Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Friday, June 23, 2017

Head position may not affect outcomes during acute stroke treatment

So are these previous ones now obsolete? Your doctor better know the answer. I bet none of these ever made it into use at your hospital, which shows complete and total fucking incompetency.

HOBOE (Head-of-Bed Optimization of Elevation) Study: association of higher angle with reduced cerebral blood flow velocity in acute ischemic stroke.         May, 2012

The influence of positioning upon cerebral oxygenation after acute stroke: a pilot study  Nov. 2011

Bedding and pillows improve positioning in stroke patients Feb. 2015 

Lying Flat, Sitting Up Equal for Mild Stroke Recovery Feb. 2017
During treatment for acute stroke, whether a patient was lying down or sitting up did not make a difference in disability outcomes, according to a study in The New England Journal of Medicine.
“What we found is that head position does not matter so much over and above good nursing care,” Craig S. Anderson, MD, PhD, professor of stroke medicine and clinical neuroscience at the University of Sydney George Institute for Global Health, said in a press release. “It does not help with recovery, with mortality or how a patient feels. However, we also found there was no significant harms associated with either lying down flat or sitting up.”
Head position for acute stroke
For the pragmatic, cluster-randomized, crossover HeadPoST trial, researchers analyzed data from 11,093 patients (mean age, 68 years; 40% women) with acute stroke. Patients were assigned a lying-flat (n = 5,295) or sitting-up position (n = 5,798) in the ED and maintained the position for 24 hours. The patient’s head was elevated at least 30° for the sitting-up position. Patients were followed up at 90 days through phone interview.
The primary outcome was the degree of disability at 90 days as assessed by the modified Rankin scale. Secondary outcomes included major disability or death at 90 days and death at 90 days. Researchers also recorded serious adverse events such as pneumonia.
Patients were placed in the assigned head position at an average of 14 hours after onset of stroke (interquartile range [IQR] = 5-35).
Rate of adherence to the assigned head position for 24 hours was lower in patients assigned the lying-flat position (87%; median time, 23.3 hours; IQR = 20-24) vs. those assigned the sitting-up position (95%; median time, 24 hours; IQR = 23-24; P < .001).
Similar outcomes
At 90 days, the degree of disability did not differ between the two groups (unadjusted OR for difference in distribution of scores on modified Rankin scale in those assigned the lying-flat position = 1.01; 95% CI, 0.92-1.1). Prevalence of major disability or death was also similar in patients assigned the sitting-up position (39.7%) and lying-flat position (38.9%; OR = 0.94; 95% CI, 0.85-1.05). Death occurred in 7.4% of patients in the sitting-up group vs. 7.3% of patients in the lying-flat group (OR = 0.98; 95% CI, 0.85-1.14). The rate of pneumonia did not differ between the two groups.
“Most of the patients in our trial had the assigned head position implemented after the time window for reperfusion with thrombolytic or endovascular treatment had passed, and the patients had mostly mild neurologic deficits from a range of causes of stroke,” Anderson and colleagues wrote. “It is possible that earlier initiation of head position after the onset of symptoms when the ischemic penumbra is potentially modifiable may have produced different results.” – by Darlene Dobkowski

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