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PubMed2006

Recovery of a motor skill in rats with different forelimb preferences after lesioning of the caudate nucleus: the role of intense training.

The aim of the present work was to study the effects of training on the restoration of a lateralized motor skill (a food-procuring forelimb movement) in Wistar rats (n = 83) after lesioning of the caudate nucleus in conditions of infrequent testing and intensive retraining. On the basis of the training results, the rats were divided into those preferring the right (right-handers) or left (left-handers) limb. Testing was followed by lesioning of the head of the caudate nucleus on the side contralateral to the preferred paw. Animals with identical initial preferences were then divided into two groups: an infrequently tested group in which recovery of the skill was tested once weekly for five months, and an intensive retraining group, in which experiments were performed 3-4 times weekly, again for five months. After surgery, animals had to perform the food-procuring skill only with the "impaired" paw. Differences in the recovery of the skill were seen in animals with different limb preferences both in conditions of spontaneous recovery and in those recovering with training. Overall, animals with lesions of the left caudate nucleus (right-handers) showed better recovery than animals with lesions of the right caudate nucleus (left-handers) in both spontaneous recovery and in recovery with training. These findings suggest that the central neural mechanisms of recovery of a lateralized motor skill after unilateral lesioning of the caudate nucleus are different after lesions to the right and left hemispheres.

Animals↗

PubMed1995

A random trial comparing recovery after midazolam-alfentanil anesthesia with and without reversal with flumazenil, and standardized neurolept anesthesia for major gynecologic surgery.

STUDY OBJECTIVE: To compare the recovery characteristics of total intravenous anesthesia (TIVA) using midazolam-alfentanil, with or without reversal with flumazenil to a standardized neurolept anesthesia with nitrous oxide (N2O). DESIGN: Randomized, double-blinded clinical study. SETTING: University medical center. PATIENTS: 80 ASA physical status I and II women scheduled for major elective gynecologic surgery. INTERVENTIONS: Patients were anesthetized with one of three different anesthetic techniques. Patients in the TIVA group with reversal received midazolam-alfentanil reversed with flumazenil (Group 1), the TIVA group without reversal received midazolam-alfentanil reversed with placebo (Group 2), and patients in the neurolept group received anesthesia using thiopental sodium, droperidol, fentanyl, and N2O (Group 3). MEASUREMENTS AND MAIN RESULTS: Recovery was assessed by an observer blinded to the treatment allocation, using a Modified Steward Recovery Score and judgment of orientation and comprehension, collaboration and degree of sedation for the first 4 hours after extubation. Arterial blood gases were measured 30 minutes after extubation. A questionnaire regarding the degree of perioperative amnesia was presented to the patients 4 and 24 hours after surgery. The recovery scores were better in the TIVA group with reversal than in the other two groups from 0 to 30 minutes postoperatively. No difference between the groups could be found thereafter, although after 30 minutes some resedation occurred in the TIVA group with reversal. The median injected amount of flumazenil in Group 1 was 0.5 mg. Respiratory depression (breathing frequency below 10 breaths/min) was reversed with naloxone in one patient in the TIVA group with reversal, five patients in the TIVA group without reversal, and no patient in the neurolept group (p < 0.001). On blood gas analysis, there was no evidence of hypoxemia or carbon dioxide retention. No difference was seen between the groups regarding consumption of analgesics, degree of amnesia, or patient rating of the quality of anesthesia. One patient in Group 2, however, recorded awareness at skin incision when questioned 4 hours after the operation, but could not recall this 20 hours later. CONCLUSIONS: TIVA with midazolam and alfentanil can be used for major gynecologic surgery. Recovery in the neurolept group was equal to recovery in the TIVA group without reversal, and flumazenil improves the recovery after midazolam anesthesia. Overall, in comparison with the neurolept technique no major advantage could be demonstrated using TIVA with midazolam-alfentanil.

Adult↗

PubMedDate not supplied

At-home recovery following hospitalization for bronchiolitis.

