Brammatha A1
1KMCH, Physiotherapy, Coimbtore, India
Background: HELLP syndrome (H: haemolysis; EL: elevated liver enzymes; LP: low platelet count) is a serious form of severe pre-eclampsia with high maternal mortality and morbidity. The syndrome considered a variant of preeclampsia, can occur on its own or in association with preeclampsia. Pregnancy induced hypertension (PIH), preeclampsia and HELLP are related and overlap in their presentation. Various life threatening complications such as placental abruption, pulmonary oedema, cerebral haemorrhage, hepatorenal failure and disseminated intravascular coagulation (DIC) can occur in these patients. Cerebral haemorrhage is a life threatening complication which leads to major maternal stroke. Considering the post natal women's health scenario, significance is given to pregnancy complications and child care. The rehabilitation needs of mother is considered secondary. If they wanted to optimise their functional performance after some years the best practice and evidences for functional change is inconclusive.
Purpose: To describe how exercises and motor learning principles could be incorporated into an ecletic model for a patient who desires to optimise functional performance after seven years.
Methods: A prospective, single case study was used to follow a 31 year-old female chronic hemiplegic due to HELPP syndrome right hemisphere haemorrhagic stroke which occurred seven years ago. Study was undertaken in Department of Physical Medicine and Rehabilitation, KMCH, Coimbatore. She presented with deficits in gait, balance and upper limb activities with FIM score of 104/126. Multichannel Functional Electrical Stimulation (frequency 25Hz, duration 150 micro seconds and intensity of 120mA) was given as adjuvant, to retrain her reaching and walking which had some abnormal synergy pattern along with functional activities and intensive practice. She was treated for 3 months, 6 days a week, 5 hrs per day.
Results: Pre-Post test after three months included measures which showed the following changes: Fugl Meyer assessment (70 to 80), Berg Balance scale 39 to 52, Functional Reach test(3.2 inches to 14 inches), Functional Ambulation category(Level IV to V),Timed 10 meter walk test(Self selected speed 0.6m/s to 0.9m/s and fast selected 1.3m/s to 1.5 m/s).Also subject reported increased satisfaction and participation in functional activities. Incidentally, after 7 weeks of treatment, the participant also reported being able to use both hands together and 'walk better'. After 77 complete sessions, subject reported significant and clinically meaningful improvement on all outcome measures. This study showed a positive trend in motor recovery even after seven years in the absence of natural recovery.
Conclusion(s): Even after seven years, the subject benefitted from intensive individualized FES and Integrated Physiotherapy program which resulted in positive outcomes.
Implications: The training was feasible and tolerated for 3 months with no adverse events. Eclectic model program that incorporates motor learning principles - goal oriented, practice, intensity and feedback focusing on functional needs is effective for patient with long term disability.
Implications: The training combination was feasible and tolerated for 3 months with no adverse events. Eclectic model program that incorporates motor learning principles - goal oriented, practice, intensity and feedback focusing on functional needs are effective for patients with longterm stroke.
Keywords: Eclectic/Integrated therapy; FES;, Post HELLP Stroke, FES
Funding acknowledgements: None
Purpose: To describe how exercises and motor learning principles could be incorporated into an ecletic model for a patient who desires to optimise functional performance after seven years.
Methods: A prospective, single case study was used to follow a 31 year-old female chronic hemiplegic due to HELPP syndrome right hemisphere haemorrhagic stroke which occurred seven years ago. Study was undertaken in Department of Physical Medicine and Rehabilitation, KMCH, Coimbatore. She presented with deficits in gait, balance and upper limb activities with FIM score of 104/126. Multichannel Functional Electrical Stimulation (frequency 25Hz, duration 150 micro seconds and intensity of 120mA) was given as adjuvant, to retrain her reaching and walking which had some abnormal synergy pattern along with functional activities and intensive practice. She was treated for 3 months, 6 days a week, 5 hrs per day.
Results: Pre-Post test after three months included measures which showed the following changes: Fugl Meyer assessment (70 to 80), Berg Balance scale 39 to 52, Functional Reach test(3.2 inches to 14 inches), Functional Ambulation category(Level IV to V),Timed 10 meter walk test(Self selected speed 0.6m/s to 0.9m/s and fast selected 1.3m/s to 1.5 m/s).Also subject reported increased satisfaction and participation in functional activities. Incidentally, after 7 weeks of treatment, the participant also reported being able to use both hands together and 'walk better'. After 77 complete sessions, subject reported significant and clinically meaningful improvement on all outcome measures. This study showed a positive trend in motor recovery even after seven years in the absence of natural recovery.
Conclusion(s): Even after seven years, the subject benefitted from intensive individualized FES and Integrated Physiotherapy program which resulted in positive outcomes.
Implications: The training was feasible and tolerated for 3 months with no adverse events. Eclectic model program that incorporates motor learning principles - goal oriented, practice, intensity and feedback focusing on functional needs is effective for patient with long term disability.
Implications: The training combination was feasible and tolerated for 3 months with no adverse events. Eclectic model program that incorporates motor learning principles - goal oriented, practice, intensity and feedback focusing on functional needs are effective for patients with longterm stroke.
Keywords: Eclectic/Integrated therapy; FES;, Post HELLP Stroke, FES
Funding acknowledgements: None
Topic: Neurology: stroke
Ethics approval required: No
Institution: KOVAI MEDICAL CENTER AND HOSPITAL
Ethics committee: kmch because study is case study
Reason not required: not RCT
All authors, affiliations and abstracts have been published as submitted.
