Skip to main content Skip to main navigation menu Skip to site footer

Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient

Abstract

Background: Muscle strength impairment in stroke patient affect the patient daily life, especially when it occurs on the extremities muscles. Manual Muscle Testing (MMT) is an examination method to measure muscle strength using standardized scoring. Objectives: To find possible improvement of Manual Muscle Test (MMT) Score after administration of Intra Arterial Heparin Flushing in chronic ischemic stroke patient. Methods: This is an experimental study using pretest-posttest group design, with randomized controlled clinical trial, conducted among patients in Cerebrovascular Center Unit in Army Central Hospital Gatot Soebroto starting from February 2014. With 75 patients included in this study. The examination of muscle strength was done by trained physicians. The MMT score were taken before and after the IAHF procedure is conducted. Results: This study found higher score of MMT-MRC scoring system on chronic stroke patient with IAHF procedure (mean MMT-MRC Score = 6,05 point. With p<0,05). Indicating that IAHF procedure is associated with better muscle strength improvement shown with higher MMT-MRC score on stroke patient, which will have better prognostic outcome in their recovery. Conclusions: Intra Arterial Heparin Flushing have significant effect on chronic stroke patient with decreased muscle strength, which shows a significant increase of MMT-MRC score.

References

  1. Sacco R., Kasner S., Broderick J., et al. 2013. An Update Definition of Stroke for the 21st Century. American Heart Association/American Stroke Association, Stroke. 2013;44:2064-2089.
  2. Rathore S., Hinn A., Cooper L., Tyroler H., Rosamond W., 2002. Characterization of Incident Stroke Signs and Symptoms. Stroke. 2002;33:2718-2721.
  3. Lawrence E., Coshall C., Dundas R., et al. 2001. Estimates of the Prevalance of Acute Strokes Impairments and Disability in a Multiethnic Population. Stroke. 2001;32:1279-1284.
  4. Dobkin B., 1997. Journal of Stroke and Cerebrovascular Diseases, Vol.6 No. 4. 1997:pp 221-226
  5. Tae-Kim J., Park-Seok M., Kang-Ho C., 2016. Different Antiplatelet Strategies in Patients with new Ischemic Stroke While Taking Aspirin. Stroke. 2016;47:128-134.
  6. Paternostro-Sluga T., Stieger-Grim M., Posch M., 2008. Reliability and Validity of The Medical Research Council (MRC) Scale and A Modified Scale for Testing Muscle Strength in Patients with Radial Palsy. J Rehabil Med 2008;40:665-671.
  7. Coull, B.M., Williams, L.S, Goldstein, L.B., et al. 2002. Anticoagulants and Antiplatelet
  8. Agents in Acute Ischemic Stroke : Report of the Joint Stroke Guideline Development
  9. Committee of the American Academy of Neurology and the American Stroke
  10. Association (a Division of the American Heart Association). Stroke. 33: 1934-1942
  11. Coutinho, J., de Bruijn, S. F. T. M., deVeber, G., Stam, J. 2011.Anticoagulation for
  12. Cerebral Venous Sinus Trombosis.Cochrane DB Syst Rev. 8: 1- 21.
  13. Dalkara,T., Arsava,E.M. 2012. Can Restoring Incomplete Microcirculatory
  14. Reperfusion Improve Stroke Outcome After Thrombolysis. Journal of Cerebral Blood
  15. Flow Metabolism.32: 2031-2099.
  16. Deb, P., Sharma, S., Hassan, K.M. 2010. Pathophysiologic Mechanism of Acute
  17. Ischemic Stroke: An Overview with Emphasis of Therapeutic Significance Beyond
  18. Thrombolysis. Pathophysiology. 17: 197 – 218.
  19. Durran, A. C., dan Watts, C. 2012.Current Trends in Heparin Use During Arterial
  20. Vascular Interventional Radiology.CardiovascInterventRadiol.35: 1308-1314.
  21. Dvorak, M., Vlasin, M., Dvorakova, M., et al. 2010. Heparin and its Derivatives in
  22. the Treatment of Arterial Trombosis: A Review. Vet Med. 55: 523–546.
  23. Font, M. A., Arboix, A., Krupinski, J. 2010. Angiogenesis, Neurogenesis and
  24. Neuroplasticity in Ischemic Stroke. CurrCardiol Rev. 6: 238-244.
  25. Gutiérrez, L. M., Díez, Tejedor, E., Alonso de Leciñana, M., Fuentes, B., Carceller,
  26. F.,Roda, J. M. 2006.Thrombolysis and Neuroprotection in Cerebral
  27. Ischemia.Cerebrovasc Dis. 21:118-26.
  28. Hurtado, O., Pradili, J. M., Alonso-Escolano, D., Lorenzo, P., Sobrino, T., Castillo,
  29. J., Lizasoain, I., Moro, M. A. 2006.Neurorepair versus Neuroprotection.Stroke. 21 (2):
  30. -63.
