Category: Stroke

Executive summary

The Four-stroke diesel engine is a type of internal combustion engine whose operation involves four separate strokes that are completed by its pistons. These strokes are compression, intake, exhaust, and power (Cengel,Boles and Yalling 54). This paper analyzes the relationship between different parameters involved in the operation of the four-stroke engine. These parameters are speed, torque, power, and specific fuel consumption (Hardenberg 72).

The three graphs show the relationship between the specified variables. In figure 1, the curve shows that torque fluctuates with the magnitude of the speed. An increase in speed may either increase torque or decrease it depending on several factors such as exhaust and intake restrictions. In figure2, pressure fluctuates with the speed in such a way that an increase in speed may either lower or increase pressure. In figure 3, an increase in specific fuel consumption reduces pressure whereas a decrease in specific fuel consumption increases pressure (Cengel,Boles and Yalling 54.

At a higher speed (rads per second), torque primarily drops as a result of exhaust and intake restrictions. Volumetric efficiency reduces because the engine cannot take in more air for combustion. Mechanical efficiency also reduces when the speed ( rads per second) is high because of resistance from friction(Hardenberg19). From the graph, torque is lowest when the speed is at the highest point. After the maximum torque is attained, it starts decreasing while the speed increases. From this graph, it can be generalized that when speed increases, torque decreases (Cengel, Boles and Yalling 54)

The graph of speed in rad/sec vs power (W) shows the relationship between power and speed. There are two peaks. One peak shows that when speed is at the highest point, power is at the lowest point (Hardenberg 72). When the speed lowers, power starts to increase and maintains a rising trend as the speed increases gradually. At high speed, power momentarily drops due to exhaust and intake restrictions. At a reduced speed, power rises in order to overcome forces that oppose speed (Cengel,Boles and Yalling 77).

The graph of Power against specific fuel consumption in figure 3 shows that increased power occurs when the specific fuel consumption is low. Increased specific fuel consumption leads to decrease in power (Hardenberg 90). Specific fuel consumption refers to the mass of fuel required to provide a net thrust within a specified period of time. In most cases, mass of fuel is used instead of volume because of its independence from effects of temperature (Cengel,Boles and Yalling 54).

The specific fuel consumption in four stroke engine varies inversely to the effects of temperature, which in turn affect power directly. The specific fuel consumption varies inversely to power. When specific fuel consumption is high, the magnitude power lowers and when power is high, specific fuel consumption lowers (Cengel,Boles and Yalling 54).

From the three curves, different parameters that assist the four stroke engine to operate are related either directly, inversely or both directly and inversely. Power is inversely related to specific fuel consumption. Power is directly and inversely related to speed while Torque is both directly and inversely related to speed. Generally, the three curves can be used to analyze and explain how the four stroke diesel engine operates.

Works Cited

Boles, Michael ,Cengel, Yunus and Yaling, He. Thermodynamics :An Engineering Approach. Boston:The McGraw Hill Companies, 2009. Print.

Hardenberg, Horst. The Middle Ages of the Internal combustion Engine. London:Society of Automotive Engineers (SAE), 1999. Print.

Introduction

Strokes are one of the leading causes of death in many parts of the world. Consequently, it is essential to adopt procedures that lead to the accurate diagnosis of the condition. The CT scan is a primary mode of investigation of the disease. This report will determine its impact on the management of the condition within clinical and emergency settings.

Impact of CT scans on stroke diagnosis

A stroke is a condition in which one looses brain functions at a rapid rate owing to disruptions in blood supply in the cerebral region. The syndrome may result in physical symptoms, such as, the inability to control limbs on one side, uncoordinated speech, visual defects on one side of the body, pain, seizures, emotional inability, coma, loss of speech, muscle numbness, pneumonia, anxiety, or even death.

The latter effect may occur if the stroke persists for more than one day. All physical manifestations correspond to the part of the brain that the stroke affected. It should be noted that, during a stroke, clinicians can look out for symptoms, such as stiffness of the neck, convulsions and headaches, to diagnose the condition.

Since the effects of a stroke are dependent on the swiftness and response given, then it is essential to use a method of diagnosis that can be done quickly.

Therapeutic interventions depend on the stroke that clinicians identify. For instance, it may be thrombolytic, so this necessitates the use of anti- platelet therapy. Alternatively, it could be hemorrhagic, so this should lead to the use of agents like Nimodipine.

Early detection of the pathology of the stroke is essential in the therapeutic decision. The Computerized Tomography (CT) scan has assisted in the early identification of these pathologies, and thus facilitated timely treatment responses. If patients lack access to CT scanning technologies or other clinical detection methods, then they may get wrong treatment, which could lead to health deterioration.

The management of stroke patients has tremendously improved owing to the use of CT scans. Computerized Tomography scans assist in differentiating between the two key types of stroke; Ischemic or hemorrhagic. Hemorrhagic strokes emanate from burst blood vessels in the cerebral region while Ischemic strokes stem from the absence of blood flow in the same region.

Additionally, the scan can assist in location of which part of the brain the problem affects. It is also necessary to determine the severity of a stroke, and the CT scan also assists in this course of action. If the condition has ever occurred in the past, one needs to know the risk of future transient Ischemic attacks (a condition that mirrors symptoms of a stroke but reverses within 24 hours); CT scans assist in that process, as well.

Treatment methods for strokes are evidence-based. Therefore, clinicians ought to strive to make diagnoses that are as accurate as possible. Most modern methods used in detection lack the sensitivity and specificity of the CT scan. The CT scan aids in excluding or confirming the existence of a cerebral hemorrhage at an early stage. Consequently, clinicians can begin anti- platelet therapy on such patients if they find no hemorrhage.

Alternatively, blood pressure may be controlled, depending on the stroke subtype, if a clinician uses a CT scan. If medical facilities lack these technologies, then they might give patients anticoagulants when they have intracerebral hemorrhage, which is a serious mistake (Fiebach et al 530). Anticoagulants work by increasing the flow of blood, so they are inappropriate for a patient who already has a hemorrhaging problem.

There are conditions in which the CT scan is more useful than MRI scans or other detection methods. For instance, when a patient has a severe stroke and an immediate decision is imperative, then the easily-administered CT scan is superior to other methods. It can easily differentiate between the two key types of strokes mentioned earlier.

In fact, the short length of time required for the administration of CT scans explains why it is a superior method for patients with severe strokes. Before clinicians can administer thrombolysis drugs, they need to make a time-limited analysis, and the CT scan is quite useful for this purpose. Patients with low consciousness levels particularly rely on CT scans because this can contribute to the successful administration of treatment.

When treatment is necessary, certain physiological conditions are more effectively noted using CT scans than other methods. If the internal carotid artery possesses surgical stenosis, then a CT scan can be quite appropriate. Experts use the method for its specificity and sensitivity in this area. It provides an accurate visualization of plaque ulcerations or other defects on the arterial wall. Therefore, the method is critical in illustrating how the interior section of an arterial wall looks like.

The best application of a CT scan is in the detection of cerebral hemorrhage. The method has specificity of 89% and a sensitivity of 100%. Conversely, the MRI scan has a sensitivity of 81% and specificity of 100% (Nogueira et al. 870). As a consequence, the CT scan is more effective for hemorrhagic strokes.

This advantage stems from the superior visualization of blood vessels. Therefore, if one has ruptured a blood vessel or an arteriovenous malformation exists, then the CT scan will reveal it quite clearly. This category of strokes can be quite detrimental if left untreated. The presence of excess blood in the brain often leads to pressure build up, and brain damage, so it ought to be corrected as soon as it arises.

A CT scan is also desirable in instances where patient movement may be difficult to control. The equipment will still read through movement, and thus give useful images. Furthermore, the technology can be used even when a patient contains an implanted medical device. Other scanning technologies like MRIs are too sensitive to patient movement and will react to the presence of medical devices in the bodies of stroke patients.

Case studies

Scholars have carried out a number of case studies on the effect of CT scans on clinical outcomes, and most of them have demonstrated positive results. Goyal et al. (95) carried out one such study. The team wanted to find out whether CT scan appearance led to the improvement of time taken to recanalize patients in acute Ischemic strokes as well as in endovascular thrombectomy.

A patient with an Ischemic stroke undergoes treatment by recanalization of an occluded artery. Recanalization refers to the creation of new paths through a blockage in an artery. An institution may decide to use intravenous IV administration for treatment of acute Ischemic strokes. However, the latter path often leads to poor recanalization rates.

Conversely, one may use endovascular methods, which lead to high recanalization rates but low clinical outcomes. In order to determine the right treatment method, many institutions rely on baseline CT scans. The authors of the above case study went ahead and studied the effect of a favorable CT scan on the time it takes to recanalize. They found that if a CT scan score were less than or equal to 4, then a patient would not get positive outcomes from recanalization.

