Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 29,112 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 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:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Showing posts with label 69 percent sedentary time. Show all posts
Showing posts with label 69 percent sedentary time. Show all posts
More protocols for your doctor to have to
make sure you are treated correctly. No protocols, you have an
incompetent doctor and hospital. I take no prisoners in trying to hold
stroke medical 'professionals' accountable. Your doctors and therapists are required to have NO sedentary time for you in the hospital, you should have rehab every hour you're awake and lucid dreaming rehab when sleeping.
Fully 11% of older patients have pressure injuries when admitted to
skilled nursing facilities for post-acute stroke rehabilitation(so it occurred while in the hospital!), a new
study finds. Certain factors make such a diagnosis more likely,
investigators say.
Providing care for pressure injuries early in stroke rehab may help
improve these patients’ overall clinical outcomes and reduce associated
costs, according to Shilpa Krishnan, PT, PhD, of Emory University School
of Medicine in Atlanta, and colleagues.
The investigators examined data for more than 65,000 older adults
aged 65 years and older who were admitted to SNFs following strokes.
They aimed to determine the prevalence of pressure wounds upon admission
and investigate factors that contributed to deep and superficial
injury.
The 11% of patients arriving for care with pressure wounds tracks
closely with the numbers found across the long-term care facility
spectrum, the researchers reported. Older adults, non-Hispanic Blacks
and patients with multiple comorbidities were more likely to have these
injuries.
When compared to patients with superficial wounds, patients with deep
pressure wounds were more likely to be younger than 75 years,
non-Hispanic Black and have a lower socioeconomic status. Many had also
experienced an intensive care unit stay, had higher functional
impairments, skin integrity issues, system failure and infections.
Patients receive less PT, OT
For reasons that may be associated with higher comorbidities and
pain, individuals with pressure wounds received less individual physical
therapy and occupational therapy treatment than those with no pressure
wounds. The researchers recommend that comorbid chronic disease be
addressed during post-acute care. A reduction in stroke rehabilitation
therapy secondary to a pressure wound may impede stroke recovery, they
noted.
Study data came from the 2013 and 2014 Medicare’s Master Beneficiary
Summary, Medicare Provider Analysis and Review, and Minimum Data Set
3.0. Pressure injury data came from SNF admission assessments.
Full findings, including more analysis of SNF skin care and restorative treatments for these patients, were published in JAMDA.
The direct cause of all this sedentary time is the failure to have 100% recovery protocols. Quit blaming the survivor. We've known about 69% sedentary time for over two years, so solve that problem, don't just lazily tell us it exists. I'd have you all fired.
We
examined differences in the volume and pattern of physical activity
(PA) and sedentary behavior between adults with and without stroke.
Methods:
We
studied cohort members with an adjudicated or self-reported stroke
(n=401) and age-, sex-, race-, region of residence-, and body mass
index-matched participants without a history of stroke (n=1203) from the
REGARDS study (Reasons for Geographic and Racial Differences in
Stroke). Sedentary behavior (total volume and bouts), light-intensity
PA, and moderate-to-vigorous-intensity PA were objectively measured for 7
days via hip-worn accelerometer.
Results:
Sedentary
time (790.5±80.4 versus 752.4±81.9 min/d) and mean sedentary bout
duration (15.7±12.6 versus 11.9±8.1 min/d) were higher and PA
(light-intensity PA: 160.5±74.6 versus 192.9±73.5 min/d and
moderate-to-vigorous-intensity PA: 9.0±11.9 versus 14.7±17.0 min/d)
lower for stroke survivors compared with controls (P<0.001).
Stroke survivors also accrued fewer activity breaks (65.5±21.9 versus
73.31±18.9 breaks/d) that were shorter (2.4±0.7 versus 2.7±0.8 minutes)
and lower in intensity (188.4±60.8 versus 217.9±72.2 counts per minute)
than controls (P<0.001).
Conclusions:
Stroke
survivors accrued a lower volume of PA, higher volume of sedentary
time, and exhibited accrual patterns of more prolonged sedentary bouts
and shorter, lower intensity activity breaks compared with persons without stroke.
Despite acute care improvements, the risk of subsequent vascular events remains substantial among stroke survivors.1 While moderate-to-vigorous-intensity physical activity (MVPA) reduces subsequent cardiovascular event risk,2 few stroke survivors meet MVPA recommendations (≈20%).3
Research has emerged documenting the health benefits of light-intensity
physical activity (LIPA) and sedentary behavior reduction4;
accelerating a paradigm shift towards targeting the full movement
continuum (versus MVPA alone) for behavioral interventions in general
and clinical populations. Given the poor poststroke adherence to MVPA
guidelines, sedentary behavior and LIPA may be more achievable
behavioral intervention targets. However, it is largely unclear if the
physical activity (PA) profiles of stroke survivors are different from
their nonstroke peers and which components of the PA continuum should be
targeted to improve poststroke prognosis. Using data from a national
cohort study, we examine differences in the volume and pattern of
objectively measured PA and sedentary behavior among stroke survivors
relative to their peers.
