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Rehabilitation after Aneurysmal Subarachnoid Hemorrhage (SAH)

Clipping of cerebral aneurysm

cerebral or intracranial aneurysm is an abnormal focal dilation of an artery in the brain that results from a weakening of the inner muscular layer (the intima) of a blood vessel wall. The vessel develops a “blister-like” dilation. This defect can produce pressure on nearby structures, causing problems such as double vision or changes in pupil size.  It can become thin and rupture without warning. The resultant bleeding into the space around the brain is called a subarachnoid hemorrhage (SAH). This kind of hemorrhage can lead to a stroke resulting in disabilities, coma and/or death.

Thus a subarachnoid hemorrhage is a medical emergency and immediate treatment is essential to help reduce the risk for permanent brain damage. Today there are two treatment options for people who have been diagnosed with a brain aneurysm:

  • Surgical clipping.
  • Endovascular therapy.

Surgical clipping:
An operation to “clip” the aneurysm is performed by doing a craniotomy (opening the skull surgically), and isolating the aneurysm from the bloodstream by placing one or more clips across the neck of the aneurysm.  This eliminates further blood flow into the aneurysm, significantly reducing the risk of rupture.  After clipping the aneurysm, the skull bone is secured in its original place, and the wound is closed.  Surgical clipping of an aneurysm is always performed by a trained and licensed neurosurgeon.

Endovascular Treatment:
A less invasive technique called endovascular treatment, does not require a craniotomy. This technique uses existing spaces within the artery to deliver implants that can seal off the weakened aneurysm wall from any further contact with pulsatile arterial blood flow.  Access into the blood vessels is via a small incision at the groin crease.  Under X-ray guidance, a microcatheter is used to reach and deliver coils into the aneurysm to induce stagnation of blood flow in the sac, leading to thrombosis (clotting) of the aneurysm.

Endovascular treatment sometimes requires the use of an additional device such as an intracranial stent.   This device enables treatment of a broader scope of aneurysms that may be difficult to treat with coils alone.  Stenting with coiling utilizes a small flexible cylindrical mesh tube that provides a scaffold for the coiling. Lower porosity stents or flow diverters achieve aneurysm occlusion without placing coils into the aneurysm sac.  These devices function by redirecting flow to stay within the parent vessel, also inducing thrombosis in the aneurysm sac.

Recovering from a brain aneurysm or a Subarachnoid Hemorrhage is a major life event that continues long after discharge from the hospital.  Following a brain injury, patients often face a myriad of physical, emotional and cognitive changes, ranging from minor setbacks to major challenges with long-lasting impact. Rehabilitation can significantly influence long-term recovery by helping patients learn new ways to compensate for abilities that may have been lost or impacted by their brain injury. Rehabilitation services include physical, mental and emotional treatments that help the injured brain make new connections.

Most rehabilitation programs focus on three types of therapies:

  • Physical therapy
  • Occupational therapy
  • Speech therapy

In this article we will address physical rehabilitation and hand rehabilitation in particular.. The debilitating effects on hand function from the neurological damage that may ensue from Subarachnoid Hemorrhage and cerebral aneurysm surgery has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients.

Conventional robotics are composed of metal which provide a rigid framework in order to assist in motor function. It is possible that the rigid structures of these devices is impeding the therapeutic potential of robotics by reducing their biomimetic qualities. This may include reducing motion in unactuated directions such as finger abduction or could include having rigid axes of rotation that become misaligned with the finger’s anatomic axis during motion.

In contrast, we adopt soft robotics which are fabricated from easily deformable materials such as fluids, gels, and soft polymers that have better biomimetic qualities due to their increased compliance and versatility while conforming to the contours of the human body. The lack of rigid components removes constraints on non-actuated degrees of freedom and also reduces joint alignment issues, which could prevent joint damage. Additionally, soft robotics may be lighter and have simpler designs, making them more likely to be portable and opening up the possibility of at-home rehabilitation.

 Our rehabilitation products meant for clinics like the SIFREHAB-1.2 puts emphasis on  cross-over between information technologies, data science, material science and neuroscience, while the overlaps in our consumer electronic goods like the SIFREHAB-1.0 (home use) are, mainly in the area of material science, communication, navigation and gaming.

Surgical clipping Endovascular coiling of an aneurysm is always performed by a trained and licensed neurosurgeon or a trained and licensed neurointerventionalist.

Reference: Brain Aneurysm Foundation (bafound.org)

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