However, if the patient had a CT scan score of greater than 7, then they had better chances of benefiting from the recanalization. Additionally, if the CT scan illustrated that a patient had severe damage and a score of greater than 4, then they benefited from fast recanalization. The above study, therefore, shows that CT scans play a crucial role in boosting clinical outcomes for patients undergoing treatment.

Hill et al. (1612) also carried out research on how CT scans can enhance clinical effectiveness in the treatment of stroke. They focused on intravenous (IV) therapy as well as intra- arterial (IA) therapy for treatment of ischemic strokes. The authors explained that hospitals and patients spend a lot of resources on the administration of IV-IA therapy.

Therefore, it is always crucial to select the right patients first before taking them through this intensive procedure. Neuro- imaging, through CT scans, is an effective way of ensuring that clinicians select the right patients for treatment. In the analysis, they looked into the CT scores of 460 ischemic stroke patients. The authors compared the clinical outcomes of patients with unfavorable baseline CT scan readings to the ones with unfavorable and neutral scores.

They found that those individuals whose CT appearance was favorable, had a higher success rate during the treatment of the stroke (through IV-IA therapy) than those without an unfavorable outcome. Consequently, this research also proves that medical imaging using CT scans can aid in the selection of the right patients for treatment of the disease.

Limitations of the CT scan

CT scans have their limitations, as well; clinicians cannot diagnose Ischemic strokes unless these have occurred 6 hours before, which undermines the application of the method. The presence of blood clots or lesions principally cause Ischemic strokes. CT scans are not effective in visualizing these lesions, especially because the lesions could be secondary or acute.

Nonetheless, if early signs of ischemia already exist and more accurate methods of detection are unavailable, then clinicians may opt for the use of a CT scan. Statistics indicate that MRI scans have a sensitivity of 83% and specificity of 98% when assessing ischemic strokes. Conversely, CT scans only have a sensitivity of 16% and specificity of 96% when used for this same purpose.

CT scans cannot assist in understanding the symptoms behind complicated strokes. If a clinician is uncertain about the location of the stroke, then a CT scan cannot shed more light on it. In this circumstance, it would be more effective to rely on an MRI scan. The latter method provides more details of brain tissue than CTs.

Conclusion

CT scans support the treatment of patients with strokes by facilitating fast detection of the nature of the stroke. They are particularly useful when the concerned individual has a hemorrhagic stroke.

The technology also assists in selecting the right patients for treatment of ischemic stroke thus leading to more successful outcomes. Nonetheless, this form of medical imaging has its limits as it has low sensitivity when analyzing complex strokes or diagnosing ischemic strokes. Therefore, CT scans should be used to complement other imaging technologies and in the above-mentioned cases alone.

Works Cited

Fiebach, J, P Schellinger & A Gass. Stroke Magnetic Resonance Imaging is Accurate in Hyper Acute Intracerebral Hemorrhage: A Multicenter Study in the Validity of Stroke Imaging. Stroke 35.2(2004): 502-506. Print.

Goyal, Mayank, Bijoy Menon, Shelagh Coutts, Michael Hill & Andrew Demchuk. Effect of Baseline CT Scan Appearance and Time to Recanalization on Clinical Outcomes in Endovascular Thrombectomy of Acute Ischemic Strokes. Stroke 42(2011): 93-97. Print.

Hill, Micheal, Andrew Demchuk, T Tomsick, Y Palesch & J Broderick. Using the Baseline CT Scan to Select Acute Stroke Patoents for IV-IA Therapy. American Journal of Neuroradiology 27(2006): 1612-1616. Print.

Nogueira, R, A Yoo, F Buonanno, J Hirsch. Endovascular Approaches to Acute Stroke: A Comprehensive Review of Studies and Trials. American Journal of Neuroradiology 30(2009): 859-875. Print.

Search strategy

Medline database was reviewed for articles with information on stroke since 1995 utilizing the following main terms: medical trials, stroke events, and aspirin. Also, the American Medical Association and published list comprising of Anti-platelet Trials Association was searched to seek randomized medical trials complying with these stipulations. Of six medical trials searched, five were incorporated in the key evaluations since the remaining diminutive case trial did not evaluate stroke events as per the treatment guidelines. Of the 5 articles, an inclusion/exclusion criterion of the number of participants was utilized with a view of selecting the most relevant article from the search. In addition, a computerized review utilizing the following main terms: population, and epidemiological, was performed, the five articles were in addition reviewed, and one study was identified.

Study quality

Methodological quality

The quality of the methods utilized in this randomized controlled trial would be analyzed using the Critical Appraisal Skill Program Tool. The authors focused on identifying all published randomized medical trials examining the impact of aspirin in all doses versus placebo used for the major treatment of stroke and related conditions in people without medically visible vascular infection. Medical tests in which over 25% of the contributors had medically detected vascular infection, participants who did not indicate stroke results, and participants without detected stroke events were not evaluated.

In addition, any subgroup of participants in major treatment tests that had vascular infection was excluded for minor evaluations. Also, a medical test in which aspirin was utilized together with other anti-platelet tests was excluded. Together with randomized medical tests, large, potential observational researches were evaluated in isolation with a view of weighing up the impact of the normal application of aspirin on stroke events in an inclusive view of people using broadly varied aspirin doses (Hart et al., 2000, p. 2). Based on the Critical Appraisal Skill Program Tool for randomly controlled tests, the following questions and responses are necessary for appraising the study.

• Did the study ask a clearly-focused question?
  • Yes Cant tell No
• Was this a randomized controlled trial (RCT) and was it appropriately so?
  • Yes Cant tell No
• Were participants appropriately allocated to intervention and control groups?
  • Yes Cant tell No
• Were participants, staff and study personnel blind to participants study group? Yes Cant tell No. Double blinding, that is to both intervention and control groups was ensured with a view of protecting against any likelihood that insight may influence participant feedback.
• Were all of the participants who entered the trial accounted for at its conclusion?
  • Yes Cant tell No
• Were the participants in all groups followed up and data collected in the same way?
  • Yes Cant tell No
• Did the study have enough participants to minimize the play of chance?
  • Yes Cant tell No
• How are the results presented? And what is main result?
  • The outcomes of the randomized medical tests were put together utilizing a grouped Mantel Hansel approximate based on 0.95 confidence levels (CLs) and odds ratio. Evenness of the merged outcomes was examined through the Breslow assessment, and verified utilizing an arbitrary effect framework for confidence level and odds ratio because stroke levels were low. A calculation was done utilizing SAS (Hart et al., 2000, p. 3). The main outcome is that the impact of aspirin use on stroke events varies between persons based on the availability or non-availability of evident vascular infection.
• How precise are these results?
  • Combined evaluation of five randomized medical tests comprising more than 50 thousand participants examining aspirin use for major treatment indicates no general impact on stroke condition, an outcome inconsistent (p = 0.001) with the clear impact of aspirin use in reducing stroke by almost 0.25 for people suffering from vascular infection. While existing data are possibly confused with variations in aspirin dosage and gender, the data support the premise that in those people suffering from key vascular risk elements, the effects of aspirin use may be halfway between people suffering from vascular infection and people without such infections (Hart et al., 2000, p. 10).
• Were all important results considered so the outcomes can be applied
  • Yes Cant tell No

Biasness

Bias refers to fault or variation in outcomes. The following section describes the kind of bias that affect or is avoided during the reporting of this study.

• Is the quality of the study so poor that any observed effect(s) can be explained by the biases?
  • Yes No
• All things considered, is the study of sufficient quality (i.e. sufficiently valid) to warrant its use to inform practice?
  • Yes No

Study results

Recruits ranged broadly between medical tests, from healthy male practitioners to persons suffering from diabetes or high blood pressure or males having stroke risk elements. Death levels varied from 0.4-3 percent a year, with an average of 1% per annum. Combined effect on participants having detected vascular infection (i.e. higher risk) utilizing the Anti-platelet trials relationship generated a 0.27 reduction (0.73; 0.95 CL, 67%-79%) in stroke utilizing aspirin.

This effects are inconsistent with the effects of utilizing anti-platelet in the five medical tests of major treatment (p = 0.001). Combined assessment of four such medical tests indicate stroke levels of 0.7% a year on average, and aspirin use linked to a 0.35 reduction in the occurrence of stroke events at 0.95 CL for a reduction of 0.5-0.9 (Hart et al., 2000, p. 6).

Clinical significance of study findings

It is not clear whether aspirin use can absurdly boost the chance of acquiring stroke in some people at minimum internal risk. This was first proposed through the findings of two extensive major treatment tests comprising of male practitioners. The effects of aspirin use on stroke differ for people depending on the availability or non-availability of vascular infection. The general impact of the frequent utilization of aspirin in major treatment of vascular conditions in old people is not known because randomized medical tests so far have targeted mostly mid-aged people who have lower likelihood of suffering from stroke.

