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Shengping Yang
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
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Liugan M, Zhang M, Cakmak YO. Neuroprosthetics for Auricular Muscles: Neural Networks and Clinical Aspects. Front Neurol 2018; 8:752. [PMID: 29387041 PMCID: PMC5775970 DOI: 10.3389/fneur.2017.00752] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 12/28/2017] [Indexed: 11/13/2022] Open
Abstract
The mammalian external ear houses extrinsic and intrinsic auricular muscles. There are three extrinsic auricular muscles-the posterior, superior, and anterior auricular muscles-and six intrinsic muscles-the helicis major and minor, tragicus, anti-tragicus, transverse and oblique muscles. These muscles have been considered vestigial in humans. However, numerous therapeutic and diagnostic wearable devices are designed to monitor and alleviate the symptoms of neurological disorders, brainstem injuries, emotional states, and auditory functions, by making use of the neural networks of the auricular muscles and their locations, which are easily accessible for ergonomic wearable biomedical devices. They can also serve as a bio-controller of human neuroprosthetics. The functionality of these auricular muscles remains elusive and requires further experimentation for a more in-depth understanding of their anatomy. The aims of this review are (1) to provide a detailed account of the neural networks of the extrinsic and intrinsic auricular muscles, (2) to describe diagnostic and therapeutic functions of these muscles as demonstrated in the current literature, and (3) to outline existing and potential neuroprosthetic applications making use of the auricular muscles and their neural networks.
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Affiliation(s)
- Mikee Liugan
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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21
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Jung JH, Kim NS. The correlation between diaphragm thickness, diaphragmatic excursion, and pulmonary function in patients with chronic stroke. J Phys Ther Sci 2017; 29:2176-2179. [PMID: 29643599 PMCID: PMC5890225 DOI: 10.1589/jpts.29.2176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the correlation between the diaphragm thickness
and diaphragm excursion, and pulmonary function in individuals with stroke. [Subjects and
Methods] One hundred fourteen patients who were clinically diagnosed with ischemic or
hemorrhagic stroke were included. The diaphragm thickness and excursion were assessed
using ultrasonography, and the diaphragm thickening ratio was standardized using a
formula. To analyze pulmonary function, we measured the forced vital capacity, forced
expiratory volume in one second, and peak expiratory flow. [Results] A statistically
significant correlation was found between the diaphragm thickness, thickness ratio, and
diaphragm excursion; and the forced vital capacity, forced expiratory volume in one
second, and peak expiratory flow. [Conclusion] This study demonstrated that there is a
relationship between respiratory function and diaphragm thickness and diaphragm excursion,
especially in the paretic side of the diaphragm. Therefore, the role of the respiratory
muscles of the paretic side is important in rehabilitation programs to improve the
respiratory function of stroke patients.
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Affiliation(s)
- Ju-Hyeon Jung
- Department of Physical Therapy, Gimhae College, Republic of Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan: 9 Bugok 3-dong, Geumjung-gu, Busan 609-757, Republic of Korea
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22
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Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord 2017; 18:525. [PMID: 29233164 PMCID: PMC5727966 DOI: 10.1186/s12891-017-1889-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/01/2017] [Indexed: 01/27/2023] Open
Abstract
Background Although upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP. Methods Thirty-two participants with FHP were randomized into the cervical group or the thoracic group. The treatment period was 4 weeks, with follow-up assessment at 4 and 6 weeks after the initial examination. Outcome measures including the craniovertebral angle (CVA), cervical range of motion, numeric pain rating scale (NPRS), pressure pain threshold, neck disability index (NDI), and global rating of change (GRC) were collected. Data were examined with a two-way repeated-measures analysis of variance (group × time). Results Participants in the thoracic group demonstrated significant improvements (p < .05) in CVA, cervical extension, NPRS, and NDI at the 6-week follow-up compared with those in the cervical group. In addition, 11 of 15 (68.8%) participants in the thoracic group compared with 8 of 16 participants (50%) in the cervical group showed a GRC score of +4 or higher at the 4-week follow-up. Conclusions The combination of upper thoracic spine mobilization and mobility exercise demonstrated better overall short-term outcomes in CVA (standing position), cervical extension, NPRS, NDI, and GRC compared with upper cervical spine mobilization and stabilization exercise in individuals with FHP. Trial registration KCT0002307, April 11, 2017 (retrospectively registered).