OBJECTIVES: To characterize the at-home recovery of infants after hospitalization for bronchiolitis, the impact of recovery from this illness on the family, and the association between delayed infant recovery and parental satisfaction with hospital care. METHODS: Otherwise healthy infants less than 1 year of age admitted to 6 children's hospitals were eligible. Telephone interviews with 486 parents (85% of sampled), 1-2 weeks following discharge, addressed functional recovery, lingering symptoms, family disruption, returns to the emergency department, and parental recall of satisfaction with care. RESULTS: Two thirds of infants experienced difficulties with normal routines (feeding, sleeping, contentedness, liveliness) on the day of discharge. By 5 days at home, 22% continued to experience disruption in sleeping, and 16% in feeding routines. Coughing (56%) and wheezing (27%) were common 4 to 6 days after discharge. Parents who reported longer delays in return to normal family routines took additional time off work, kept their infants out of day care twice as many days, and were more likely to take their infants to the doctor or hospital for repeat medical care. Parents from families slower to return to a normal routine recalled the hospital stay less favorably. CONCLUSIONS: A small but important proportion of infants have a protracted recovery period following hospitalization for bronchiolitis. Delayed recovery is associated with parental work time loss and less favorable parental impressions of care in the hospital. Anticipatory guidance about home recovery could allow parents to plan for extended home care and improve satisfaction with hospital care.

Bronchiolitis↗

PubMed2004

Functional recovery of gait and joint kinematics after right hemispheric stroke.

OBJECTIVE: To gain insight into the relation between changes in gait patterns over time and functional recovery of walking ability in stroke patients. DESIGN: Cohort study. SETTING: Inpatient rehabilitation center of a university hospital in the Netherlands. PARTICIPANTS: Thirteen stroke patients admitted, or awaiting admission, for inpatient rehabilitation 3 weeks poststroke, and 16 healthy control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: At 3, 6, 12, 24, and 48 weeks poststroke, functional recovery of walking ability was assessed with the Rivermead Mobility Index (RMI) and the Functional Ambulation Categories (FAC). When possible, kinematics of the knee, hip, and pelvis were assessed through gait analysis in an 8 x 4 m gait laboratory. Minimal scores of 8 on the RMI and 4 on the FAC were necessary before patients were classified as functionally recovered. RESULTS: Patients whose joint kinematics during ambulation had recovered to within the range of the control group showed functional recovery of walking ability. However, some patients whose kinematics had developed toward an abnormal pattern also showed functional recovery. CONCLUSIONS: Recovery of joint kinematics toward a normal pattern is not required for functional recovery of walking ability. Early recognition of compensatory walking patterns that facilitate functional recovery may have implications for rehabilitation programs.

Adult↗

PubMed2006

Recovery of dynamic balance after additional small divided doses of midazolam given intravenously for sedation.

We have previously reported that a dynamic balance test with perturbation stimuli and computerised dynamic posturography sensitively reflected the inhibitory effect on balance of intravenous midazolam sedation given intravenously as a single dose, and recovery time was within 80 min. The purpose of this study was to investigate the recovery of dynamic balance after additional doses of midazolam. Eighteen young adult male volunteers were sedated with midazolam given intravenously. The initial dose was given until the Wilson sedation score reached 3, and an additional dose was given until the same score was obtained 40 min later. They were tested with perturbation stimuli 40, 80, 100, and 120 min after the additional doses had been given. Their recovery time was recorded. The mean (S.D.) initial dose of midazolam was 0.07 (0.005) mg kg(-1), and additional doses were 41 (7)% of the initial dose. The serial changes in bispectral index after initial and additional doses were similar. The recovery time for the dynamic balance test (within 80 min) was the same as that recorded in the previous single-dose study. The recovery time of the psychomotor function test was within 75 min. Additional doses of midazolam aiming for a Wilson sedation score of 3 at a dose about 40% of the initial dose and given 40 min after the initial dose are valid in terms of the maintenance of sedation and recovery of dynamic balance. Complete recovery time, including psychomotor function, was within 80 min of the additional dose of the drug.

Adult↗

PubMed2003

Risk factors associated with prolonged recovery and delayed healing after third molar surgery.