Permanent aspirin consumption boosts the occurrence of stroke, but the probability is less (roughly 0.0005 aspirin consumers a year for old people). Due to a clear impact in reducing pain in an extensive spectrum of dosages, aspirin utilization for major treatment would aid most people at unique threat of vascular infections. In conclusion, the effects of aspirin use on stroke are difficult, varying in various people population groups, and additional research of the risk factors causing those variations would enable modification of treatment with this broadly-utilized therapy.

Reference

Hart, G., Jonathan, H., McBride, R., Oscar, B., Malcolm, M., & Richard, K. (2000). Aspirin for the primary prevention of stroke and other major vascular events: Meta-analysis and hypotheses. American Medical Association, 57(3), 326-332.

Objectives and Importance of a Teaching Plan

In the modern world where people are exposed to numerous threats, it is vital to be informed and educated in the areas which might affect a persons life and wellbeing. Since stroke is one of the most frequently occurring health conditions in the community, it is essential to understand the statistics, the level of problem severity and its main influential factors. As information might occur to be the most powerful weapon, one should learn the signs and symptoms of stroke to be ready to identify it in others and provide the timely help. In the case of stroke, fast action is the key to saving lives and preserving chances for the healthy life after stroke.

Statistical Data of Stroke Prevalence in the Community

According to the statistical data available about stroke prevalence, the population at the highest level of risk are adults in the age of 25 and older (Yang et al., 2017). Since 2013, stroke is the fifth leading cause of death in the country; also, this condition often leads to disabilities as the aftermath of the incident (Yang et al., 2017). Over the last few decades there has been a rapid decline in the number of strokes experienced in the community, as well as in the USA in general. However, the latest research examining stroke occurrences between 2000 and 2015 shows that the decreasing rates are slowing (Yang et al., 2017).

This tendency emphasizes the need for more accurate addressing of the issue not only in the professional spheres but also among communities to provide citizens with necessary information about the discussed condition. Moreover, many organizations raise awareness about stroke and develop specific programs aimed at immediate stroke treatment.

What are the Causes of Stroke?

There are multiple causes of stroke in adults, which could be categorized into main groups of risk factors influencing the occurrence rate of the condition. According to Boehme, Esenwa, and Elkind (2017), there are two main groups of risk factors: non-modifiable and modifiable ones. Non-modifiable risks are the ones that cannot be influenced and embrace such characteristics as age, gender, genetics and others. As for modifiable factors, they incorporate medical conditions, such as previously experienced diseases or health particularities which demand specific caution, and behavioral patterns constituted of habits, lifestyle, and everyday life decisions of a person. It is important to address modifiable risk factors to minimize the chances of stroke occurrence and prolong ones healthy life.

How to Identify a Stroke?

When a person experiences a stroke, the most frequent reason for mortality is a failure to timely identify the condition and implement immediate care. Centers for Disease Control and Prevention (CDC) provides a concise list of symptoms that indicate the need for urgent actions (Stroke signs and symptoms, 2018). The main stroke signs include unexpected numbness or weakness in face or body parts, difficulty uttering or perceiving speech, trouble seeing, loss of coordination and dizziness when walking, and sudden headache. Remembering these symptoms might help identify stroke immediately and increase the chances of saving a life.

What to Do if Someone Has a Stroke?

Immediate actions are the foundation of successful treatment of stroke. As suggested by CDC, F.A.S.T-approach is the most effective in the provision of first help to an individual suffering from stroke (Stroke signs and symptoms, 2018). Firstly, one should ask a person to smile; if one side of the mouth is directed down, it is a sign of stroke. Secondly, one should ask a person to lift both arms; a person experiencing stroke will likely raise only one hand. Thirdly, ask a person to repeat a simple phrase; the speech of a person suffering from stroke will be unclear and confusing. Lastly, if the sings were detected, one call emergency, thus contributing to timely medical help for the person.

How to Prevent a Stroke?

Despite high rates of occurrence and the overall risk of the adult population to be exposed to this chronic condition, it is possible to influence modifiable risk factors and prevent stroke. The majority of guidelines for stroke prevention are aimed at the promotion of health conditions awareness and changes to a lifestyle. It is even more important for older people due to the higher level of exposure to diverse risks and health impairments. The older a person becomes, the more time and effort he or she should pay to the overall health and the possible ways of its improvement.

To prevent stroke, adults should maintain a healthy lifestyle; the stepping stone of good health is balanced and nutritious dieting on an everyday basis. One should eat more fruit and vegetables, incorporate diverse nutrients in a diet, and maintain regular food consumption. It is also vitally important to do sports or at list exercise regularly to improve the working order of body systems and strengthen the cardiovascular system (Preventing stroke: Healthy living, 2018). A crucial aspect of stroke prevention is the elimination of harmful habits and behavioral patterns. To minimize stroke risk, one should refuse from smoking and alcohol consumption. Adhering to these simple rules will guarantee longevity, well-being, and will keep the danger of stroke away.

Concluding Points

In summary, it has been stated that stroke causes death and disabilities in adults after 35. During the latest decades, the occurrence rate has stopped reducing and the threat of stroke has become an acute healthcare issue. Today, the statistics of mortality causes places stroke on the fifth position which makes it a dangerous chronic condition requiring urgent actions in terms of treatment and prevention. Since there are modifiable and non-modifiable risk factors, it is vital to address modifiable ones to prevent the condition. Acting F.A.S.T will help in the identification of stroke symptoms and the provision of timely medical treatment. To minimize the risk of stroke, one should lead a healthy lifestyle and be aware of the influential factors.

References

Boehme, A. K., Esenwa, C., & Elkind, M. C. V. (2017). Stroke risk factors, genetics, and prevention. Circulation Research, 120(3), 472-495.

Preventing stroke: Healthy living. (2018). Web.

Stroke signs and symptoms. (2018). Web.

Yang, Q., Tong, X., Schieb, L., Vaughan, A., Gillespie, C., Wiltz,J. L., & George, M. G. (2017). Vital signs: Recent trends in stroke death rates  United States, 20002015. Morbidity and Mortality Weekly Report, 66(35), 933-939.

Stroke is one healthcare issue that requires quick medical attention to avoid death or adverse health outcomes for a patient. Therefore one of the methods that the US government uses to ensure quick access to healthcare services for stroke patients is telehealth. However, less is known concerning the effect of telehealth services in improving the health outcomes of stroke patients. This study aims at evaluating the effectiveness of telehealth in addressing stroke, its outcomes, and its impact on clinical health systems.

Halbert, K., & Bautista, C. (2019). Telehealth Use to Promote Quality Outcomes and Reduce Costs in Stroke Care.Critical Care Nursing Clinics of North America, 31(2), 133139. Web.

Halbert and Bautista researched to evaluate the impact of telehealth services helping to promote the quality of outcomes and reduce costs of stroke care. Stroke is a severe disease that can cause disability or death if not quickly treated (Halbert & Bautista, 2019). Therefore stroke patients, especially those with ischemic stroke, need quick administering of intravenous thrombolytic within a short period to improve patient outcomes. According to evidence-based studies, patients who receive thrombolytic therapy within the first three hours of symptom onset are likely to have better health outcomes. However, only 3.7% of Americans receive this therapy on time, given that a large population lives in rural areas (Halbert & Bautista, 2019). There are four neurologists for every 100,000 people in the US, and most of them are based in urban areas (Halbert & Bautista, 2019). Transferring patients from the rural is time-consuming and expensive and, therefore, may lead to the lapse of the three-hour treatment window, after which the stroke may damage the brain. This has resulted in corresponding figures showing 20% more stroke deaths in rural areas than in urban areas (Halbert & Bautista, 2019). Therefore, for the people in rural areas to get effective care, they have to rely on telestroke heavily.

American Stroke Association has approved Telestroke for use because it enables tele-neurologists to assess, visualize, converse with a patient, and develop a treatment plan based on the patients current history, current presentation, risk factors, and expected outcomes (Halbert & Bautista, 2019). Hospitals that offer telestroke services have a live consultation service with vascular fellowship-trained neurologists, enabling ongoing education and real-time consultation, leading to improved outcomes. This shows that telestroke helps to improve patient outcomes and ensures that their services are more efficient and accessible using telestroke.

Patients with stroke require quick interventions. However, it is important to ensure an accurate stroke diagnosis because many other conditions can imitate stroke symptoms. Therefore, telestroke provides neurologists in the comprehensive stroke hub with data and other relevant information, which helps bedside healthcare practitioners in decision-making (Halbert & Bautista, 2019). The ability of face-to-face examination and real-live transmission of remote images using the Picture Archiving and Communication System (PACS) enables accurate decision-making, hence quick intervention improving the quality of outcomes.