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Affiliation(s)
- Juchul Cho
- Department of Physical Therapy, Graduate School of Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, South Korea
| | - Eunsang Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, South Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, South Korea.
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Cabral EEA, Resqueti VR, Lima INDF, Gualdi LP, Aliverti A, Fregonezi GAF. Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study. Braz J Phys Ther 2017; 21:416-424. [PMID: 28736210 PMCID: PMC5693280 DOI: 10.1016/j.bjpt.2017.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/22/2016] [Accepted: 01/25/2017] [Indexed: 12/04/2022] Open
Abstract
The PEP device at 10 cmH2O may be a potential home treatment for stroke group. The intensities above 10 cmH2O may lead to lung hyperinflation in stroke group. Stroke group reduced shortening velocity index for expiratory muscles during use PEP.
Background Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. Objective To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. Methods 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20 cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. Results During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32 L, 0.56 vs. 1.54 L, 0.52 vs. 1.8 L, at 10, 15, 20 cmH2O positive expiratory pressure, for stroke and control groups; p < 0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage. Conclusion Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10 cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke.
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Affiliation(s)
- Elis E A Cabral
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Vanessa R Resqueti
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Illia N D F Lima
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Santa Cruz, RN, Brazil
| | - Lucien P Gualdi
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Santa Cruz, RN, Brazil
| | - Andrea Aliverti
- Politecnico Di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Laboratorio di Tecnologie Biomediche, Milan, Italy
| | - Guilherme A F Fregonezi
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil.
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Batlle D, Chin-Theodorou J, Tucker BM. Metabolic Acidosis or Respiratory Alkalosis? Evaluation of a Low Plasma Bicarbonate Using the Urine Anion Gap. Am J Kidney Dis 2017; 70:440-444. [PMID: 28599903 DOI: 10.1053/j.ajkd.2017.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/14/2017] [Indexed: 11/11/2022]
Abstract
Hypobicarbonatemia, or a reduced bicarbonate concentration in plasma, is a finding seen in 3 acid-base disorders: metabolic acidosis, chronic respiratory alkalosis and mixed metabolic acidosis and chronic respiratory alkalosis. Hypobicarbonatemia due to chronic respiratory alkalosis is often misdiagnosed as a metabolic acidosis and mistreated with the administration of alkali therapy. Proper diagnosis of the cause of hypobicarbonatemia requires integration of the laboratory values, arterial blood gas, and clinical history. The information derived from the urinary response to the prevailing acid-base disorder is useful to arrive at the correct diagnosis. We discuss the use of urine anion gap, as a surrogate marker of urine ammonium excretion, in the evaluation of a patient with low plasma bicarbonate concentration to differentiate between metabolic acidosis and chronic respiratory alkalosis. The interpretation and limitations of urine acid-base indexes at bedside (urine pH, urine bicarbonate, and urine anion gap) to evaluate urine acidification are discussed.