Methods
We studied participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a national population-based study designed to examine racial/regional disparities in stroke.5
Briefly, demographic and risk factor data were collected upon
enrollment (2003–2007). Thereafter, follow-up was conducted biannually
by telephone to ascertain potential strokes and vital status.
Objective
measures of PA were collected from 2009 to 2013. Participants who
self-reported an ability to ambulate were invited to wear a hip-based
Actical accelerometer during waking hours for 7 days.6
Present analyses included participants with compliant accelerometer
wear who either had a self-reported history of stroke or an adjudicated
first-time stroke that preceded accelerometer data collection.7 Accelerometer protocol, data processing, and stroke adjudication details are provided in the Data Supplement.
For
group comparisons, participants with valid accelerometer wear and
without an adjudicated/self-reported stroke were included as a control
(Figure in the Data Supplement).
Three age-, sex, race-, region of residence-, and body mass
index-matched participants were selected for each stroke case using a
propensity score model (Data Supplement).
Methods were approved by Institutional Review Boards and all
participants provided informed consent. STROBE reporting guidelines were
followed (Data Supplement). The data that support the findings of this study are available from the corresponding author upon reasonable request.
Statistical Analysis
Two-sample t
tests and Wilcoxon signed-rank tests were used to compare stroke
survivors and controls. As a sensitivity analysis, analyses were
repeated restricting stroke cases to participants who self-reported a
history of stroke (n=281) and, separately, those with an adjudicated
stroke (n=120). We also conducted a sensitivity analysis additionally
matching participants for select comorbidities and marital status.
Results
There
were 1604 participants successfully matched and included in the
analysis, of which 401 had a stroke (self-report: n=281 and adjudicated:
n=120) and 1203 did not (Table 1; Figure in the Data Supplement).
Time (mean±SD) since the first self-reported stroke and adjudicated
stroke was 14.5 (10.5) years and 2.9 (2.0) years, respectively. Compared
with controls, stroke survivors had significantly greater sedentary
time and accumulated a greater volume of their sedentary time in
prolonged bouts of ≥30, ≥60, and ≥90 minutes (Table 2).
Conversely, stroke survivors had significantly lower LIPA and MVPA
compared with their nonstroke peers. With respect to activity breaks,
stroke survivors accrued fewer breaks and their activity breaks were, on
average, shorter in duration and at a lower intensity relative to their
nonstroke peers. In sensitivity analyses, similar results were observed
when defining stroke survivors by self-reported stroke and adjudicated
stroke, separately (Tables I and II in the Data Supplement) and when additionally matching participants for comorbidities and marital status (Table III in the Data Supplement).
Values presented as mean (SD) or %. BMI indicates body mass index.
* P value<0.001.
Table 2. PA and Sedentary Behavior Characteristicsowspan="1"> Mi
Values
presented as mean (SD). LIPA indicates light-intensity PA; MVPA,
moderate-to-vigorous-intensity PA; and PA, physical activity.
Discussion
In
this US national cohort study, stroke survivors accrued a higher volume
of sedentary time and a lower volume of LIPA and MVPA relative to their
nonstroke peers. The pattern in which PA and sedentary time was accrued
also differed between participants with and without stroke. Stroke
survivors accumulated fewer activity breaks, and, on average, these
activity breaks were shorter in duration and lower in intensity relative
to nonstroke participants. These findings emphasize LIPA and sedentary
behavior (total volume and pattern), in addition to MVPA, as potential
targets for behavioral interventions among stroke survivors.
English et al8
previously found that stroke survivors (n=40) spent significantly more
time sitting (10.9±2.0 h/d versus 8.3±2.0 h/d) and less time physically
active (LIPA: 3.4±1.6 versus 6.0±1.4 h/d; MVPA: 4.9±5.8 versus 38.0±31.0
min/d) compared with sex- and age-matched controls.8 Similarly, in a nationally representative sample (n=262), Butler and Evenson9
demonstrated that stroke survivors spent significantly less time in
accelerometer-measured LIPA (212.0±6.0 versus 237.2±3.6 min/d) and more
time in sedentary behavior (10.0±0.2 versus 9.2±0.1 h/d) compared with
age-, race- and ethnicity-, and sex-matched controls.9
These studies provided initial evidence that stroke survivors, beyond
having low MVPA, also exhibit a poorer overall PA profile relative to
their peers. The present study confirms and extends upon previous work
to show in a national, diverse population-based sample that stroke
survivors are more sedentary and less active than their peers, even when
controlling for key comorbidities. We observed differences in
established determinants of PA (quality of life and depression) between
participants with and without stroke, however, future research is needed
to elucidate contributing factors.