Zerna, C., Jeerakathil, T., & Hill, M. D. (2017). Telehealth for Remote Stroke Management. Canadian Journal of Cardiology, 34(7), 889896. Web.

Zerna, Jeerakathil, and Hill conducted another study in Canada to determine the effectiveness of telehealth services in diagnosing and treating stroke. Stroke is the fourth leading cause of death and the leading cause of adult disability in Canada (Zerna et al., 2017). This can be attributed to the vast geographical distance between the patients and the neurologists expertise. Telestroke is essential in the diagnosis and determination of the effective treatment method. However, for the treatment method to be implemented, it is important to know the main cause of the stroke. One of the tools used in measuring the severity of the stroke is the National Institutes of Health Stroke Scale (NIHSS), which sums up the score from different 11 domains and can range from 0 to 42 (Zerna et al., 2017). A score of five or less shows that it is a minor stroke, while a score of 15 and above may indicate a major stroke (Zerna et al., 2017). A study was conducted to determine the effectiveness and reliability of telehealth in examining patients using NIHSS compared to bedside examination. The study conducted in Germany revealed telehealth to be good to excellent in testing all stroke subgroups within the first six hours (Zerna et al., 2017). Another study conducted in the US found that telestroke does not have a difference of more than three points between bedside testing and using telehealth, showing that it is an accurate method of diagnosis of stroke.

Another important technique is computed tomography, an imaging technique for differentiating between haemorrhagic and ischemic stroke. Studies have been conducted to determine the accuracy and reliability of telehealth services in measuring these services. A study was conducted in Germany whereby two neurologists were given CT scans of nine patients, and their disagreeing rate was 1.7% (Zerna et al., 2017). Another controlled, randomized study was conducted in Arizona, the US, using 54 subjects and found that telestroke services effectively assess, make decisions, and treat stroke. This shows that telestroke services can provide a quick and accurate interpretation of store results. This, in turn, leads to timely treatment, which improves the outcomes quality. Therefore, telestroke helps in the quick diagnosis and treatment of stroke, hence improving patient outcomes.

Sharma, R., Nalleballe, K., Kapoor, N., Dandu, V., Veerapaneni, K., Yadala, S., Jasti, M., Siddamreddy, S., Onteddu, S., & Brown, A. (2020). Telestroke: A New Paradigm. Ischemic Stroke. Web.

Sharma et al. examine the use of telestroke in the US by analyzing how technology has helped in improving care. In one section, the author examines the effectiveness of telestroke in the management of acute ischemic stroke. The study found that telestroke helps improve healthcare outcomes by eliminating the TPA window, which enables stroke patients to receive adequate care without transporting them to healthcare facilities during the first few hours since the onset of the symptoms significantly affects the outcomes (Sharma et al., 2020). According to the study, the adequate training of NIHHS has proved to be reliable when it is integrated with in-person measurements. Teleradiology enables rapid evaluation of stroke images and helps in the decision-making process. The use of telestroke in rural hospitals helps reduce the time between the onset of symptoms and needle time compared to those in tertiary hospitals. According to a controlled non-blinded randomized study in Germany, patients treated in rural telestroke network hospitals had better outcomes than those treated in rural hospitals telestroke capabilities (Sharma et al., 2020). This shows that telestroke is a cost-effective method of reducing the need for transporting patients to urban expensive tertiary hospitals.

The other factor that the study evaluated was telestroke outcomes on patient health. Sharma et al. (2020 ) noted that there were no significant differences between patients treated directly by a neurologist and through telestroke services after 90 days (Sharma et al., 2020). The study also found that the average time between the onset of the symptoms and treatment at the hub site was relatively long compared to the time in telestroke. The earlier the diagnosis and treatment, the decreased the time of stay at the hospital. Therefore, telestroke was found to have rapid diagnosis and treatment, leading to a shorter stay in the hospital and better outcomes. The shorter stay in the hospital led to fewer costs; hence telestroke is cost-effective.

Lindley, R. I. (2020). Telemedicine is improving outcomes for patients with stroke. Medical Journal of Australia, 212(8), 364365. Web.

To enhance the inclusivity and diversity in this paper, the last article was based on telestroke in Australia. Lindley (2020) conducted a study in Australia to determine how telemedicine improves outcomes for stroke patients. The author evaluates the Victorian Stroke Telemedicine program after its first 12 months and its impact on more than 6000 patients (Lindley, 2020). The results of the study revealed that there was less delay in administering thrombolysis for ischemic stroke patients after the program was rolled out. Additionally, the patients with symptomatic intracranial haemorrhage were reduced from 16% to 4%, and the number of deaths from 20% to 6%, indicating safety improvement (Lindley, 2020). Since not all clinicians can administer thrombolysis, the telestroke helps in facilitating the correct administration of thrombolysis. Computed tomography scanners and public health campaigns have enabled the implementation of thrombolysis by having thrombolysis data for over 80% of patients with stroke (Lindley, 2020). This shows that technology has significantly contributed to the advancement of telstroke.

Early treatment of stroke is important and leads to better health outcomes. A one-minute delay in stroke treatment leads to the loss of 12 kilometers of myelinated fibers, 14 billion synapses, and 1.9 million neurons. The Victorian Stroke Telehealth has enabled to reduce this loss and improve health outcomes by having effective leadership and appropriate financial backup. Therefore, according to this study, telestroke services have helped improve health outcomes for stroke patients.

From the four studies, telestroke has proved to help ensure rapid diagnosis and treatment of stroke. In fact, the study by Sharma found that telestroke was more effective in accessing a neurologist than going to the treatment hub. Telstroke has also proved to have better health outcomes by timely administration of thrombolysis which saves the loss of myelinated fibbers, synapses, and neurons. Finally, the studies have revealed that telestroke is also cost-effective because early diagnosis and treatment leads to quick intervention, decreasing hospital stay. Therefore, telestroke is an effective method in treating stroke and has proved to improve the health outcomes of the patients.

NIH Stroke Scale is a tool that is primarily used internationally to assess the cognitive effects of stroke. It can scientifically be described as the quantitative measure of stroke-associated neurologic deficit. Before this scale, other scales were in use, but with the help of videos available on how to efficiently use the scale, it has led to it being adopted internationally. The tool was developed as clinical equipment to research stroke patients, but lately, it has been incorporated into the health care sector by specialists to determine stroke severity. The scale is vital as it creates a common language among all the practitioners responsible for treating stroke patients. In the treatment procedure, the scale has three main functions: predicting the patients outcomes, determining the appropriate treatment, and evaluating the severity of stroke.

The scale comprises several elements that are vital in evaluating a specific ability. The scores for every ability are given a number between 0 and 4, with zero being a normal functioning and four as total impairment (Purrucker et al., 2017). The highest score possible is 42, and the scores are derived by adding the numbers of every score on the scale. When the score is high, so is the severity of the impairment the stroke patient. Although the scale has proven to be helpful over the past, it has developed complications in determining stroke index in the cortex area of the brain by giving a less accurate prediction. With a score higher than 16, there is a high possibility of death, and with a score of 6 or lower, the probability of recovery is high.

The NIH Score is essential to patients as it determines the course of treatment and action to be taken once a stroke has been identified. The scale is applied at the onset of stroke-like symptoms, which is basically in the emergency department. When patients conditions change significantly, the scale is then applied at regular intervals as described by the physician. Additionally, it is essential to keep the patients records in order, monitor the progress, make amendments to the treatment where necessary, and quantify the improvement or decline with time.

As mentioned above, the scale contains several elements containing a specific action used when reading the scale. According to Purrucker et al. (2017), these elements are grouped according to their importance, and the first one is the level of consciousness. This element evaluates responsiveness and alertness through asking simple questions and following simple commands. Best gaze analyses the ability to move ones eyes normally. Visual element tests the ability to see things that are not directly in front of the patient. Facial palsy is the ability to move facial muscles with actions like raising the eyebrows. Motor arm and motor leg test the capability to hold arms up for a given time and rotate the legs at a certain angle. Limb ataxia examines any damage in the cerebellum, the motor center of the brain. Sensory scale determines the sensory abilities, while best language evaluates the amount of damage the stroke has caused on language abilities. Dysarthria examines the level of overlapping in ones speech. Lastly, extinction and inattention evaluate the attention levels the patient gives to their surroundings.

Stroke location affects the stroke severity as people with the condition on the left hemisphere have high scores than those with it on the right hemisphere. The NIH Stroke scale is most preferred for predicting outcomes for patients with the disorder located on the left hemisphere. With this knowledge, both the physician and the patient are better suited to learning about this scale and can comfortably use it without fear of misleading results or technical complications.