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Affiliation(s)
- Daniel Batlle
- Division of Nephrology & Hypertension, Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Jamie Chin-Theodorou
- Division of Nephrology & Hypertension, Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bryan M Tucker
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
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Hawkins VE, Takakura AC, Trinh A, Malheiros-Lima MR, Cleary CM, Wenker IC, Dubreuil T, Rodriguez EM, Nelson MT, Moreira TS, Mulkey DK. Purinergic regulation of vascular tone in the retrotrapezoid nucleus is specialized to support the drive to breathe. eLife 2017; 6. [PMID: 28387198 PMCID: PMC5422071 DOI: 10.7554/elife.25232] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022] Open
Abstract
Cerebral blood flow is highly sensitive to changes in CO2/H+ where an increase in CO2/H+ causes vasodilation and increased blood flow. Tissue CO2/H+ also functions as the main stimulus for breathing by activating chemosensitive neurons that control respiratory output. Considering that CO2/H+-induced vasodilation would accelerate removal of CO2/H+ and potentially counteract the drive to breathe, we hypothesize that chemosensitive brain regions have adapted a means of preventing vascular CO2/H+-reactivity. Here, we show in rat that purinergic signaling, possibly through P2Y2/4 receptors, in the retrotrapezoid nucleus (RTN) maintains arteriole tone during high CO2/H+ and disruption of this mechanism decreases the CO2ventilatory response. Our discovery that CO2/H+-dependent regulation of vascular tone in the RTN is the opposite to the rest of the cerebral vascular tree is novel and fundamentally important for understanding how regulation of vascular tone is tailored to support neural function and behavior, in this case the drive to breathe. DOI:http://dx.doi.org/10.7554/eLife.25232.001 We breathe to help us take oxygen into the body and remove carbon dioxide. Our cells use the oxygen to break down food to release energy, and as they do so they produce carbon dioxide as a waste product. Cells release this carbon dioxide back into the bloodstream so that it can be transported to the lungs to be breathed out. Carbon dioxide also makes the blood more acidic; if the blood becomes too acidic, tissues and organs may not work properly. The brain uses roughly 25% of the oxygen consumed by the body and is particularly sensitive to the levels of gases and acidity in the blood. It has been known for more than a century that increased carbon dioxide causes blood vessels in the brain to widen, allowing the excess carbon dioxide to be carried away quickly. More recent work has shown that increased carbon dioxide also activates neurons called respiratory chemoreceptors. These in turn activate the brain centers that drive breathing, causing us to breathe more rapidly to help us remove surplus carbon dioxide. But this scenario contains a paradox. If high levels of carbon dioxide cause widening of the blood vessels in the brain regions that contain respiratory chemoreceptors, this should, in theory, wash out that important stimulus, reducing the drive to breathe. So how does the brain prevent this unhelpful response? By studying the brains of adult rats, Hawkins et al. show that different rules apply to the brain centers that control breathing compared to other areas of the brain. In one such region, if the blood becomes too acidic, support cells called astrocytes release chemical signals called purines. This counteracts the tendency of high carbon dioxide levels to widen blood vessels in this region, and instead causes these vessels to become narrower. This mechanism ensures that local levels of carbon dioxide in respiratory brain centers remain in tune with the demands of local networks, thereby maintaining the drive to breathe. The next challenges are to identify the molecular mechanisms that control the diameter of blood vessels in brain regions containing respiratory chemoreceptors, and to find out whether drugs that modulate these mechanisms have the potential to treat some respiratory conditions. DOI:http://dx.doi.org/10.7554/eLife.25232.002
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Affiliation(s)
- Virginia E Hawkins
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
| | - Ana C Takakura
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ashley Trinh
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
| | - Milene R Malheiros-Lima
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Colin M Cleary
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
| | - Ian C Wenker
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
| | - Todd Dubreuil
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
| | - Elliot M Rodriguez
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
| | - Mark T Nelson
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, United States.,Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Thiago S Moreira
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Daniel K Mulkey
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, United States
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Andresdottir GT, Hjaltason H, Ragnarsdottir M. Irregular amplitude and frequency of respiratory movements in hemispheric stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2016.1261367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Haukur Hjaltason
- Department of Neurology, Landspitali University Hospital, Reykjavik, Iceland
| | - Maria Ragnarsdottir
- Department of Physiotherapy, Landspitali University Hospital, Reykjavik, Iceland
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Abstract
Neuropulmonology refers to the complex interconnection between the central nervous system and the respiratory system. Neurologic injury includes traumatic brain injury, hemorrhage, stroke, and seizures, and in each there are far-reaching effects that can result in pulmonary dysfunction. Systemic changes can induce impairment of pulmonary function due to changes in the core structure and function of the lung. The conditions and disorders that often occur in these patients include aspiration pneumonia, neurogenic pulmonary edema, and acute respiratory distress syndrome, but also several abnormal respiratory patterns and sleep-disordered breathing. Lung infections, pulmonary edema - neurogenic or cardiogenic - and pulmonary embolus all are a serious barrier to recovery and can have significant effects on outcomes such as hospital course, prognosis, and mortality. This review presents the spectrum of pulmonary abnormalities seen in neurocritical care.