Evidence indicates that the
manner in which sedentary time is accumulated (eg, sitting for hours at a
time) influences disease risk; suggestive that regularly breaking up
sedentary time may have clinical relevance. English et al8
reported stroke survivors accumulated a greater percentage of their
sedentary time in bouts ≥30 minutes compared with controls. Our findings
confirm that stroke survivors accumulate more sedentary time not only
from bouts ≥30 minutes but also from bouts ≥60 and ≥90 minutes relative
to their nonstroke peers. Furthermore, our findings impart new knowledge
that stroke survivors engage in fewer activity breaks than those
without stroke and that these breaks, on average, are shorter in
duration and intensity. Thus, future behavioral interventions may need
to emphasize not only the frequency but also the quality of activity
breaks.
Limitations of the present study include self-reported
stroke assessment for some participants, inability of the Actical to
distinguish between sitting/standing postures, lack of disability status
information, use of day-level accelerometer measures (temporal patterns
were not characterized), and limited generalizability to other races
and ethnicities beyond Black and White participants. These limitations
notwithstanding, while increasing MVPA should remain a secondary
prevention target for stroke survivors, our findings highlight a
potential need to promote sitting less, moving more (of any intensity),
and moving frequently in this high-risk population.
Sources of Funding
This
project is supported by U01-NS041588 co-funded by the National
Institute of Neurological Disorders and Stroke and National Institute on
Aging and R01-NS061846. Additional funding was provided by an
unrestricted grant from the Coca-Cola Company.
Supplemental Materials
Online Figure
Online Tables I–IV
Disclosures
B. Hutto, Dr Howard, and Dr Colabianchi received grants from the
National Institutes of Health during the conduct of the study. Dr
Colabianchi received a speaker fee from the University of
Alabama-Birmingham. The other authors report no conflicts.
Topics in Stroke Rehabilitation , Volume 26(5) , Pgs. 327-334.
NARIC Accession Number: J81268. What's this? ISSN: 1074-9357. Author(s):Hendrickx, Wendy; Riveros, Carlos; Askim, Torunn; Bussmann, Johannes B. J.; Callisaya, Michele L.; Chastin, Sebastien F. M.; Dean, Catherine M.; Ezeugwu, Victor E.; Jones, Taryn M.; Kuys, Suzanne S.; Mahendran, Niruthikha; Manns, Trish J.; Mead, Gillian; Moore, Sarah A.; Paul, Lorna; Pisters, Martijn F.; Saunders, David H.; Simpson, Dawn B.; Tieges, Zoe; Verschuren, Olaf; English, Coralie. Publication Year: 2019. Number of Pages: 8. Abstract:
Study identified factors associated with high sedentary time in
community-dwelling people with stroke. For this data pooling study,
authors of published and ongoing trials that collected sedentary time
data, using the activPAL monitor, in community-dwelling people with
stroke were invited to contribute their raw data. The data was
reprocessed; algorithms were created to identify sleep-wake time and
determine the percentage of waking hours spent sedentary. Linear
regressions (adjusting for age, gender, and study) were conducted to
determine the association of demographic and stroke-related factors with
percentage of total sedentary time, percentage of sedentary time in
bouts greater than 30 minutes, and percentage of sedentary time in bouts
greater than 60 minutes. The 274 included participants were from
Australia, Canada, and the United Kingdom, and spent, on average, 69
percent of their waking hours sedentary. Of the demographic and
stroke-related factors evaluated, only slower walking speeds were
significantly and independently associated with a higher percentage of
waking hours spent sedentary and uninterrupted sedentary bouts greater
than 30 minutes and greater than 60 minutes. Regression models explained
11 to 19 percent of the variance in total sedentary time and time in
prolonged sedentary bouts. This study found that variability in
sedentary time of people with stroke was largely unaccounted for by
demographic and stroke-related variables. Behavioral and environmental
factors are likely to play an important role in sedentary behavior after
stroke. Further work is required to develop and test effective
interventions to address sedentary behavior after stroke. Descriptor Terms: BEHAVIOR, BODY MOVEMENT, CLIENT CHARACTERISTICS, MOBILITY, OUTCOMES, PREDICTION, STROKE.
Citation: Hendrickx, Wendy, Riveros, Carlos,
Askim, Torunn, Bussmann, Johannes B. J., Callisaya, Michele L., Chastin,
Sebastien F. M., Dean, Catherine M., Ezeugwu, Victor E., Jones, Taryn
M., Kuys, Suzanne S., Mahendran, Niruthikha, Manns, Trish J., Mead,
Gillian, Moore, Sarah A., Paul, Lorna, Pisters, Martijn F., Saunders,
David H., Simpson, Dawn B., Tieges, Zoe, Verschuren, Olaf, English,
Coralie. (2019). Identifying factors associated with sedentary time after stroke. Secondary analysis of pooled data from nine primary studies. Topics in Stroke Rehabilitation, 26(5), Pgs. 327-334. Retrieved 8/20/2019, from REHABDATA database.