PURPOSE: We sought to identify the demographic, oral health, and surgical risk factors associated with prolonged recovery after third molar surgery using health-related quality of life (HRQOL) and clinical outcomes. PATIENTS AND METHODS: HRQOL responses from patients and clinical outcomes were obtained after third molar surgery. Criteria were selected for HRQOL outcomes that separated patients with from those without prolonged recovery. Delayed clinical healing was indicated by a patient having at least 1 postsurgery visit with treatment. Risk assessment models for prolonged HRQOL recovery and delayed clinical healing were developed using stepwise logistic regression analysis. RESULTS: We included 547 subjects with HRQOL and clinical outcome data in this analysis. Age, gender, and occlusal plane position were statistically significantly associated with prolonged recovery for early symptoms, oral function, and pain. Recovery for lifestyle was prolonged only if both lower third molars were below the occlusal plane before surgery. Age, gender, prior symptoms related to the third molars, and the surgeon's perception of difficulty were statistically significant predictors of delayed clinical recovery. CONCLUSIONS: Certain demographic and oral health conditions available to the surgeon before surgery, and characteristics of the surgery itself, increase the risk of a prolonged recovery for HRQOL outcomes and delayed clinical outcomes after third molar surgery.

Adolescent↗

PubMed2006

Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery.

PURPOSE: This study was designed to test the hypothesis that removal of lower third molars below the occlusal plane and in close proximity to the inferior alveolar canal (IAC) delays recovery after surgery as compared with lower third molars below the occlusal plane yet not close to the IAC. PATIENTS AND METHODS: Recovery data were available for 579 patients enrolled in an institutional review board-approved clinical trial. After surgery a questionnaire designed to assess health-related quality of life (HRQOL) recovery was given to the patient to be completed each day for 14 days. At each postsurgery visit, clinical data were collected detailing healing and treatment. Based on radiographic findings, patients with at least 1 mandibular third molar below the occlusal plane were identified. Outcomes for patients with at least 1 radiographic sign indicating proximity of a lower third molar to the IAC were compared with those with none. Clinical and HRQOL outcomes were compared with Cochran-Mantel-Haensel statistics (P < .05). RESULTS: No significant differences were found between groups for delayed clinical recovery. If radiographic signs for a patient at presurgery evaluation indicated close proximity of a lower third molar to the IAC, odds were significantly increased for delayed HRQOL recovery for worst pain, lifestyle, and oral function. CONCLUSION: Our findings support the hypothesis that a presurgery finding of a lower third molar below the occlusal plane and in close proximity to the IAC is associated with patients' prolonged HRQOL recovery, but not a significant delay in clinical recovery.

Adolescent↗

PubMed2005

[Neurological recovery after cervical cord decompression for canal stenosis myelopathy].

PURPOSE OF THE STUDY: Progressive myelopathy secondary to stenosis of the spinal canal is generally treated by surgery. Results of surgical decompression are generally good but the pattern of neurological recovery has not been studied. We followed a cohort of patients who underwent cervical cord decompression to study the course of neurological recovery. MATERIAL AND METHODS: The study cohort included 39 patients (22 men and 17 women), mean age 65.7 years who underwent surgery between 1998 and 2002 for progressive cervical myelopathy. The same surgeon performed all procedures (23 posterior and 16 anterior approaches). The JOA score and MRI findings were noted. The patients were seen at 1, 3, 6, 12, and 18 months then annually (JOA score). The Hirabayashi score was used to assess neurological recovery. Two populations were identified (group 1: preoperative JOA score > 6, group 2: preoperative JOA score<or=6). RESULTS: The mean preoperative JOA score was 8.3/17, range 1-15. Ten patients had a severe JOA score (<6). The mean postoperative JOA score was 13.3 (range 3-17) at six months and remained stable during follow-up. Neurological recovery as assessed with the Hirabayashi technique was 52.5% on average at last follow-up. Neurological gain occurred mostly during the first to third month following decompression, remaining stable thereafter. Patients with a severe deficit exhibited the same recovery pattern but stabilized at a lower neurological level. Expressed in JOA points, neurological gain was very similar in the two groups. There was no significant difference between patients who under went anterior or posterior procedures. DISCUSSION AND CONCLUSION: The pattern of neurological recovery in patients with degenerative cervical disease appears to be rapid during the first six months following surgical decompression. The level of recovery then levels off, irrespective of the severity of the initial deficit. This work demonstrated that more specific evaluation scales than the JOA score should be developed for assessment and follow-up of these patients.

