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Early aggressive mobilization is as effective as treadmill training for ambulation recovery in patients with stroke
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ABSTRACTS
A "Touch" of Carotid Surgery and Nursing Care, takes only twenty-four hours.
C.L. Guaraldi, Lebanon, N H
Back_m'o~k~.~d: This poster presentation is a project report on the changes in nursing practice, involving patients undergoing Carotid Endarterectomy (CEA). It reflects a timeline of surgical care that demonstrates unequivocal and desired patient outcomes. Meth.od: Recent improvement in the surgical approach to CEA at Dartmouth-Hitcheock Medical Center has created a cascade of changes in nursing care for these patients. Descriptive statistics of this history of change, plus nursing care plugs and patient teaching guides will be presented. In addition, graphs/tables of patient satisfaction, cost and complications will be displayed. ~ : Indisputable outcomes are manifested from this procedure. Patients bypass an Intensive Care Unit stay, thus transferring from recovery into a Neuro stepdown unit for twenty-four hours prior to discharge. This reflects improvement in patient education and hence decreased needs for calls post discharge. Nursing care hours, complications and costs have been dramatically reduced, while patient satisfaction has intensified. Conclus2~: In this era of concern about containing heal~care costs and maintaining high quality care, the CEA procedure has been selected as one way of responding to this decades demands. The procedure has been carefully challenged and drastically simplified. Along with these changes, nursing care has since been redefined, which as had a tremendous impact on desired patient outcomes.
Returning to Work After Stroke: Medical and Socioeconomic Influences
Prosthetic Heart Valves, Anticoagulation ~ n d Hematomas
K.Logan, A.Furlan, J.Hanna (Cleveland OH) E.Walz (Columbus, OH)
BACKGROUND: Few guidelines exist regarding anticoagulation in patients with prosthetic heart valves following intracerebral hemorrhage. We sought to understand the clinical course of these patients reviewing the effects of reinstituting and withholding anticoagulants. METHODS: Retrospective chart review identifying patients with both prosthetic heart valves and intracerebral hemorrhage, RESULTS: The review identified 22 patients. Hematomas were small (<30ml) in seventeen and large (>30ml) in five. Nine patients died prior to reinitiating anticoagulants. Five patients had large hematomas. Recurrent symptomatic emboli occurred in two of six patients in whom anticoagulation was terminated. One caused death. Seven medically stable patients reinitiated anticoagulation between day 2 and 19. Hematomas were predominantly lobar and small. Three patients had treated infective endocarditis without angiographic evidence of mycotic aneurysm or embolic arterial occlusion, None of the 7 patients had further clinical stroke. CONCLUSION: Hematomas in patients with prosthetic heart valves are associated with nearly 50% mortality. Those with large hematomas die more frequently, often prior to reinitiating anticoagulation. Anticoagulation appears safe for patients with prosthetic heart valves following intracerebral hematoma when the hemorrhage is smal~and the patient is stable. Patients with infective endocardifis may safely be anticoagulated after excluding mycotic aneurysm or embolic arterial occlusion.
Early Aggressive Mobilization is as Effective as Treadmill Training for Ambulation Recovery iu Patients with Stroke
M. Kosak, M.Reding(White Plains, New York) M. McRae, H. Finestone. R. Tcasell (London. t r u a n t )
Background: The purpose oftNs study was to determine the medical and socioeconomic predictors of return to work for stroke rehabilitation patients. Previous studies have not examined return to work in a stroke rehabilitation population using a socioeconomic index for occupations. Methods: Nine~'-six stroke patients admitted to the rehabilitation unit between January 1986 and December i996 were studied. [nclusion criteria consisted of patients who were younger titan 60 years and were working full time at tee onset of their stroke. Demograpluc and medical data, as well as a socioeconomic index for occupations were obtained and correlated with the patients abili~ to return to work at one year post discharge. Stepwise regression analysis was used to deterrame the predictors of return to work. Results: Of the 96 patients, 27 (28.1%) returned to work with 18 returmng to part time and 9 returning to full tmae employment. Patients who worked full ~ime in non.physically demanding jobs returned to work more than those in physically demanding occupations (40%versos 19.6%. p=0.028). Patients who were serf-employed returned to work more than those who ~ere not selfemployed (50% versus 19.1%, p = 0.002). Patients whose jobs ranked in the 60 to79 range o f ~ e socioeconomic index of occupations returned to work more than patients whose jobs ranked in ~ e 20 to 59 ranges (61.5% versus 22.9%, p = 0.0 [6), Factors such as age, side ofhemiparesis, aphasia, apraxia, neglect and hemianopsia did not correlate with retunung to work. Logistic regression identified the socioeconomic index and self employment status as factors associated with return to work. Conclusion: Slightly more than one-quarter of previously employed stroke rehabilitation patients returned to work at one ?ear post discharge. Significant predictors of return to work were self employment, involvement in a nonph3 sically demanding job and a higher score on the socioeconomic index of occupations.