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Lee JH, Kim MK, Yoo BG. Sleep Related Hypoventilation Disorder in the Absence of Medullary Lesion in a Patient with
Diffuse Axonal Injury. JOURNAL OF NEUROCRITICAL CARE 2016. [DOI: 10.18700/jnc.160085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Morrone E, Pistarini C, Cazzulani B, Rossi M, Prpa A, Fanfulla F. Sleep apnea after posterior cerebral artery aneurysm rupture and elevated intracranial pressure: a Chiari-like syndrome. Sleep Med 2016; 21:42-4. [DOI: 10.1016/j.sleep.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/11/2015] [Accepted: 01/08/2016] [Indexed: 11/24/2022]
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Hirano M, Katoh M, Kawaguchi S, Uemura T. Intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer for geriatric and stroke patients. J Phys Ther Sci 2016; 28:51-5. [PMID: 26957727 PMCID: PMC4755973 DOI: 10.1589/jpts.28.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to verify the appropriate number of measurements and the
intrarater reliabilities of shoulder joint horizontal adductor muscle strength
measurements using a handheld dynamometer (HHD) for geriatric and stroke patients.
[Subjects and Methods] The subjects were 40 inpatients, who were divided into two groups:
20 stroke patients in the stroke group (SG), and 20 geriatric patients in the no-stroke
group (N-SG). Measurements were performed three times using an HHD with a belt. The
reliability was verified using Bland-Altman analysis and the intraclass correlation
coefficient (ICC). [Results] ICC (1, 1) was >0.9. A systematic bias was not observed
between the first and second measurement values except for the right side in N-SG. A
systematic bias between the maximum value obtained during the first and second
measurements and third measurement value was observed on the left side in N-SG, and on the
non-paralyzed side in SG: the third measurement values were small in both cases.
[Conclusion] Intrarater reliabilities were high for shoulder horizontal adductor strength
measurements using an HHD with a belt for geriatric and stroke patients. Taking the
systematic bias into consideration, these findings suggest that the required number of
measurements is two.
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Affiliation(s)
- Masahiro Hirano
- Department of Physical Therapy, Faculty of Health Sciences, Ryotokuji University, Japan
| | - Munenori Katoh
- Department of Physical Therapy, Faculty of Health Sciences, Ryotokuji University, Japan
| | - Saori Kawaguchi
- Department of Rehabilitation, Higashi Funabashi Hospital, Japan
| | - Tomomi Uemura
- Department of Rehabilitation, Higashi Funabashi Hospital, Japan
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Dynamic changes in sleep-related breathing abnormalities in bilateral paramedian mesencephalon and thalamus stroke: a follow-up case study. Sleep Breath 2015; 20:237-42. [PMID: 26070534 DOI: 10.1007/s11325-015-1212-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/28/2014] [Accepted: 05/29/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bilateral paramedian thalamic stroke is characterized by hypersomnia, vertical gaze palsy, amnestic alteration, and apathic state. Combined lesion of the paramedian thalamus and mesencephalon bilaterally is extremely rare. Little is known about the breathing disturbances of the particular region due to the lesion. The following describes the specific case of a woman, age 62, with bilateral paramedian thalamic and mesencephalic stroke. Initially, the patient's complaints exhibited altered vigilance and vertical gaze palsy. Notably, following the acute phase, fluctuating hypersomnia was detected. The MRI (brain) revealed an ischemic lesion in the medial part of the mesencephalon and paramedian thalamus, bilaterally. AIMS The aim of the present study is to elucidate the involvement and characteristics of sleep-related breathing abnormalities in the clinical manifestation of the combined paramedian thalamic and mesencephalic stroke. METHODS Polysomnographic recordings were accomplished seven times with 1-week interval between the consecutive recordings, toward investigating the early changes of sleep and sleep-related breathing abnormalities. RESULTS Sleep structure examination featured a decrease in N3 and REM ratio and an increase in N1 and N2 ratio with minimal improvement during the recovery period. In contrast, significant changes were found in the breathing pattern: the initial central apnea dominance was followed by obstructive apneas with a gradual decrease of the total pathological respiratory events. CONCLUSION In addition to the structural abnormality of the sleep regulating network, sleep-disordered breathing is another possible cause of hypersomnia in patients afflicted with the present localization of the lesion.