Adult↗

PubMed2000

Vasopressin pressor effects in critically ill children during evaluation for brain death and organ recovery.

BACKGROUND: Vasopressin (VP) shows promise as a pressor agent in animals and adult human cardiac arrest and resuscitation, but has not been studied for pressor effect in critically ill or arrested children. VP infusion is routine treatment for diabetes insipidus during brain death evaluation and organ recovery. We hypothesized that low dose VP infusion during organ recovery in critically ill children exerts a pressor effect, without major organ toxicity. METHODS: 34 VP-treated and 29 age-matched critically ill controls (C) < or =18 years were retrospectively reviewed during brain death evaluation and organ recovery. VP infusion protocol titrated VP dose clinically to urine output, with high variability. Pressor and inotrope management was titrated clinically to BP, cerebral perfusion and central venous pressures (when available) and peripheral perfusion with similar protocol targets for pre-load in VP and C groups. Outcome measures include dose, type and number of pressors and inotropes. Organ function was assessed at recovery and 48 h post-transplant by independent surgeon and transplant program organ function criteria. Analysis by Odds Ratio (OR), and chi-square. RESULTS: VP dose averaged 0.041+/-0.069 U/kg/h. Average baseline mean arterial pressure (MAP) before VP infusion was 79+/-17 mmHg VP and 76+/-14 mm Hg C (P=0.6). Subsequent average MAP were: 82+/-21 mmHgVP after VP infusion versus 71+/-16 mmHg C (P=0.01) and 80+/-14 mmHg VP versus 68+/-22 mmHg C (P=0.01). Ability to wean/stop pressors and inotropes was: dopamine (14/23) 42% VP versus (10/26) 38% C (P=0.75), dobutamine (4/7) 57% VP versus (0/6) 0% C (P=0.026), epinephrine (4/5) 80% VP versus (0/6) 0% C (P=0.006), norepinephrine/phenylephrine (4/4) 100% VP versus (2/5) 40% C (P=0. 057). Alpha agonist pressor dependence was successfully weaned from 7/9 (78%) VP versus 0/9 (0%) C: odds ratio=7.3, (P<0.01). There was no VP induced dysrhythmia, hypertension, anuria or toxicity reported. Good organ recovery function was not significantly different at recovery or 48 h post-transplant for kidney (79% VP versus 69% C, P=0.068), liver (87% VP versus 95% C, P=0.533), or heart (90% VP versus 71% C, P=0.11). CONCLUSIONS: Low dose vasopressin infusion exerts a pressor effect in critically ill children treated for diabetes insipidus during brain death and organ recovery. VP treated patients were 7.3 times more likely to wean from alpha agonists than comparably managed age matched controls, without adverse affect on transplant organ function. We speculate that further prospective assessment of VP safety and efficacy as a pressor adjunct for resuscitation of critically ill children is warranted.

Adolescent↗

PubMed2002

High levels of fatty acids delay the recovery of intracellular pH and cardiac efficiency in post-ischemic hearts by inhibiting glucose oxidation.