Reference

Purrucker, J.C., Härtig, F., Richter, H., Engelbrecht, A., Hartmann, J., Auer, J., Hametner, C., Popp, E., Ringleb, P.A., Nagel, S. and Poli, S. (2017). Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: The shortened NIH Stroke Scale for emergency medical services. BMJ Open, 7(9), e016893. Web.

Introduction

Sit to Stand (STS) movement is believed to be one of the most demanding activities. The given activity can be described as the process of standing up from a chair or any other object to an upright posture. It is a movement with great clinical interest that helps in defining an individuals motor and functional level. This movement requires an individual to move from a sitting position that is a more stable 3 point base to a standing position that is a less stable 2 point base (Tully et al., 2005).

Thus, it requires more muscle strength. In addition, it involves peak joint moments and yields greater hip joint contact pressure, which sets the difference between a sit-to-stand process and any other activity involving movement. Stroke is the leading cause of disability in the world. Because of the changes that a human body undergoes because of impairments and the subsequent treatment, the organism becomes highly susceptible to any outside factors, especially mechanical ones.

In addition, inside and outside factors that cause mechanical effects are likely to have rather a tangible effect on a human body. That being said, it can be supposed that movement changes as a kind of an inside mechanical factor may both be the cause and the effect of the impairment.

Impairment is due to the kinetic and kinematic changes that cause one to be incapacitated in the performance of STS movement whereas functional limitation influences the ability to remain independent and relates to the quality of life. This paper will discuss both kinetic and kinematic changes of sit to stand position following stroke. Therefore, to complete the research, it will be required to identify compensatory patterns and clinical implications to quantify the functional limitations by the effect of foot positioning and height of the seat.

The change of posture in STS has three aspects. They are flexion, an extension of a trunk, and extension of the legs which is essential for normal movement. STS kinetic and kinematic parameters are relevant in the assessment of functional recovery and the effects of the intervention. Some of how stroke affects an individuals STS movement include causing a slowdown in bodily functions, the center of pressure (COP) displacement, asymmetry of the kinematics of the persons joints, asymmetry of joint moments, disproportionate support of body weight & force over the heels and the need of support of the person (Janssen et al., 2002).

Patients suffering from chronic stroke have serious issues arising from an inability to balance their weight during the performance of STS movement and is mostly due to asymmetry of kinetics and kinematics (Hesse et al, 1994a). Having the capacity to control ones weight when one is standing requires the proper functioning of the central nervous system. Some stroke patients are completely unable to perform the movement whereas others require some assistance or are completely slow in their performance.

The types of performance that require assistance may include the strength of the muscle and the balance of a person. Getting up from a sitting position to a standing position leads to instability in hemiplegia due to the displacement of the center of gravity (COG) within the base of support (Eng and Chu, 2002). It is required to control the equilibrium deviations due to the unequal distribution of body weight. Also, the ability of a person to execute STS depends on various factors which include the height of the chair, with or without armrest, the tilting position of the chair, speed of the movement, and the position where one has placed their feet.

In addition, the age and the strength of the lower limb of an individual also determine the ability of a person to perform the STS movement. Asymmetrical bodyweight distribution is related to impaired balance, increased expenditure of energy and may be associated with a high risk of falls and fractures. Balance and stability in the performance of this movement are important in guaranteeing the safety of an individual. Thus the main aims of rehabilitation are ensuring that patients can have a symmetrical weight-bearing and to improve their speed with balance and stability on their performance of STS movement.

The study of Galli et al., (2008) reported both kinetic and kinematic parameters in 13 normal and 7 right hemiplegia subjects which is suitable for clinical application. The study selected 8 camera optoelectronic systems for evaluation of kinematics and used two force platforms for kinetic evaluation, a pair of pressure-sensitive switches on the seat placed in contact recording, and a synchronized video system.

Temporal, kinematic, and kinetic parameters were recorded. The chair used in the study have no armrest and the subjects were asked to cross the arms in front of the chest to prevent upper limb movement and to evaluate forward trunk movement. The data were collected in 2 to 5 trials with a break. Based on the study the subject prepared to seat off is the preparation phase, the seat off happens and vertical acceleration is converted to deceleration in ascending phase.

The final phase is stabilization the subject begins the phase reaching quite standing. Since Lee et al (1997) defines STS movement as a movement that alters one position from the position of sitting to a standing, which involves the movement of the center of mass without loss of balance, in the sitting position, the center of mass (COM) is more stable where it acquires the highest position in the ascending phase. Therefore, this movement leads to instability in hemiplegia due to the presence of kinematic and kinetic asymmetry between the left and right side: Common approaches to evaluating asymmetrical movement in hemiplegia include measures of kinematics and kinetics (Taguch, Igarashi & Mori, 1994, 263).

Temporal and kinematic changes

In the findings of Galli et al., (2008) the time taken by stroke patients (3.89 seconds) to stand up was 60% longer than normal subjects (2.42 seconds) due to compensatory pattern addressing muscle weakness of the lower limb:

STS requires some skills, such as coordination between the trunk and lower limbs movements, correction of muscles strength, control of equilibrium, and stability and it is often considered into clinical evaluation scales of different pathologies. In literature, although some studies are focused on STS, the essential functions of standing up are not well standardized and uniformly defined: for this reason, its application in clinical centers is difficult. (Galli et al., 2008, 80)

Thus, the execution of STS mainly done by the unaffected limb required a longer period for standing up and need to stabilize during limb extension: It requires significant torque and range of motion at the knee joint and to a lesser extent the ankle joint (Galli et al., 2008, 80). In particular, ascending phase took double the duration (2.16 seconds) to maintain balance in the stabilization phase, as Tully, Footahabadi & Galea (2005) also state.

In cases where the patients were unable to stand from a sitting position, the Peak angular velocity was also relatively low at the knee and the hip((Osman, 2011)?). Especially to improve the stability at seat off and during standing up, affected individuals showed an excessive trunk forward flexion movement. During the preparation phase, there was an excessive inclination and rotation in the forward and transverse plane and the trunk was shifted more towards the affected side.

As a result, the shoulder on the affected side had a high range of motion in all planes (shoulder tilt, obliquity, rotation was 42.1 (27.28), 7.34 (4.08), and 7.45 (5.41) degrees respectively) and was more forward than the normal side during the ascending phase (Tully et al., 2005). This finding of initial trunk flexed position and increased duration in limb extension was supported by Schenkman et al., (1990) who specified the elements of a momentum transfer strategy in which the momentum generated by the upper body is later on used in kinematic changes. Unlike Tully, however, Schenkman et al. did not relate their paper to impairments, providing a full overview of the kinematic changes around the hip. Moreover, as the results of shoulder tilt, ankle movements indicated an excessive dorsiflexion movement.

This movement can be used as a strategy to align the forward displacement of the center of gravity with the supporting area of the foot and improved the stability, as Schenkman et al (1990) claim. In patients following chronic stroke, poor coordination in the creation of momentum is also a factor that may lead to failure in the execution of STS movement. This is particularly useful in cases a training strategy that targets the temporal characteristics may be beneficial. All this was indicated represents the asymmetrical distribution of kinematics between hemiplegic and normal limb.

Kinetic changes

Although there was no change in peak support moment (Schenkman et al., 1990, 58), increased duration of the maximum support moment was observed during the initial more flexed trunk position. Using the trunks maximum flexion strategy (flexing the trunk towards the knee before standing from the chair), the knee joint moment is decreased by 27% compared to normal subjects. The kinetic parameters represented a strong asymmetry between the peak vertical ground reaction force (normal side 6.67 N/kg and 4.73 N/kg hemiplegic sides) and Anteroposterior ground reaction force ( a normal side -0.77 N/kg and -0.31 N/kg hemiplegic side).

It was also confirmed by a maximum joint moment of the knee (normal side 0.87 N m/kg and hemiplegic side 0.39 N m/kg) and maximum joint moment of the ankle (normal side 0.52 N m/kg and hemiplegic side 0.35 N m/kg). This highlighted more force distribution on the normal side and fewer joint moments on the hemiplegic side. In comparison with normal subjects, hemiplegic subjects demonstrated lateral force asymmetry. The maximum forces beneath the hemiplegic side heel were 37% body weight and the mean hell value was 21%. The maximum forces beneath the normal side heel, i.e., the non-flat, were 63% body weight, and the mean heal value was 42%.

The new issue, new paragraph? The maximum ankle power of the unaffected and affected side of 0.09 w/kg and 0.08 w/kg respectively represented low capacity of bilateral propulsion. Cheng et al., (2004) classified the phases based on the changes in vertical ground reaction force in stroke patients by the force plates. Phase one is the initial phase which starts when the vertical reaction force is decreased at the beginning of trunk flexion.