  31. Kaste, M., Mikulik, R., Kostulas, N., et al. 2008.Should the time window for
  32. intravenous thrombolysis be extended? 7th Karolinska Stroke Update meeting on
  33. November 18, 2008. (Online)
  34. (http://www.strokeupdate.org/Cons_thrombolysis_2008.aspx, diakses 25 Spetember
  35. .
  36. Kilic, C., Bassetti, C. L., Kilic, E., Wang, Z., Hermann, D. M. 2005.Post-Ischemic
  37. Delivery of the 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor
  38. Rosuvastatin Protects Agains Focal Cerebral Ischemia in Mice via Inhibition of
  39. Extracellular-Regulated Kinase -1/-2.Neuroscience. 134: 901-906.
  40. Lewis, J. H., Kerber, C. W., Wilson, J. H. 1964. Effects of Fibrinolytic Agents and
  41. Heparin on Intravascular Clot Lysis.Am J Physiol.207: 1044-1048.
  42. Nawashiro, H., Wada, K., Nakai, K., Sato, S. 2012. Focal Increase in Cerebral Blood
  43. Flow After Treatment with Near-Infrared Light to the Forehead in a Patient in a
  44. Persistent Vegetative State.Photomedicine and Laser Surgery. 30(4): 231-233.
  45. Perrey, S. 2013. Promoting Motor Function by Excercising the Brain. Brain
  46. Sciences. 3: 101-122.
  47. Sacco, R. L., Kasner, S. E., Broderick, J. P. et al. 2013. An Updated An Updated
  48. Definition of Stroke for the 21st Century: A Statement for Healthcare Professionals
  49. From the American Heart Association/American Stroke Association. Stroke 44 : 2064
  50. Slevin, M., Kumar, P., Gaffney, J., Kumar, J., Krupinski, J. 2006. Can Angiogenesis
  51. Be Exploited to Improve Stroke Outcome? Mechanism and Therapeutic Potential.Clin
  52. Sci. 111: 171-183.
  53. The Internet Stroke Center. 2014. Acute Infarction .(Online) http://www.strokecenter.org/professionals/stroke-diagnosis/ neuropathology-image-library/acute-infarction/, diakses 25 September 2014).
  54. Schellinger, P.D., Fiebach, B.J., Mohr, A., Ringleb, P.A., Jansen, O., Hacke, W. 2001. Thrombolytic Therapy for Ischemic Stroke. Crit Care Med. 29(9): 1812-8.
  55. Liang, J. F., Li Y., Yang V. C., 2000. The Potential Mechanism for The Effect of Heparin on Tissue Plasminogen Activator-mediated Plasminogen Activation. Thromb Res.97(5): 349-58.
  56. Colucci M., Pentimone A., Binetti, B.M.,Cramarossa M., Piro D., Semeraro N. 2002. Effect of Heparin on TAFI-dependent inhibition of fibrinolysis: relative importance of TAFIa generated by clot-bound and fluid phase thrombin. 88(2):282-7.
  57. Pollard, H. Lakay, B., Tucker, F., Watson, B., Bablis, P. 2005. Interexaminer
  58. Realibility of The Deltoid and Psoas Muscle Test. J Manipulative Physiol Ther;
  59. (1): 52-6.
  60. Taher, E., Hamdy. G., Abu Farha, M., Awad, M. 2010. Predictors of Stroke Outcome
  61. in Egyptian Patients Following Acute Stroke. The Egyptian J Comm Med : 28 : 1 – 13.
  62. Yen-Mou, L., Yi-Jing, L. 2012. Musc Dystrophy. 17: 322-330.
  63. Gregson, J.M., Leathley, J.M., Moore, A. P., Smith, T. L., Sharma, A. K., Watkins, C.
  64. L. 2000. Reliability of Measurements of Muscle Tone and Muscle Power in Stroke
  65. Patients. Age and Ageing. 29: 223-228.
  66. Schwerin,S.,2013. The Anatomy of Movement (Online)
  67. (http://brainconnection.brainhq.com/2013/03/05/the-anatomy-of-movement/, diakses 12
  68. September 2014)
  69. Silva-Coto, Mde A., Prado-Medeiros, CL., Oliveira, AB., Alcantara, CC., Guimaraes,
  70. AT., Salvini Tde F., et al. 2014. Muscle Atrophy, Voluntary Activation Disturbances, and
  71. Low Serum Concentrations of IGF-1 and IGFBP-3 are Associated with Weakness in
  72. People with Chronic Stroke. Phys Ter.; 94(7): 957-67.
  73. Guggenmos, D.J., Azin, M., Barbay, S., Mahnken, J.D., Dunham, C., Mohseni, P., et
  74. al. 2013. Restoration of function after brain damage using a neural prosthesis.
  75. Neuroscience. 110(52): 21177-21182.
  76. Muhammad, S.bin I., Gofir, A., Ismail, S., 2014. Reability of Manual Muscle Test
  77. Examination of Stroke Patient in Sardjito Hospital. Department of Neurology. Gadjah
  78. Mada University, Jogjakarta.
  79. Langhorne, Peter., Coupar, Fiona., Pollock, Alex. 2009. Motor Recovery After
  80. Stroke: A Systematic Review. Lancet Neurol. 8: 741-54.

How to Cite

Putranto, T. A., Yusuf, I., Murtala, B., & Wijaya, A. (2016). Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient. Bali Medical Journal, 5(2), 216–220. https://doi.org/10.15562/bmj.v5i2.200

HTML
2

Total
2

Share

Search Panel