OBJECTIVES: This study was designed to determine if the fatty acid-induced increase in H(+) production from glycolysis uncoupled from glucose oxidation delays the recovery of intracellular pH (pH(i)) during reperfusion of ischemic hearts. BACKGROUND: High rates of fatty acid oxidation inhibit glucose oxidation and impair the recovery of mechanical function and cardiac efficiency during reperfusion of ischemic hearts. METHODS: pH(i) was measured by 31P nuclear magnetic resonance spectroscopy in isolated working rat hearts perfused in the absence (5.5 mmol/l glucose) or presence of 1.2 mmol/l palmitate (glucose+palmitate). Glycolysis and glucose oxidation were measured using [5-3H/U-14C]glucose. RESULTS: When glucose+palmitate hearts were subjected to 20 min of no-flow ischemia, recoveries of mechanical function and cardiac efficiency were significantly impaired compared with glucose hearts. Glucose oxidation rates were significantly lower in glucose+palmitate hearts during reperfusion compared with glucose hearts, whereas glycolysis rates were unchanged. This resulted in an increase in H(+) production from uncoupled glucose metabolism, and a decreased rate of recovery of pH(i) in glucose+palmitate hearts during reperfusion compared with glucose-perfused hearts. Dichloroacetate (3 mmol/l) given at reperfusion to glucose+palmitate hearts resulted in a 3.2-fold increase in glucose oxidation, a 35% +/- 3% decrease in H(+) production from glucose metabolism, a 1.7-fold increase in cardiac efficiency and a 2.2-fold increase in the rate of pH(i) recovery during reperfusion. CONCLUSIONS: A high level of fatty acid delays the recovery of pH(i) during reperfusion of ischemic hearts because of an increased H(+) production from glycolysis uncoupled from glucose oxidation. Improving the coupling of glucose metabolism by stimulating glucose oxidation accelerates the recovery of pH(i) and improves both mechanical function and cardiac efficiency.

Animals↗

PubMed1996

[Delay of clinical recovery from paralysis induced by atracurium: comparison between orbicularis oculi and adductor pollicis].

OBJECTIVE: To compare with train-of-four stimulation the delays of the beginning of the spontaneous recovery of the orbicularis oculi and of the adductor pollicis after profound neuromuscular blockade with atracurium. STUDY DESIGN: Prospective, comparative open study. PATIENTS AND METHODS: Twenty-eight physical class ASA 1 and 2 patients under general anaesthesia (propofol, N2O, fentanyl) and profound neuromuscular blockade with atracurium. Train-of-four stimulation, every 10 s, of the ulnar nerve at the wrist (for assessing by tactile means the response of the adductor pollicis) and of the temporal branch of the facial nerve (for assessing visually the response of the orbicularis oculi). On each site, measurement of the delay between the end of the maintenance of deep neuromuscular blockade (last dose of atracurium) and the beginning of the recovery (first response to train-of-four stimulation). RESULTS: In each case, the recovery of the orbicularis oculi began earlier than the recovery of the adductor pollicis (26 +/- 9 min vs 34 +/- 9 min, P < 0.001). The delays of recovery at each site were strongly correlated (r = 0.87; P < 0.001) but the time lag between the responses varied greatly: 1 to 21 min, mean: 8 +/- 5 min, coefficient of variation: 56.6%. CONCLUSION: The orbicularis oculi should not be monitored alone for assessment of recovery from profound neuromuscular blockade by atracurium, as it predicts poorly the time of the recovery of the adductor pollicis.

Adult↗

PubMed2002

Functional recovery after facial nerve crush is delayed in severe combined immunodeficient mice.

The goal of the current study was to determine if T and B lymphocytes play a role in functional recovery after peripheral nerve injury. The time course of behavioral recovery following facial nerve crush injury at the stylomastoid foramen was established in scid mice which lack functional T and B cells and reconstituted scid mice as compared to wild-type mice. The average time necessary for recovery of full eye blink reflex and vibrissae movements in wild-type mice was 10.3+/-0.2 and 9.9+/-0.34 days, respectively. In contrast, recovery of full eye blink reflex and vibrissae movements took 14.8+/-0.54 and 12.3+/-0.41 days, respectively, in scid mice. Reconstitution of scid mice with whole splenocytes resulted in functional recovery times similar to wild-type, with eye blink reflex recovery and vibrissae movement being 10.5+/-0.3 and 10.0+/-0.0 days, respectively. These results suggest that the delayed behavioral recovery time observed in scid mice may be due to the absence of T and B lymphocytes.

Animals↗

PubMed2006

Progress in clinical neurosciences: stroke recovery and rehabilitation.