Serving as the execution phase, which starts once the vertical force reaches its maximum and ends when peak vertical momentum has been reached, phase two is also crucial for the process. Phase three is the standing phase begins at the moment of peak vertical momentum and ends with the stabilization of vertical force with body weight and achieves stable standing. As a result of this compensatory mechanism, stroke patients decrease the speed of ascent during the STS task.

Effects of kinematic and kinetic changes of STS in gait

To evaluate the effects of kinematic and kinetic changes in the STS Gail, it is important to keep in mind that there is a significant relationship between the functional movement of STS and gait speed (Berger et al, 1988). The duration of STS movement in stroke patients is a main predictive for gait speed and symmetry. According to Ahmed and Ahmed (2008), STs dysfunction experienced due to the kinetics and kinematic changes in stoke patients joints located on the lower limbs has a direct influence mainly during the walking process. Therefore, during the first phase of the Sit to stand cycle, the mean value of maximum ankle angle for hemiplegia was greater than the normal individuals.

These patients registered a decrease in the dorsiflexion of the ankle when they start walking. This happened because of the paretic weakness of plantar flexors. The reduction in ankle dorsiflexion caused the knee joint to have more flexion. Simultaneously, flexion of the hip and knee joints was reduced in these cases. A similar mobility style was registered on the other side where the lower limbs were not affected. However, this similarity was not due to paretic muscle weakness.

It was because of the heightened mechanisms in co-contraction. As a result, asymmetry in the kinetic and kinematics in STs movement influences over increased stride time and decreased walking speed with decreased single limb support and increased double limb support. Chou et al., (2003) findings suggested that the chronic stroke patient who could stand up from a sitting position for less than 4.5 seconds and had a vertical ground reaction force asymmetry of less than 30% could have a better gait performance. This includes increased velocity, stride time, and single support. This highlighted completing the STS movement in a safe and controlled manner which is a basic requirement for normal daily living.

The integration of gait analysis from STS is significant clinically during the execution of movement and to identify and monitor Neuro-motor treatment. In addition, gait speed also influences the fall risk of a person. A slow rate of STS is an important tool in the foretelling of further disability in a patient. The transfer of more weight on the unaffected side causes the patients to limp and resulted in stiffed hip and knee gait.

This highlights the weakness of the affected side compensation mechanism by unaffected limb due to the asymmetrical distribution of the anteroposterior force, vertical force, and lateral distribution of the force. Considering the differences in weight-bearing parameters and characteristics of stroke affiliated patients and normal people, stroke patients portrayed asymmetrical weight-bearing may lead to disequilibrium during sit-to-stand actions. Instructions and training to perform better through practicing on standing symmetrically portrayed improvements on the symmetry of weight-bearing and to prevent poor balance ability (Janssen et al., 2002).

Effects of foot position and height of the chair in rehabilitation

Understanding the biomechanical abnormalities in the STS task can provide a rationale for the therapist to target their treatment to the appropriate areas. Therefore, Various methods of measuring the effects of the determinants have also elicited different reactions to increase symmetrical weight-bearing in rehabilitation. Some scholars have ventured into the biomechanical factors that affect the ability of patients with chronic stroke when they are rising from a sitting position to a standing position. The foot position, the height of the chair, and the tilting of the chair have all elicited different reactions from various clinicians.

Height of the seat

Various clinicians use chairs with different heights. For instance, chairs with 40 and 43 cm are commonly used for assessments (Whitney et al., 2005, 1034). For the successful execution of STS for elderly people appears to be 120% of their lower leg length ( Janssen et al., 2002). When sitting on low chairs, patients with chronic stroke experience an increase in their trunk flexion angular velocity and hip flexion angular velocity which can make STS activity unsuccessful. During rehabilitation, the alterations in the height of the chair affect the biomechanical demands of an individual. Alteration in the height of a chair affects the maximum moment that is required at the hip and knee to enable one to rise from a sitting position (Janssen et al., 2002).

The joint moment depends on horizontal forces and the center of pressure. The maximum value of vertical ground reaction force will be decreased with an increase in height of the chair (Whitney et al., 2005). Also, it reduces the total displacement of the Center of mass and pressure and it showed a trend towards a shorter duration in STS movement. These include the fact that one is expected to move the center of mass of the body over a large distance in low chairs. It was also found that when rising from a high chair than with a low chair knee joint forces and muscle tension were reduced between 8% to 56%, irrespective of arm activity (Ellis et al., 1984).

Overall, less demanding tasks by the elevated height of the chair promote the asymmetrical distribution of body weight. Consequently, the use of armrests affects the distribution of forces, reduction in trunk forward flexion, and reduction in hip and knee joint moment. Eriksrud et al., (2003) reported that the maximum vertical force of 15% body weight was lowered by each hand during STS movement.

Positions of the foot

Another important factor is the position of the feet which is found to cause changes in a joint moment and body movement. The study of Brunt et al., (2002) Foot positioning is used as one of the stabilization strategies used to improve asymmetrical weight-bearing patterns in hemiparesis. Roy et al., (2006) tested 12 chronic hemiparesis subjects at their natural speed level of sit to stand movement with different foot positions. In the cases when the patient was asked to stand up without any instruction and in symmetrical both the feet are placed with 15 degrees of ankle dorsiflexion with 90 degrees standardized knee angle, the given instances of sit to stand movement seem spontaneous.

An asymmetrical 1 and in asymmetrical 2 the affected foot is placed forward and backward respectively with 15 degrees of ankle dorsiflexion at a distance to 50% of the subjects foot length. The mean asymmetry was compared and reported that the mean asymmetry mainly at the transition phase was nearly 10% in the affected foot placed backward as compared to 24% in the spontaneous foot position, 21% in the symmetry condition, and 28% in the unaffected foot backward position. In the other three movements except the affected limb placed posteriorly, there is no difference in peak vertical reaction forces of the two sides during STS which resulted in asymmetrical weight-bearing.

The results revealed that there is a need to control the position of the foot which had a strong correlation with asymmetry in knee strength and knee extensor moments. Based on Briere et al., (2013) findings in normal subjects suggested that the foot placed backward asymmetrically resulted in a displacement of the trunk towards the posterior foot with more weight-bearing and higher moment on this side. This can be used to modify asymmetry of trunk position, knee joint moment, and body weight distribution in hemiparetic patients. The clinical implication of this finding suggests that the training with the hemiparesis foot placed backward considerably reduced the asymmetry of vertical ground reaction force between the lower limbs, indicating more symmetrical weight-bearing under the thighs and feet during sit to stand.

The effect of foot positioning with the increased height of seat 130% of knee-height could be presented as a therapeutic route to increase the symmetrical STS task. It is important that asymmetry can also be observed in other positions, noty necessarily in feet motion. For example, the study of Hesse et al., (1994a) has reported that chronic stroke patients shifted their COG laterally by 78% before seat off and 50% after seat off. This showed that asymmetry of weight-bearing is mostly occurred before seat off.

You have mentioned chair title above? Evidence for this?

Training is a useful tool in helping patients with chronic stroke to execute STS movements with symmetrical weight bearing. Training that lasts for four weeks where these patients undergo rehabilitation can help them perform STS more easily than when they try to do it without any prior training. During these four weeks, patients are trained how to spread the weight equally on their two legs prevent the trunk from tilting laterally (Eng and Chu, 2002). The four weeks training is aimed at teaching the patients concerning the temporal and spatial aspects of STS movement. Such training is most effective when done on people with left hemiparetic stroke.

Patients who suffer from left hemiplegia have greater difficulty in achieving a stable position as they tended to have visual, spatial and perceptual problems. This was due to having more media lateral sway than anterior posterior direction and this leads to poor postural control and increased risk of fall in left hemiplegic patients. This indicates that stroke fellers from sit to stand position has taken a longer duration with an asymmetrical distribution of body weight and greater COP sway in the mediolateral direction.

So prevention strategies also important to be developed and included in the rehabilitation program. Consequently, patients with chronic stroke with right hemiparesis are in a better position to exercise postural control and balance than people with left hemiparesis due to the damage of the learning process (Adams, Gandevia, Skuse, 1990). However, in patients with right hemiparesis and left hemiparesis, a significant difficulty is experienced when rising up from a sitting to a standing position.

Conclusion

Kinetic and kinematic data are the most effective ways to model the path of the center of mass and for evaluation of muscle inactivity caused by a stroke in a patient. This helps in the identification of various abnormal movements exhibited by the joints found in the lower limbs. The reduction in the ability to coordinate ones muscles as well as weakness and spasticity of various muscles were considered to differentiate stroke subjects from normal subjects.