Background: To compare Partial Body Weight Supported Treadmill Training (PBWSTT) with Traditional Physical Therapy (TPT), using bracing and therapist assisted walking for recovery of ambulation follow/ng stroke. Methods: Following informed consent, patients with initial stroke, previously independent, participating in an inpatient rehabilkation program without orthostatic hypotension, symptomatic dyspnea, or angina pectoris were randomized to receive PBWSTT vs. TPT. PBWSTI' was described by Hesse et al Arch Phys Meal Rehabil 1994;75:1087-93. TPT included aggressive early therapist assisted ambulation using knee ankle combination bracing and bemi-bar if needed. Trealment sessions of up to forty-five minutes per day, five days per week were given as tolerated for the duration of the inpatient stay or until patients could walk over grotmd unassisted. Results: Fifty-six patients with a mean age of 71.2 + I0.1 SD were enrolled at a mean of 39.7 • 20.3 SD days post stroke. After a mean 12.5 _+_4.7 SD treadmill treatment sessions there was no significant difference in over ground ambulation endurance or speed for the two groups, PBWSTT vs. TPT; 262.9 + 46.8 SEM vs. 247.6 + 35.1 SEM, and 72,8 + 13.1 SEM vs. 71.9 +_9.5 SEM respectively. Conclusion: Early aggressive mobilization with bracing as needed is as beneficial as PBWSTT for treatment of ambulation recovery following stroke.
ABSTRACTS
A "Touch" of Carotid Surgery and Nursing Care, takes only twenty-four hours.
C.L. Guaraldi, Lebanon, N H
Back_m'o~k~.~d: This poster presentation is a project report on the changes in nursing practice, involving patients undergoing Carotid Endarterectomy (CEA). It reflects a timeline of surgical care that demonstrates unequivocal and desired patient outcomes. Meth.od: Recent improvement in the surgical approach to CEA at Dartmouth-Hitcheock Medical Center has created a cascade of changes in nursing care for these patients. Descriptive statistics of this history of change, plus nursing care plugs and patient teaching guides will be presented. In addition, graphs/tables of patient satisfaction, cost and complications will be displayed. ~ : Indisputable outcomes are manifested from this procedure. Patients bypass an Intensive Care Unit stay, thus transferring from recovery into a Neuro stepdown unit for twenty-four hours prior to discharge. This reflects improvement in patient education and hence decreased needs for calls post discharge. Nursing care hours, complications and costs have been dramatically reduced, while patient satisfaction has intensified. Conclus2~: In this era of concern about containing heal~care costs and maintaining high quality care, the CEA procedure has been selected as one way of responding to this decades demands. The procedure has been carefully challenged and drastically simplified. Along with these changes, nursing care has since been redefined, which as had a tremendous impact on desired patient outcomes.