BACKGROUND: Recent literature has provided new insights into the role of rehabilitation in neurological recovery post-stroke. The present review combines results of animal and clinical research to provide a summary of published information regarding the mechanisms of neural recovery and impact of rehabilitation. METHODS: Plasticity of the uninjured and post-stroke brain is examined to provide a background for the examination of brain reorganization and recovery following stroke. SUMMARY AND CONCLUSIONS: Recent research has confirmed many of the basic underpinnings of rehabilitation and provided new insight into the role of rehabilitation in neurological recovery. Recovery post stroke is dependent upon cortical reorganization, and therefore, upon the presence of intact cortex, especially in areas adjacent to the infarct. Exposure to stimulating and complex environments and involvement in tasks or activities that are meaningful to the individual with stroke serves to increase cortical reorganization and enhance functional recovery. Additional factors associated with neurological recovery include size of stroke lesion, and the timing and intensity of therapy.

Animals↗

PubMed2005

Spontaneous recovery of excitation but not inhibition.

Five magazine approach experiments with rats and 1 sign-tracking experiment with pigeons explored the possibility of an analogue to spontaneous recovery of excitatory conditioning from extinction: spontaneous recovery of inhibitory conditioning from training. Stimuli were 1st treated as conditioned inhibitors and then as conditioned exciters or as irrelevant to reinforcement. At issue was whether the passage of time after the 2nd treatment would allow partial restoration of the initial conditioned inhibition. The experiments differed in the design used to study recovery, the manner of reinforcing the inhibitor, the means of testing for recovery, the time interval allowed for recovery, and the species used. None of the experiments found evidence for recovery of the inhibitory learning with time, despite the concurrently measured presence of spontaneous recovery of excitatory conditioning after extinction. These experiments suggest that changes with time may be preferential to the learning that occurs during extinction.

Acoustic Stimulation↗

PubMed2004

Neuromuscular recovery following rocuronium bromide single dose in infants.

BACKGROUND: Rocuronium bromide, a steroid nondepolarizing muscle relaxant, has a rapid onset and an intermediate duration of action in infants, children and adults. However, clinical evidence shows a longer duration of recovery in small infants. The aim of this study was to investigate the influence of age on rocuronium recovery during the first year of life. METHODS: ASA I-II infants, scheduled for elective surgery under general anaesthesia and intubation were included after ethics committee approval and parents' written consent. According to age the patients were randomly allocated to receive either 0.45 mg.kg(-1) or 0.6 mg.kg(-1) rocuronium bromide in three age-groups: (A) 0-1 month, (B) 2-4 months and (C) 5-12 months. After induction with thiopentone (5-7 mg.kg(-1)), anesthesia was maintained with isoflurane without opioids. Prior to surgery, caudal block with bupivacaine (0.125%) 1.0 ml.kg(-1) and paracetamol 25 mg.kg(-1) rectally were given for analgesia. Efficacy variables were intubation conditions 60 s after administration of muscle relaxant (T(0)) and recovery of neuromuscular blockade measured as T(1) at 10, 25, 50 and 75 % of baseline, train-of-four (TOF) of 0.7 and Recovery Index (RI). Data were characterized by summary statistics and analysis of variance. RESULTS: A total of 61 infants with a median age range of 67 (2-364) days were included. Intubation conditions were excellent or good in all dose and age groups. T(0) in group A was reached in a range of 15-30 s, in others up to 60 s. T(1) recovery (T75) after 0.45 mg.kg(-1) was 56.4 +/- 16 (A), 62.7 +/- 32 (B) and 45.8 +/- 18 (C) min. Recovery times for of 0.6 mg.kg(-1) were 100.8 +/- 35 (A), 70.6 +/- 19 (B) and 63.4 +/- 21 (C) min, respectively. The TOF ratio (0.7) was 62.3 +/- 18 (A), 64.1 +/- 27 (B) and 43.7 +/- 12 (C) min using 0.45 mg.kg(-1) compared with 94.8 +/- 31 (A), 63.8 +/- 14 (B) and 67.5 +/- 18 (C) min with 0.6 mg.kg(-1). The differences of T75 and TOF 0.7 in A and C were significant (P </= 0.05). CONCLUSIONS: Recovery of muscle relaxation using rocuronium bromide under isoflurane anesthesia in infants differs widely and shows great differences between age groups as well as dose regimen. A dose of 0.6 mg.kg(-1) resulted in a significantly longer duration of action in group A. The reduced dose of 0.45 mg.kg(-1) resulted in rapid and good relaxation in all infants without very long lasting effects. Reduced doses of rocuronium should be used in newborns and small infants.