Therefore the findings from the study of Galli et al., (2008) about the kinetic and kinematic asymmetry in relation to the findings of Roy et al., (2006) the effects of the foot positioning, height of the chair and the differences in weight bearing parameters can be used during rehabilitation. This helps them to overcome any mechanical challenges that they may encounter in this process. Inactivity makes one leads to decreased speed in performing the STS movement. The slowdown in the STS times that cause huge deficiencies in the major activities that a person does in their day to day lives. Therefore, recovery from the inability to perform successful sit to stand task with symmetrical weight distribution with increased speed should be the priority of physiotherapists.

References

Adams, RW, Gandevia, SC, & Skuse, NF, 1990, The distribution of muscle weakness in upper motor neuron lesions affecting the lower limb, Brain;,vol. 113, pp. 14591476.

Ahmed, M & Ahmed, S, 2008, Kinetics and kinematics of loading response in stroke patients, Annals, vol 14 no. 4, pp. 143147.

Berger, RA, Riley PO, Mann, RW, Hodge, WA, 1988, Total body dynamics in ascending the stairs and rising from a chair following total knee arthroplasty, Trans Orthop Res Soc, vol. 13, pp. 542.

Briere, A, Nadeau, S, Lauziere, S, Gravel, D, & Dehail, P, 2013, Knee efforts and weight bearing asymmetry during sit to stand tasks in individuals with hemiparesis and healthy controls, Journal of electromyography and kinesiology, vol. 23 no. 2, pp. 508-515.

Brunt, D, Greenberg, B, Wankadia, S, Trimble M A, Shechtman, O, 2002, The effect of foot placement on sit to stand in healthy young subjects and patients with hemiplegia, Archives of Physical Medicine and Rehabilitation, vol. 83 no.7,; pp. 924-929.

Cheng, PT, Liaw MY, Wong MK, Tang FT, Lin PS, (1998). The sit to stand movement in stroke patients and its correlation with falling, Archives of Physical Medicine and Rehabilitation, 79, pp. 1043-1046.

Chou, SW, Wong, AM, Leong CP, Hong, WS, Tang, FT, & Lin, TH, 2003, Postural control during sit to stand and gait in stroke patients, Archives of Physical Medicine and Rehabilitation, vol. 82, pp. 42-47.

Ellis, MI, Seedhom, BB, & Wright, V, 1984, Forces in the knee joint whilst rising from a seated position, Journal of Biomedical Engineering, vol. 6, pp. 113-120.

Eng, JJ, & Chu, KS. 2002, Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke, Archives of Physical Medicine and Rehabilitation, vol. 83, pp. 11381144.

Eriksrud, O, & Bohannon, RW,2003, Relationship of Knee Extension Force to Independence in Sit-to-Stand Performance in Patients Receiving Acute Rehabilitation, Physical Therapy, vol. 83, pp. 544551.

Galli, M, et al., 2008, Quantitative analysis of sit to stand movement: experimental set up the definition and application to healthy and hemiplegic adults, Gait and posture, vol. 28, pp: 80-85.

Hesse, S, et al., 1994,. Quantitative analysis of rising from a chair in healthy and hemiparetic subjects, Scandinavian Journal of Rehabilitative Medicine, vol. 26, pp. 161166.

Janssen, W GM, et al., 2002, Determinants of the sit to stand movement: a review, Journal of the American Physical Therapy Association, vol. 82, pp. 866-879.

Lee, MY, Wong, MK, Tang, FT, Cheng, PT & Lin, PS, 1997, Comparison of balance responses and motor patterns during sit-to-stand task with functional mobility in stroke patients, American Journal of Physical Medicine Rehabilitation, Vol. 76, pp. 401410.

Osman, HAA, 2011, Ifmbe proceedings: 5Th Kuala Lumpur international conference on biomedical engineering 2011, Springer, Berlin, DE.

Roy, G, Nadeau, S, Gravel, D, Malouin, F, & Mcfadyen, BJ, 2006, The effect of foot position and chair height on the asymmetry of vertical forces during sit to stand and stand to sit tasks in individuals with hemiparesis, Clinical Biomechanics, vol, 21 no. 6, pp. 585-593.

Schenkman, M, Berger, RA, Riley, PO, Mann, RW, & Hodge, WA, 1990, Whole-body movements during rising to standing from sitting. Physical Therapy, vol. 70, pp. 638651.

Taguch, K, Igarashi, M, & Mori, S, 1994, Vestibular and neural front: proceedings of the 12th International Symposium on Posture and Gait, Matsumoto, Elsevier, Amsterdam.

Tully EA, Footahabadi, MR, Galea, MP, 2005, Sagittal spine and lower limb movement during sit to stand in healthy young subjects, Gait and Posture, vol. 22, pp, 338-345.

Whitney, S L et al., 2005, Clinical easurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test, Physical Therapy, vol. 85 no. 10, pp. 10341045.

In the video, Jill gives an informative insight into the intricate workings of the human brain. She is a neuroanatomist who personally experienced the distinct characteristics of the brains two hemispheres after having a stroke. Since her incident occurred in the left cerebral half, Jill could not understand human language and move her right arm. However, with the right side of the brain still intact, she felt peaceful and at one with the world. This realization made me think about how we could utilize the qualities of both hemispheres in our daily lives.

Before I had the opportunity to watch the video, I assumed the human brain worked in a unified and collaborative way. The two halves to me were not independent of one another and could not perform any tasks without input from each hemisphere. However, as presented passionately by Jill in the video, recent scientific research has shown that the two hemispheres can operate alone and approach problems differently (Taylor, 2008). Consequently, it is apparent for me now that the two sides have two different functioning methods and act independently.

There are several implications on behavior in light of the above understanding of the human brains specialized functioning. Using the right brain more in our daily lives helps us cultivate a more caring existence with the rest of humanity (Tops et al., 2017). It would lead to, for example, people performing more acts of kindness to alleviate the suffering of fellow humans. Additionally, since the left brain enables one to understand human language, it facilitates efficient communication between people (Wiper, 2017). Thus, the lateralization of the brain influences human conduct to enable a deeper connection with others.

To conclude, the brains lateralization has essential effects on how people interact with their environment. The right hemisphere enables one to create good interpersonal skills while the left eases communication between community members. Since the two hemispheres perform their functions with little input from each other, a conscious decision on which half to use appropriately is needed for meaningful interaction with the world.

References

Taylor, B. J. (2008). My stroke of insight. TED. Web.

Tops, M., Quirin, M., Boksem, M. A., & Koole, S. L. (2017). Large-scale neural networks and the lateralization of motivation and emotion. International Journal of Psychophysiology, 119, 41-49. Web.

Wiper, M. L. (2017). Evolutionary and mechanistic drivers of laterality: A review and new synthesis. Laterality: Asymmetries of Body, Brain and Cognition, 22(6), 740-770. Web.

A transient ischemic attack (TIA), or so-called mini-stroke, is a short-duration stroke that may last only for several minutes. According to the National Institute of Neurological Disorders and Stroke, it is traditionally caused by the brief blockage of the blood supply to the brains part (MedlinePlus, n.d.). TIAs symptoms are similar to the symptoms of stroke, however, they do not last for a long period of time. In general, the symptoms of mini-stroke include weakness and numbness, especially on the bodys one side, face, legs, and arms, visual disturbance, trouble speaking, barely understandable speech, difficulties with walking, dizziness, and the loss of coordination or balance. As a matter of fact, the majority of TIAs symptoms disappear within an hour, however, in certain circumstances, they may last for 24 hours (MedlinePlus, n.d.).

It is highly essential to apply to the hospital having the described symptoms as it is almost impossible to conclude whether a person has a transient ischemic attack or stroke. In any case, TIAs may be regarded as a warning sign for strokes in the future, and the administration of appropriate medications, such as blood thinners, may substantially reduce its risk (MedlinePlus, n.d.). TIA treatment depends on the patients medical history and age and traditionally implies lifestyle changes  regular exercise, limiting alcohol, smoking cessation, and a healthy diet for weight maintenance. The individuals control over other health problems, including diabetes, atrial fibrillation, cholesterol, and high blood pressure, helps to minimize his or her stroke risk, as well (MedlinePlus, n.d.). Under certain specific conditions, a carotid endarterectomy is required in order to unblock the patients arteries that supply the brain with blood.

Reference

MedlinePlus. (n.d.). Transient ischemic attack. Web.

Overview

A stroke usually occurs due to decreased or interrupted blood supply to the whole or part of the brain, which prevents the brain from getting enough nutrients and oxygen. When this is not corrected immediately, brain cells begin to die within few minutes. A stroke is considered a medical emergency that needs prompt management. Early treatment of stroke can prevent brain complications and reduce damages that are caused due to stroke (Catanese et al., 2017). This essay will discuss ischemic stroke origin, systems and organs involved, statistics, clinical manifestation, diagnostic measures, and treatment.

