Pulmonary Physiotherapy for Ischemic Stroke
Condition: Stroke, Ischemic; Intensive Care Neurological Disorder; Morality; Rehabilitation
MeSH terms: Stroke; Ischemic Stroke; Nervous System Diseases; Ischemia
Study type: Observational

Summary: 
      This study evaluates the predictors of intensive care unit admission and mortality among
      stroke patients and the effects of pulmonary physiotherapy on these stroke patients.
      One-hundred patients participated in the pulmonary rehabilitation program and 81 patients
      served as a control group.
    

Detailed description: 
      Predicting early mortality and disability after a stroke depends on many factors, such as
      age, the type of stroke, lesional location, level of consciousness, severity of neurological
      impairment, medical risk factors (hypertension and diabetes), premorbid conditions, fever and
      history of stroke. Stroke patients may experience a reduction of up to 50% in respiratory
      function when compared to age- and gender-matched norms. The reduction in respiratory
      function can lead to decreased endurance, dyspnoea and increased sedentary behaviour, as well
      as an elevated risk of stroke. The reduction in respiratory function may also cause
      aspiration, leading to pneumonia.

      The aim of pulmonary rehabilitation program is to enhance respiratory muscle resistance
      during breathing, thereby improving respiratory function. Pulmonary rehabilitation programs
      are considered to be capable of inducing positive effects on stroke patients' respiratory
      muscles through diaphragm breathing exercise and lip puckering breathing exercise. Pulmonary
      physiotherapy (PPT) improves the quality of life of stroke patients.

      The PPT program was conducted by physical therapists at our hospital for 30 min, three
      days/week. As part of the PPT, a physiotherapist monitored this group for 12 weeks. The same
      physiotherapist supervised all the exercises. During the exercise program, all patients were
      clinically stable and all were receiving optimal medical therapy. Rehabilitation started with
      inspiratory diaphragm breathing exercises. The physiotherapist placed his hands on the
      superior rectus abdominis immediately below the anterior costal cartilage and induced
      inspiratory diaphragm breathing by instructing the patient to slowly and deeply inhale the
      air through the nose. Then the patient was instructed to perform expiratory pursed-lip
      breathing exercise by continuously exhale the air. During pursed-lip breathing exercise, the
      patient was instructed in sequence, to breathe in gently through the nose, purse his/ her
      lips as though whistling and then breathe out through the long pursed lips by not exerting
      power until she/ he is short of breath. The expiration time was set to be at least twice
      times longer than inspiration time. The patients took a rest when they complained about
      fatigue or dizziness during breathing exercise and conducted breathing exercise again. The
      exercise intensity was based on the maximal heart rate and maximal effort of the patients.
      Each patient's performance during the exercise sessions was recorded and reported regularly
      to the patient's physician. National Institute of Health Stroke Scale scores, modified Rankin
      scale scores, pneumonia onset, admission to the intensive care unit and mortality were
      recorded at the end of the first and third month.
    

Intervention name(s): Pulmonary physiotherapy
Intervention type(s): Other
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients who were admitted to the neurology clinic stroke unit or the neurological
        intensive care unit
      
Keywords: Stroke; Mortality; Intensive care unit; Pulmonary rehabilitation