Age Factors↗

PubMed2000

Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization.

AIMS: The association between stress-induced ST elevation and functional recovery following revascularization after myocardial infarction remains unclear. We assessed the relative accuracy of dobutamine- and exercise-induced ST elevation in Q wave leads in predicting functional recovery following revascularization, and we investigated the relationship of ST elevation to different wall motion responses to dobutamine. METHODS AND RESULTS: Thirty-nine patients underwent dobutamine stress echo and exercise test 8+/-2 days after Q wave myocardial infarction. All patients underwent angiography and subsequent revascularization. Follow-up echocardiograms were obtained 7+/-4 weeks after revascularization. Functional recovery was assessed by the difference between the baseline and the follow-up asynergy index. Nineteen patients (48%) developed dobutamine- and exercise-induced ST elevation. There was significant agreement between the tests (k=0.58, P<0.001). We found a significant correlation between dobutamine and exercise-induced ST elevation with functional recovery following revascularization (r=0. 45, P<0.005 and r=0.7, P<0.001, respectively). The parameters with the highest predictive value for functional recovery were: (a) the biphasic response during dobutamine infusion, (b) the development of ST elevation in both tests, and (c) the development of exercise-induced ST elevation in more than three leads. CONCLUSION: There is a strong association between dobutamine- and exercise-induced ST elevation with functional recovery following revascularization. Exercise-induced ST elevation in more than three leads and a biphasic response during dobutamine infusion accurately predict functional recovery.

Angioplasty, Balloon, Coronary↗

PubMed2000

[Median nerve evoked potentials and explicit memory function during recovery from propofol-sufentanil anesthesia].

OBJECTIVE: In a prospective study rnidlatency somatosensory evoked Potentials (SEP) were investigated in relation to explicit memory function during recovery from propofol/sufentanil anaesthesia. METHODS: Anaesthesia was maintained in 20 patients with 8 mg kg-1 h-1 propofol and supplemented with sufentanil. SEPs (N20, P25, N35, P45 N50) elicited by median nerve stimulation were recorded at the day before surgery (AWAKE) and during recovery from anaesthesia, when patients were able to identify a shown object (RECOVERY). The day after surgery patients were interviewed about their memory of the recovery period. STATISTICS: Hotellings' T2. RESULTS: One day after anaesthesia 9 patients could remember events during the recovery period. At RECOVERY SEP-latencies P45 and N50 were significantly shorter in the patients with recall for the wakeup-phase (p < 0.05). CONCLUSION: SEP latencies P45 and N50 indicated impaired explicit memory function during recovery from propofol/sufentanil anaesthesia.

Adult↗

PubMed2002

Patients' expectations of recovery following stroke: a qualitative study.

PURPOSE: Patients and carers frequently express disappointment with the extent of recovery achieved at the point of discharge from physiotherapy. Research has suggested that high expectations of recovery may be encouraged by physiotherapists. This study examined the information exchanged between physiotherapists and patients in relation to recovery following stroke in order to explore this issue. METHODS: The study comprised in-depth longitudinal case studies of 16 patients with a first incident stroke. Qualitative interviews were conducted with patients and their physiotherapists to explore their understandings and expectations of recovery and of physiotherapy at three time points. Patients were assessed for deficits of movement, function and mood at the same three stages and observations of out-patient sessions were also conducted. Qualitative data were analysed using thematic analysis. The assessment data were analysed using descriptive and comparative statistics. RESULTS: Data indicated deficits of movement improved significantly between the first and third assessments. The qualitative data showed that physiotherapists did not encourage over-optimistic expectations of recovery through the verbal information they provided to patients. Nevertheless patients did maintain high expectations of recovery throughout the three-month post-stroke period. CONCLUSION: Improved communication strategies, informed by an evidence base of recovery, should be used to encourage realistic expectations of physiotherapy without destroying the process of active participation and skill acquisition.

Adult↗