Keywords
Rehabilitation Nursing
Brain Injuries
Autonomic Nervous System
Standing Position.
How to Cite
Citações
Dimensions
Abstract
Introduction: Autonomic dysfunction is a common condition after brain injury (BI) and is related to the ability to ensure cerebral self-regulation, which, when present, ensures cerebral blood flow adequate to the person's needs. Rehabilitation training on an inclined plane is related to sensory, autonomic and balance recovery. In this sense, we intend to evaluate cerebrovascular adaptation in people in critical condition (PCS) after BI undergoing standing training using an inclined plane.
Methodology: Retrospective multi-case study, carried out in a Neurocritical Care Unit. Sample consisting of (n=7). A rehabilitation program was applied using an inclined plane, with elevation of the headrest up to 60° in two moments. The variables collected were: Glasgow Coma Scale, blood pressure, heart rate (HR) and cerebral oximetry (CO). Through retrospective analysis, the following were studied: heart rate variability (HRV) and baroreflex sensitivity (BS).
Results: Median ECG 11, SAPS II 31±23 and average stay of 67±26 days. In the supine position, HRV and BS were decreased. Statistically significant differences were identified in HR during elevation of the headrest up to 60° in the first session (p=0.03). No statistical difference was identified in the calculated variables (p>0.05).
Discussion: Compared to the first training, there was an improvement in the regulation of sympathetic-vagal balance observed in the second training, through higher CO values.
Conclusion: Standing training using an inclined plane proved to be an effective and safe option in the rehabilitation of PCS after BI, as there was an improvement in cerebrovascular adaptation from the first to the second training.
References
Leipzig TJ, Lowensohn RI. Heart rate variability in neurosurgical patients. Neurosurgery. 1986 set;19(3):356–62.
Schultz MD, Alstrup M, Olsen MH, Berg RMG, Mehlsen J, Møller K, Gunge Riberholt C. Autonomic response to early head-up tilt in patients with severe traumatic brain injury: Analysis from a randomized feasibility trial. Physiol Rep [Internet]. 2023 April 20 [Cited 2023 june]; 11(8) Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10116542/ DOI: 10.14814/phy2.15666.
Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health [Internet] 2017 Sep 28 [Cited 2022 may]; 5(258). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624990/DOI: 10.3389/fpubh.2017.00258.
Taralov ZZ, Terziyski KV, Kostianev SS. Heart Rate Variability as a Method for Assessment of the Autonomic Nervous System and the Adaptations to Different Physiological and Pathological Conditions. Folia Medica [Internet]. 2016 Apr 1 [cited 2021 May];57(3-4):173–80. Available from: http://archive.sciendo.com/FOLMED/folmed.2016.57.issue-3-4/folmed-2015-0036/folmed-2015-0036.pdf
Boron WF, Boulpaep EL. Medical Physiology. 2 ed. Elsevier; 2012. 1351 p.
Takahashi C, Hinson HE, Baguley IJ. Autonomic dysfunction syndromes after acute brain injury. Handbook of Clinical Neurology [Internet]. 2015 Jan 1 [cited 2020 Sep];539–51. Available from: https://ohsu.pure.elsevier.com/en/publications/autonomic-dysfunction-syndromes-after-acute-brain-injury-2
Kox M, Vrouwenvelder MQ, Pompe JC, van der Hoeven JG, Pickkers P, Hoedemaekers CW. The effects of brain injury on heart rate variability and the innate immune response in critically ill patients. J Neurotrauma [Internet]. 2012;29(5):747–55. Available from: http://dx.doi.org/10.1089/neu.2011.2035
Sykora M, Czosnyka M, Liu X, Donnelly J, Nasr N, Diedler J, et al. Autonomic impairment in severe traumatic brain injury: A multimodal neuromonitoring study. Crit Care Med [Internet]. 2016;44(6):1173–81. Available from: http://dx.doi.org/10.1097/ccm.0000000000001624
Nasr N, Gaio R, Czosnyka M, Budohoski K, Liu X, Donnelly J, et al. Baroreflex impairment after subarachnoid hemorrhage is associated with unfavorable outcome. Stroke [Internet]. 2018;49(7):1632–8. Available from: http://dx.doi.org/10.1161/STROKEAHA.118.020729