Returning to Work After Stroke: Medical and Socioeconomic Influences
Prosthetic Heart Valves, Anticoagulation ~ n d Hematomas
K.Logan, A.Furlan, J.Hanna (Cleveland OH) E.Walz (Columbus, OH)
BACKGROUND: Few guidelines exist regarding anticoagulation in patients with prosthetic heart valves following intracerebral hemorrhage. We sought to understand the clinical course of these patients reviewing the effects of reinstituting and withholding anticoagulants. METHODS: Retrospective chart review identifying patients with both prosthetic heart valves and intracerebral hemorrhage, RESULTS: The review identified 22 patients. Hematomas were small (<30ml) in seventeen and large (>30ml) in five. Nine patients died prior to reinitiating anticoagulants. Five patients had large hematomas. Recurrent symptomatic emboli occurred in two of six patients in whom anticoagulation was terminated. One caused death. Seven medically stable patients reinitiated anticoagulation between day 2 and 19. Hematomas were predominantly lobar and small. Three patients had treated infective endocarditis without angiographic evidence of mycotic aneurysm or embolic arterial occlusion, None of the 7 patients had further clinical stroke. CONCLUSION: Hematomas in patients with prosthetic heart valves are associated with nearly 50% mortality. Those with large hematomas die more frequently, often prior to reinitiating anticoagulation. Anticoagulation appears safe for patients with prosthetic heart valves following intracerebral hematoma when the hemorrhage is smal~and the patient is stable. Patients with infective endocardifis may safely be anticoagulated after excluding mycotic aneurysm or embolic arterial occlusion.
Early Aggressive Mobilization is as Effective as Treadmill Training for Ambulation Recovery iu Patients with Stroke
M. Kosak, M.Reding(White Plains, New York) M. McRae, H. Finestone. R. Tcasell (London. t r u a n t )
Background: The purpose oftNs study was to determine the medical and socioeconomic predictors of return to work for stroke rehabilitation patients. Previous studies have not examined return to work in a stroke rehabilitation population using a socioeconomic index for occupations. Methods: Nine~'-six stroke patients admitted to the rehabilitation unit between January 1986 and December i996 were studied. [nclusion criteria consisted of patients who were younger titan 60 years and were working full time at tee onset of their stroke. Demograpluc and medical data, as well as a socioeconomic index for occupations were obtained and correlated with the patients abili~ to return to work at one year post discharge. Stepwise regression analysis was used to deterrame the predictors of return to work. Results: Of the 96 patients, 27 (28.1%) returned to work with 18 returmng to part time and 9 returning to full tmae employment. Patients who worked full ~ime in non.physically demanding jobs returned to work more than those in physically demanding occupations (40%versos 19.6%. p=0.028). Patients who were serf-employed returned to work more than those who ~ere not selfemployed (50% versus 19.1%, p = 0.002). Patients whose jobs ranked in the 60 to79 range o f ~ e socioeconomic index of occupations returned to work more than patients whose jobs ranked in ~ e 20 to 59 ranges (61.5% versus 22.9%, p = 0.0 [6), Factors such as age, side ofhemiparesis, aphasia, apraxia, neglect and hemianopsia did not correlate with retunung to work. Logistic regression identified the socioeconomic index and self employment status as factors associated with return to work. Conclusion: Slightly more than one-quarter of previously employed stroke rehabilitation patients returned to work at one ?ear post discharge. Significant predictors of return to work were self employment, involvement in a nonph3 sically demanding job and a higher score on the socioeconomic index of occupations.
Background: To compare Partial Body Weight Supported Treadmill Training (PBWSTT) with Traditional Physical Therapy (TPT), using bracing and therapist assisted walking for recovery of ambulation follow/ng stroke. Methods: Following informed consent, patients with initial stroke, previously independent, participating in an inpatient rehabilkation program without orthostatic hypotension, symptomatic dyspnea, or angina pectoris were randomized to receive PBWSTT vs. TPT. PBWSTI' was described by Hesse et al Arch Phys Meal Rehabil 1994;75:1087-93. TPT included aggressive early therapist assisted ambulation using knee ankle combination bracing and bemi-bar if needed. Trealment sessions of up to forty-five minutes per day, five days per week were given as tolerated for the duration of the inpatient stay or until patients could walk over grotmd unassisted. Results: Fifty-six patients with a mean age of 71.2 + I0.1 SD were enrolled at a mean of 39.7 • 20.3 SD days post stroke. After a mean 12.5 _+_4.7 SD treadmill treatment sessions there was no significant difference in over ground ambulation endurance or speed for the two groups, PBWSTT vs. TPT; 262.9 + 46.8 SEM vs. 247.6 + 35.1 SEM, and 72,8 + 13.1 SEM vs. 71.9 +_9.5 SEM respectively. Conclusion: Early aggressive mobilization with bracing as needed is as beneficial as PBWSTT for treatment of ambulation recovery following stroke.