May 2018 CME Article No. 5: The Link Between Cerebrovascular Hemodynamics and Rehabilitation Outcomes After Aneurysmal Subarachnoid Hemorrhage

Additional Information

Objective:
To assess the relation between cerebrovascular function early after aneurysmal subarachnoid hemorrhage (SAH) onset and functional and rehabilitation outcomes.

Design:
Observational cohort study of SAH patients (n=133) admitted to rehabilitation (n=49), discharged home (n=52), or died before discharge (n=10). Hemodynamic markers of cerebral autoregulatory function obtained from blood flow velocities in the middle cerebral artery and arterial pressure waveforms, recorded daily on days 2–4 after symptom onset, and functional independence measure (FIM™) scores and FIM efficiency for those admitted to acute rehabilitation.

Results:
Compared to those discharged home, the range of pressures within which autoregulation is effective was lower in patients admitted to rehabilitation (4.6+0.2 vs 3.9+0.2 mmHg) and those who died (2.7+0.4; p=0.04). For those admitted to rehabilitation, autoregulatory range and the ability of cerebrovasculature to increase flow were related to discharge FIM score (R2=0.33 and 0.43; p<0.01) and efficiency (R2=0.33 and 0.47; p<0.01). The latter marker along with SAH severity and admission FIM, explained 84% and 69% of the variability in discharge FIM score and efficiency.

Conclusions:
Early cerbrovascular function is a major contributor to functional outcomes after SAH, and may represent a modifiable target to develop therapeutic approaches.

Learning Objectives:

Define cerebal autoregulation
Explain the importance of the integrity of cerebral autoregulation for longer term functional and rehabilitation outcomes after aneurysmal subarachnoid hemorrhage
Theorize why treatment strategies that may be effective in reducing large-vessel vasospasms after an aneurysmal subarachnoid hemorrhage might not always translate into improved functional outcomes

Summary


Availability:	On-Demand
	Available May 01, 2018 to May 01, 2021


Cost:	FREE


Credit Offered:	0.5 CME Credit

Recommended

July 2018 CME Activity No. 7: Acute-Phase Predictors of 6-Month Functional Outcome in Italian Stroke Patients Eligible for In-Hospital Rehabilitation

1 CME

FREE

June 2018 CME Article No. 6 Automated Mechanical Peripheral Stimulation Improves Gait Parameters in Subjects With Parkinson Disease and Freezing of Gait: A Randomized Clinical Trial

0.5 CME

FREE

January 2018 CME Article No. 1: Cardiovascular Monitoring During Video Urodynamic Studies in Persons with Spinal Cord Injury

0.5 CME

FREE

February 2018 CME Article No. 2: Alterations in the Mechanical Response of Deep Dorsal Neck Muscles in Individuals Experiencing Whiplash-Associated Disorders Compared to Healthy Controls

0.5 CME

FREE

August 2018 CME Article No. 8 The Effects of a Motorized Aquatic Treadmill Exercise Program on Muscle Strength, Cardiorespiratory Fitness, and Clinical Function in Subacute Stroke Patients

1 CME

FREE

September 2018 CME Activity No. 9: Efficacy of Extracorporeal Shock Wave Therapy for Lower Extremity Tendinopathy: A Meta-analysis of Randomised Controlled Trials

1 CME

FREE

February 2019 CME Activity: The Effects of Exercise on Cognition and Mobility in Adults With Multiple Sclerosis

1 CME

FREE

March 2019 CME Activity: Effects of Video Games–Based Task-Oriented Activity Training on Patients With Juvenile Idiopathic Arthritis

1 CME

FREE

January 2019 CME Activity: Fatigue After Aneurysmal Subarachnoid Hemorrhage Is Highly Prevalent in the First-Year Postonset and Related to Low Physical Fitness

1 CME

FREE

April 2018 CME Article No. 4: Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults With Mild Cognitive Impairment and Intact Cognition

0.5 CME

FREE