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Grigorova-Petrova K, Lubenova D, Dimitrova A, Baldaranov D, Lozeva J. Feasibility of Early Physical Therapy Program In-Hospital Patients with Acute Ischemic Stroke. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND PURPOSE: Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute stroke unit care. The purpose of the study is to determine the feasibility of the application of feedback breathing device for respiratory training during the acute period in patients with ischemic cerebral stroke and appropriate program of physical therapy.MATERIAL AND METHODS: Seven patients in acute period – not later than 48 hours after the accident with light to moderate stroke severity under the NIHSS scale. The applied study methods are the following: functional respiratory evaluation, inspiratory capacity with incentive spirometer device, assessing diaphragmatic movement by ultrasonography.RESULTS: Better results in Forced Vital Capacity, Peak Expiratory Flow, inspiratory capacity and ultrasonography have been observed.CONCLUSION: An early targeted impact on respiratory disorders in patients with ischemic cerebral stroke is applicable. To determine the clinical significance larger studies are needed.
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Jung KJ, Park JY, Hwang DW, Kim JH, Kim JH. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med 2014; 38:29-37. [PMID: 24639923 PMCID: PMC3953360 DOI: 10.5535/arm.2014.38.1.29] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/24/2013] [Indexed: 01/30/2023] Open
Abstract
Objective To evaluate diaphragmatic motion via M-mode ultrasonography and to correlate it with pulmonary function in stroke patients. Methods This was a preliminary study comprised of ten stroke patients and sixteen healthy volunteers. The M-mode ultrasonographic probe was positioned in the subcostal anterior region of the abdomen for transverse scanning of the diaphragm during quiet breathing, voluntary sniffing, and deep breathing. We analyzed diaphragmatic motion and the relationship between diaphragmatic motion and pulmonary function. Results All stroke patients had restrictive pulmonary dysfunction. Compared to that exhibited by control subjects, stroke patients exhibited a significant unilateral reduction in motion on the hemiplegic side, primarily during volitional breathing. Diaphragmatic excursion in right-hemiplegic patients was reduced on both sides compared to that in control subjects. However, diaphragmatic excursion was reduced only on the left side and increased on the right side in left-hemiplegic patients compared to that in control subjects. Left diaphragmatic motion during deep breathing correlated positively with forced vital capacity (rho=0.86, p=0.007) and forced expiratory volume in 1 second (rho=0.79, p=0.021). Conclusion Reductions in diaphragmatic motion and pulmonary function can occur in stroke patients. Thus, this should be assessed prior to the initiation of rehabilitation therapy, and M-mode ultrasonography can be used for this purpose. It is a non-invasive method providing quantitative information that is correlated with pulmonary function.
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Affiliation(s)
- Kang-Jae Jung
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Ji-Young Park
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Do-Won Hwang
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jeong-Hawn Kim
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae-Hyung Kim
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Hiccups in the neuro ICU: a problem of respiratory support. J Neurosurg Anesthesiol 2013; 25:209-10. [PMID: 23434747 DOI: 10.1097/ana.0b013e318285b1f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee J, Seo K, Kim K. Measurement of Changes in Chest Mobility and Pulmonary Functions in Relation to Stroke Patients’ Positions. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- JeonHyeong Lee
- Department of Physical Therapy, Yeungnam University Medical Center
| | - KyoChul Seo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
| | - Kyung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
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Effects of hemiplegy on pulmonary function and diaphragmatic dome displacement. Respir Physiol Neurobiol 2011; 178:196-201. [DOI: 10.1016/j.resp.2011.05.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 05/29/2011] [Accepted: 05/31/2011] [Indexed: 11/22/2022]
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Britto RR, Rezende NR, Marinho KC, Torres JL, Parreira VF, Teixeira-Salmela LF. Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil 2011; 92:184-90. [PMID: 21272713 DOI: 10.1016/j.apmr.2010.09.029] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 09/20/2010] [Accepted: 09/25/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effectiveness of inspiratory muscular training (IMT) on measures of strength, resistance, functional performance, and quality of life (QOL) for chronic stroke survivors. DESIGN Double-blinded randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Subjects (N=21) with stroke (11 men, 10 women; maximal inspiratory pressure [MIP] <90% of predicted values) were randomly assigned to the experimental (n=11) and control groups (n=10); 18 participants completed all testing and training. INTERVENTIONS Interventions were based on home-based training, with resistance adjusted biweekly to 30% of MIP for the experimental group. The control group underwent the same protocol without the threshold resistance valve. Both groups received home training 30 minutes a day 5 times a week for 8 weeks. MAIN OUTCOME MEASURES MIP, inspiratory muscular endurance (IME), functional performance, and QOL. RESULTS There were significant between-group differences for the MIP and IME measures. Significant changes were observed for only the experimental group for MIP (67.8±14.6 at baseline to 102.2±26.0cmH(2)O at posttraining) and IME (31.8±19.3 to 49.2±21.1cmH(2)O). No statistically significant differences were observed for measures of functional performance and QOL. CONCLUSIONS Significant short-term effects of the IMT program for inspiratory strength and endurance were observed in chronic stroke survivors. These findings gave some indications that IMT may benefit people with stroke, and it is feasible to be included in rehabilitation interventions with this population.