Levine PA. Papel da Estimulação Artificial na Administração da Síncope - Terapia [Internet]. USA: St. Jude Medical; 2000 [updated 2022; cited 2022 may]. Available from: http://doczz.com.br/doc/267084/papel-da-estimula%C3%A7%C3%A3o-artificial-na-administra%C3%A7%C3%A3o-da-s%C3%ADncope
Nasr N, Pavy-Le Traon A, Larrue V. Baroreflex sensitivity is impaired in bilateral carotid atherosclerosis. Stroke [Internet]. 2005;36(9):1891–5. Available from: http://dx.doi.org/10.1161/01.STR.0000177890.30065.cb
Papaioannou V, Giannakou M, Maglaveras N, Sofianos E, Giala M. Heart rate and blood pressure variability and baroreflex sensitivity in patients with acute brain injury. J Crit Care [Internet]. 2005;20(4):394. Available from: http://dx.doi.org/10.1016/j.jcrc.2005.09.048
Frazzitta G, Zivi I, Valsecchi R, Bonini S, Maffia S, Molatore K, et al. Effectiveness of a Very Early Stepping Verticalization Protocol in Severe Acquired Brain Injured Patients: A Randomized Pilot Study in ICU. PLoS ONE [Internet]. 2016 jul [cited 2022 may];11(7):e0158030. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957764/
Tavares AC, Vega J, Guimaraes GV, Moran de Brito CM. A Five-day Orthostatic Training Program Improves Cardiovascular Response in Intensive Care Patients. Int J Phys Med Rehabil [Internet]. 2017 [cited 2022 may];05(05). Available from: https://www.omicsonline.org/open-access/a-fiveday-orthostatic-training-program-improves-cardiovascularresponse-in-intensive-care-patients-2329-9096-1000429.php?aid=93206
Tzeng YC, Ainslie PN. Blood pressure regulation IX: cerebral autoregulation under blood pressure challenges. Eur J Appl Physiol [Internet]. 2014 mar [cited 2022 may];114(3):545–59. Available from: http://link.springer.com/10.1007/s00421-013-2667-y
Turner-Stokes L, Nair A, Sedki I, Disler PB, Wade DT. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Syst Rev. [Internet]. 2015 dez [cited 2022 may];22(12):CD004170. Available from: https://pubmed.ncbi.nlm.nih.gov/26694853/
Brodal Per. The central nervous system: structure and function. 4 ed. USA: Oxford University Press; 2010. 591 p.
Vlutters M, Boonstra TA, Schouten AC, van der Kooij H. Direct measurement of the intrinsic ankle stiffness during standing. J Biomech [Internet] 2015 mai 1 [cited 2022 may];48(7):1258-63. Available from: https://pubmed.ncbi.nlm.nih.gov/25843262/
Brady K, Joshi B, Zweifel C, Smielewski P, Czosnyka M, Easley RB, et al. Real Time Continuous Monitoring of Cerebral Blood Flow Autoregulation using Near-Infrared Spectroscopy in Patients Undergoing Cardiopulmonary Bypass. Stroke [Internet]. 2010 set [cited 2022 may];41(9):1951-6. Available from: https://pubmed.ncbi.nlm.nih.gov/20651274/
Moerman A, De Hert S, Mathur AM. Open Peer Review Recent advances in cerebral oximetry. Assessment of cerebral autoregulation with near-infrared spectroscopy: myth or reality? F1000Res [Internet]. 2017; ago [cited 2022 may];31(6):1615. Available from: https://pubmed.ncbi.nlm.nih.gov/29026526/
Hilz MJ, Moeller S, Akhundova A, Marthol H, Pauli E, De Fina P, et al. High NIHSS values predict impairment of cardiovascular autonomic control. Stroke. 2011 jun;42(6):1528–33.
Kuriyama N, Mizuno T, Niwa F, Watanabe Y, Nakagawa M. Autonomic nervous dysfunction during acute cerebral infarction. Neurol Res [Internet]. 2013 dez 2 [cited 2022 june];32(8):821-7. Available from: https://www.tandfonline.com/doi/abs/10.1179/016164109X12464612122696
Sykora M, Diedler J, Rupp A, Turcani P, Rocco A, Steiner T. Impaired baroreflex sensitivity predicts outcome of acute intracerebral hemorrhage. Crit Care Med [Internet]. 2008 nov [cited 2022 june];36(11):3074–9. Available from: https://journals.lww.com/ccmjournal/Abstract/2008/11000/Impaired_baroreflex_sensitivity_predicts_outcome.19.aspx
Lazaridis C, Smielewski P, Steiner LA, Brady KM, Hutchinson P, Pickard JD, et al. Optimal cerebral perfusion pressure: Are we ready for it? Neurol Res. 2013 mar 12;35(2):138–48.
Kasaoka S, Nakahara T, Kawamura Y, Tsuruta R, Maekawa T. Real-time monitoring of heart rate variability in critically ill patients. J Crit Care. 2010 jun;25(2):313–6.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Portuguese Rehabilitation Nursing Journal
Downloads
| Abstract Views | 161 |
|---|
| PDF (Português (Portugal)) | 166 |
|---|