Modified Rood’s approach and ability of independent selfcare in haemorrhagic stroke patients of Assam, India

Background: Stroke is the third leading cause of death and the primary cause of serious, long-term disability which can be regarded as weakness, generalized fatigue, loss of voluntary motor control or limitation in mobility, spasticity, sensory and cognitive dysfunction. In this research, a comparative study on the ability of independent self-care was conducted between two groups of patients during a 3 months follow-up period viz. Group A - patients who were given Home Exercise Programme (HEP) with conventional physiotherapy; and Group B - patients who were given HEP with conventional physiotherapy along with neuro-facilitation via Rood’s approach.Methods: In this study 236 haemorrhagic stroke patients were recruited and randomly divided to two groups.  Both the groups were given a HEP consisting of regular physiotherapy. Additionally, one group out of the two was also taught exercises based on Rood’s approach consisting of facilitation and inhibition with the help of sensory stimulation, purposeful activity based exercises, with additional emphasis on repetition. The output was evaluated in terms of disability using the Barthel Index after 3 months of treatment.Results: After 3 months, it was found that patients who received HEP with both conventional physiotherapy and Rood’s approach had significantly greater improvement in Barthel Index scores compared to patients who received HEP only through conventional physiotherapy.Conclusions: This suggests that HEP consisting of conventional physiotherapy along with Rood’s approach is more effective in improving the ability of independent self-care in case of post intra-cerebral haemorrhagic patients when compared to conventional physiotherapy alone.

Clinical outcome in cases of hypertensive intra-cerebral haemorrhage in relation to size of haemorrhage

Introduction: Stroke is amongst the leading causes of death exceeded only by heart disease and cancer. Those who survive are usually left with permanent disability. Cerebral infarction is responsible for about 80 percent of all strokes, primary intra-cerebral haemorrhage for 10 percent, subarachnoid haemorrhage for 5 percent and 5 percent cases are due to uncertain causes. Predictors of prognosis in primary intraparenchymal haemorrhage have been evaluated in numerous studies. Objective: To observed the effect of different sizes of hematoma and utilizing them, if feasible as a marker of prognostic significance. Material and methods: In this study we observed 60 patients from the time of admission till 30th day in various wards of Department of Medicine RIMS with hypertensive intra-cerebral haemorrhage, during the period of 2008-2009. A simple method of measuring the volume of haematoma (in cc) on the CT scan is by using the following formula: A*B*C A = longest diameter of the haematoma (in cm.), B = Diameter perpendicular to A (in cm.), C = Height (in cm) which is measured by No. of slices showing the haematoma x thickness of each slide. Result: Total 60 patient were taken into study out of which 33(55%) were alive and 27(45%) were dead in 30 days follow up. In our study, 38 were male and 22 were female out of 38 male 22(66.66%) were alive and 16 (59.2%) dead and in 22 female 11(33.33%) were alive and 11 (40.7%) were dead. Outcome with volume of ICH using the χ2 had shown significant correlation (p < 0.005) with GCS at the time stroke onset (P<0.01), IVH/VE (P<0.01), midline shift test (P<0.01), B.P. at the time of admission (P<0.01). Conclusion: In these study patients with hematoma volume exceeds 60 cm3, the mortality was 100%. Mean volume of hematoma in our study was 35.21 cm3.

Capsulo-ganglionic bleed: Murder or pathology.

Intra parenchymal (intra cerebral) haemorrhage is the most common type of spontaneous intracranial haemorrhage. It accounts for 10% of all strokes with a 50% case fatality rate. Hypertension is the one of the most common causes of intra parenchymal haemorrhage followed by other causes like, amyloid angiopathies, cocaine abuse, haematologic disorders and head injury. The present case is a case of death due to intra parenchymal haemorrhage where the relatives of the deceased alleged the death to have been caused as a sequel to an assault by neighbours. Autopsy conducted by experts proved that death was due to pathology and not trauma, thereby assisting in establishment of justice. Usually a single deep seated intracranial haemorrhage in ganglionic region without any injury to scalp, skull and brain is due to natural disease. Hypertension is the most common cause of spontaneous intracranial haemorrhage.