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Affiliation(s)
- Raquel R Britto
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Balami JS, Chen RL, Grunwald IQ, Buchan AM. Neurological complications of acute ischaemic stroke. Lancet Neurol 2011; 10:357-71. [PMID: 21247806 DOI: 10.1016/s1474-4422(10)70313-6] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Complications after ischaemic stroke, including both neurological and medical complications, are a major cause of morbidity and mortality. Neurological complications, such as brain oedema or haemorrhagic transformation, occur earlier than do medical complications and can affect outcomes with potential serious short-term and long-term consequences. Some of these complications could be prevented or, when this is not possible, early detection and proper management could be effective in reducing the adverse effects. However, there is little evidence-based data to guide the management of these neurological complications. There is a clear need for improved surveillance and specific interventions for the prevention, early diagnosis, and proper management of neurological complications during the acute phase of stroke to reduce stroke morbidity and mortality.
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Affiliation(s)
- Joyce S Balami
- Acute Stroke Programme, Department of Medicine and Clinical Geratology, Oxford Radcliffe NHS Trust, Oxford, UK
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Jandt SR, Caballero RMDS, Junior LAF, Dias AS. Correlation between trunk control, respiratory muscle strength and spirometry in patients with stroke: an observational study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:218-24. [PMID: 21157882 DOI: 10.1002/pri.495] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 09/15/2010] [Accepted: 09/25/2010] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Stroke is the main cause of chronic disability in adults, and the effect of a stroke on the respiratory system depends on the structures affected by the lesion. OBJECTIVES To evaluate the correlation between trunk control, respiratory muscle strength and pulmonary function in individuals who suffered stroke. METHODS Observational, quantitative and descriptive study. Twenty-three patients who had a clinical diagnosis of ischaemic or haemorrhagic stroke. The trunk control was assessed through the Trunk Impairment Scale (TIS), and the respiratory muscle strength was assessed by manovacuometry by measuring the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). For pulmonary function analysis, we measured forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF) and the Tiffeneau index (TIFF) through spirometry. RESULTS A consistent and statistically significant correlation was found between TIS and PEF (r = 0.489, p = 0.024) and between TIS and EPmax (r = 0.517, p = 0.016). No relation was found between the other variables of pulmonary function and TIS. CONCLUSION This study demonstrated that there is a relation between trunk control and respiratory muscular strength, especially concerning the expiratory muscles. However, there seems to be no relation between trunk control and pulmonary function in this series of individuals who suffered stroke.