Ischemic stroke is the most prevalent type of stroke within the communities. Ischemic stroke develops when blood supply to the brain is obstructed reduced. This obstruction is caused by blocked or narrowed blood vessels, causing reduced oxygen supply to the brain. The cause of narrowed and blocked blood vessels includes fatty deposits that line in the blood vessels walls, known as atherosclerosis, which is the main cause of ischemic stroke (Catanese et al., 2017). Atherosclerosis can cause two types of blood vessel occlusion, which include cerebral thrombosis and cerebral embolism. In cerebral thrombosis, a thrombus is formed by the fatty plaque in the walls of the blood vessels. In cerebral embolism, an embolus is formed in other parts of the circulatory system, commonly the heart and the large arteries in the neck and the chest. This thrombus from other locations breaks loose and travels in the bloodstream to the brains where it findings blood vessels that are small to pass and lodges there (Powers, 2020). The main cause of emboli formation is irregular heartbeats such as atrial fibrillation.

Organs Involved

The organ in the body that is affected by ischemic stroke in the brain. The brain is responsible for sending signals around the body to perform certain functions. The brain is divided into two halves, the right and left hemispheres, which perform specific body functions. The right hemisphere of the brain performs functions on the left part of the body and vice versa. The different brain areas perform specific body functions, such as speaking and writing (Hinkle & Cheever, 2018). The effects of an ischemic stroke depend on the part of the brain affected and the severity of reduced blood supply to the brain.

The systems that are involved in ischemic stroke includes the neurological and the circulatory system. The neurological system is made up of the brain, whereby its blood vessels are occluded to deprive the brain of oxygen. This system contains nerves that send signals to the rest of the body. Brain damage due to ischemia leads to neurological dysfunction affecting the other body systems. In the circulatory system, blood clots form within the blood vessels. Thrombus forms in the blood vessels due to the fatty deposits within the blood vessels (Hinkle & Cheever, 2018). These clots also occur due to smoking, hypertension, high cholesterol levels, and diabetes.

Morbidity and Mortality Statistics of Ischemic Stroke

Stroke is the leading cause of cognitive impairment, disability, and deaths within the US. It accounts for about 1.7% of the national expenditure on health. In 2014-2016, the costs related to stroke within the US were approximately $46 billion (Rennert et al., 2019). This amount includes the amount of money used to treat stroke, missed days at work, and healthcare services. This is due to the increased elderly population who are more prone to stroke. This risk doubles every successive decade for the population at 55, and the costs are rise dramatically. It is estimated that about 795 000 individuals experience recurrent and new every year. Approximately 610,000 new people experience stroke, and 185,000 people experience recurrent stroke. Stroke incidence depends on gender, age, socio-economic status, and ethnicity. Studies have shown that about 87% of all strokes within the US are due to ischemic stroke, whereby there is blocked blood supply to the brain. It is reported that a 4.2-6.5 incidence of stroke per 1000 people is 55 years (Centers for Disease Control, 2021). It is estimated that 25% of ischemic stroke is deadly in one month, and it is reduced to one-third within six months and by 50% within a year.

In 2018, it was reported that one death was due to stroke in every six death associated with cardiovascular diseases. It is approximated that in every 40 seconds within the US, one person develops stroke, and within 4 minutes, one individual dies due to stroke. The risk of stroke depends on ethnicity and race, for example, the risk of developing a stroke is doubled for the African-Americans population (Centers for Disease Control, 2021). The rates of deaths among this population due to stroke prevales in this race as compared to other races.

Clinical Manifestations

Mostly ischemic strokes rapidly occur within minutes, hours, and days. Access to medical care is crucial to prevent brain damage which has devastating consequences. The signs of ischemic stroke include sudden confusion, weakness, or numbness of the face, leg, or harm, especially unilateral. The other clinical manifestations include sudden difficulty in walking, speaking, and vision. These symptoms include dysarthria, diplopia, nystagmus, and aphasia. A patient with this condition will experience sudden dizziness, a severe headache of no known cause, and loss of balance due to loss of brain coordination. Patients will present with abrupt onset of hemiparesis, quadriparesis, or monoparesis. Patients of the feminine gender experience more symptoms such as leg, face, and arm pain. The other symptoms include nausea, hiccups, palpitations, chest pains, and shortness of breath (Hinkle & Cheever, 2018). It is important to understand that not all the symptoms will occur in ischemic stroke.

Diagnostic Measures

Imaging studies are vital in the evaluation of ischemic stroke. In neuroimaging non-contrast, computed tomography is used to evaluate the presence of acute stroke. The other neuroimaging techniques that can be used also include computed tomography, angiography, and perfusion scanning. Magnetic resonance imaging, carotid duplex imaging, and digital subtraction angiography. Lumbar puncture is needed to rule out meningitis when computed tomography scan is negative (Cassella & Jagoda, 2017). Laboratory studies that can be performed to diagnosis this condition include complete blood count. A complete blood count is done to identify the causes of stroke, such as thrombocytopenia, polycythemia, and leukemia which provides evidence of other concurrent diseases. These studies rule out thrombocytopenia when prescribing fibrinolytic therapy. Coagulation studies may be performed to identify coagulopathies which is important when using fibrinolytic. Basic chemistry is performed to identify stroke mimicking conditions such as hyponatremia and hypoglycemia. Cardiac biomarkers are taken to identify coronary, heart diseases, and cerebrovascular disease (Hasan et al., 2018). Toxicology screening is done to identify sympathomimetics that can cause ischemic stroke.

Curative treatment of Ischemic Stroke

The goal of treating acute ischemic stroke is the preservation of brain tissues in areas with decreased oxygen perfusion. This can be corrected by increasing blood supply to the compromised areas of the brain. The drugs that can be used to treatment of ischemic stroke include fibrinolytic such as alteplase. 0.9mg/kg with a maximum dose of 90mg of alteplase is administered intravenously within 3 hours. 10% of this drug is given as a bolus over the first minute of this drug administration (Cassella & Jagoda, 2017). This drug dissolves blood clots, immediately restoring blood flow which helps in preventing damage to the brain tissues.

Antiplatelets such as aspirin can also be used to treat this condition. This drug is recommended to be used within 24-48 hours of the onset of symptoms. According to a Cochrane review, aspirin, which is administered within 48 hours of the onset of ischemic stroke symptoms, can prevent ischemic stroke recurrence and improve the outcomes. The other management of this illness is mechanical thrombectomy recommended by American Heart Association (Hasan et al., 2018). Reports from 2015 stroke trials showed that endovascular thrombectomy use within the first six hours is a better treatment for patients with large-vessel arterial occlusion proximal to anterior circulation.

Future Research on Ischemic Stroke

There is an increased identification and collaboration for closer interactions and experimental designs between preclinical and clinical researchers. There is hope in the stroke field due to improved and new treatments found to benefit patients. This can be illustrated by reinvigoration and excitement, which was brought by successes in endovascular thrombectomy. Guidelines that were published recently aims to improve models of preclinical stroke to provide more evidence of progress. With the increased number of patients recovering from stroke, there is a need to expand focus to the complications of post-stroke, affecting the quality of life of an individual (Kurisu & Yenari, 2018). These include complications, speech and motor impairments, and dementia, depression, anxiety, and epilepsy.

References

Cassella, C. R., & Jagoda, A. (2017). Ischemic stroke: Advances in diagnosis and management. Emergency Medicine Clinics, 35(4), 911-930. Web.

Catanese, L., Tarsia, J., & Fisher, M. (2017). Acute ischemic stroke therapy overview. Circulation Research, 120(3), 541-558. 

Centers for Disease Control and Prevention. (2021). Stroke statistics. 

Hasan, T. F., Rabinstein, A. A., Middlebrooks, E. H., Haranhalli, N., Silliman, S. L., Meschia, J. F., & Tawk, R. G. (2018). Diagnosis and management of acute ischemic stroke. Mayo Clinic Proceedings 93(4), 523-538. 

Hinkle, J. L., Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarths textbook of medical-surgical nursing (14^th ed). Philadelphia: Wolters Kluwer.

Kurisu, K., & Yenari, M. A. (2018). Therapeutic hypothermia for ischemic stroke; Pathophysiology and future promise. Neuropharmacology, 134, 302-309. 

Powers, W. J. (2020). Acute ischemic stroke. New England Journal of Medicine, 383(3), 252-260. Web.

Rennert, R. C., Wali, A. R., Steinberg, J. A., Santiago-Dieppa, D. R., Olson, S. E., Pannell, J. S., & Khalessi, A. A. (2019). Epidemiology, natural history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 85(suppl_1), S4-S8.