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The potential role of carbon dioxide in the neuroimmunoendocrine changes following cerebral ischemia. Life Sci 2008; 83:381-7. [DOI: 10.1016/j.lfs.2008.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 06/29/2008] [Accepted: 07/17/2008] [Indexed: 12/18/2022]
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Farney RJ, Walker JM, Boyle KM, Cloward TV, Shilling KC. Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain. J Clin Sleep Med 2008; 4:311-9. [PMID: 18763421 PMCID: PMC2542501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Adaptive servoventilation (ASV) can be effective therapy for specific types of central apnea such as Cheyne-Stokes respiration (CSR). Patients treated chronically with opioids develop central apneas and ataxic breathing patterns (Biot's respiration), but therapy with CPAP is usually unsuccessful. There are no published studies of ASV in patients with sleep apnea complicated by chronic opioid therapy. METHODS Retrospective analysis of 22 consecutive patients referred for evaluation and treatment of sleep apnea who had been using opioid medications for at least 6 months, had an apnea-hypopnea index (AHI) > or = 20/h, and had been tested with ASV. Baseline polysomnography was compared with CPAP and ASV. OUTCOME VARIABLES AHI, central apnea index (CAI), obstructive apnea index (OAI), hypopnea index (HI), desaturation index, mean SpO2, lowest SpO2, time SpO2 < 90%, and degree of Biot's respiration. RESULTS Mean (SD) AHI measured 66.6/h (37.3) at baseline, 70.1/h (32.6) on CPAP, and 54.2/h (33.0) on ASV. With ASV, the mean OAI was significantly decreased to 2.4/h (p < 0.0001), and the mean HI increased significantly to 35.7/h (p < 0.0001). The decrease of CAI from 26.4/h to 15.6/h was not significant (p = 0.127). Biot's breathing persisted, and oxygenation parameters were unimproved with ASV. CONCLUSIONS Due to residual respiratory events and hypoxemia, ASV was considered insufficient therapy in these patients. Persistence of obstructive events could be due to suboptimal pressure settings (end expiratory and/or maximal inspiratory). Residual central events could be related to fundamental differences in the pathophysiology of CSR compared to opioid induced breathing disturbances.
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Affiliation(s)
- Robert J Farney
- Intermountain Sleep Disorders Center, LDS Hospital, 325 8th Ave & C Street, Salt Lake City, UT 84143, USA.
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Shoja MM, Tubbs RS, Jamshidi M, Shokouhi G, Ansarin K. Lateralization of the respiratory control following unilateral cerebral ischemia-reperfusion injury. Respir Physiol Neurobiol 2008; 160:204-7. [DOI: 10.1016/j.resp.2007.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Revised: 09/23/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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Rowat AM, Dennis MS, Wardlaw JM. Central periodic breathing observed on hospital admission is associated with an adverse prognosis in conscious acute stroke patients. Cerebrovasc Dis 2006; 21:340-7. [PMID: 16490944 DOI: 10.1159/000091540] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 11/12/2005] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Central periodic breathing (CPB) is common following acute stroke, but its prognostic significance is uncertain. We determined the frequency of CPB on admission with stroke and assessed whether it was related to outcome. METHODS We measured arterial oxygen saturation (SaO2), chest wall movements and nasal airflow continually with portable monitoring equipment in a large cohort of acute stroke patients, from arrival at hospital through acute assessment to reaching the ward. Baseline neurological examination and 3-month outcome (modified Rankin scale, MRS) were assessed blind to recordings. CPB was defined as cyclical rises and falls in ventilation, with intermittent reduced respiratory airflow or total apnoea. RESULTS CPB was common in acute stroke (33/138, 24%), but was poorly recognised by clinical staff. Patients with CPB were more likely to have a total anterior circulation syndrome and higher National Institutes of Health Stroke Scale scores than those without (both p<0.01). Patients with CPB had significantly higher median SaO2 than those without (p<0.01), unrelated to whether they received oxygen or not. At 3-month follow-up: 91% of patients with CPB were dead or dependent (MRS>or=3) compared with 53% of those without (OR 8.8; 95% CI 2.5-30.5); the association remained statistically significant after adjusting for covariates (OR 5.9; 95% CI 1.4-25.4). CONCLUSION CPB is independently associated with poor outcome after stroke, but is not by association with hypoxia. Further work is required to identify causes, effects and interventions that might improve effects of CPB.
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Affiliation(s)
- Anne M Rowat
- Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.
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Affiliation(s)
- Robin S Howard
- The Lane-Fox Respiratory Unit and Department of Neurology, Guy's & St Thomas' Hospital, London, UK.
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