Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia

Abstract

BACKGROUND:

Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care.

OBJECTIVE:

This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia.

METHODS:

The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed.

RESULTS:

The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group.

CONCLUSION:

HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.

Keywords

Hyperbaric oxygen therapy-specialized care hyperbaric oxygen cerebral infarction motor function mental state

1. Introduction

The sudden decrease or cessation of the local blood supply to the brain tissue can cause cerebral ischemia and hypoxia in patients with cerebral infarction (CI), and eventually lead to brain tissue necrosis and softening, accompanied by corresponding neurological deficits [1, 2]. CI is clinically presented with hemiplegia, visual impairment, consciousness disturbance, eye pain, etc. [3], with a high risk of disability, death and recurrence, which undoubtedly imposes a heavy burden on the patient’s family and society [4]. Currently, CI is mainly treated by emergency craniotomy or conservative treatment, depending on the specific type of CI in the patient [5]. In a recent clinical study of hyperbaric oxygen therapy (HBOT)-specialized care in patients with middle cerebral artery occlusion-induced CI, the positive effect of this care model on neurological outcomes after cerebral ischemia was demonstrated [6]. However, some reports have questioned the functional recovery of patients after HBOT-specialized care [7]. Therefore, this paper discusses the application value of HBOT-specialized care in CI patients with hemiplegia, aiming to improve the limb motor function (LMF) and mental state of patients through nursing, which is of great significance to the rehabilitation of such patients.

HBOT-specialized care is a new nursing model emerging in recent years. By placing the whole body of the patient in an environment of elevated pressure, the patient can inhale 100% oxygen and continue the intervention for a period of time to promote the recovery of the patient’s physical function [8, 9]. Different from conventional nursing, HBOT-specialized care is usually divided into three stages (i.e., before entering the hyperbaric chamber, after entering the hyperbaric chamber, and after leaving the hyperbaric chamber), with the nursing measures being constantly optimized and adjusted for patients [10]. For example, for patients with acute CI, HBOT-specialized care can assist in the formulation of detailed nursing plans, including pre-thrombolytic, thrombolytic and post-thrombolytic care [11]. Through specific measures such as health education, bedside care, and psychological counseling, it greatly helps patients recover their neurological function and physical and mental health [12]. Therefore, compared with conventional nursing, the implementation of HBOT-specialized care may play an important role in the recovery of neurological function, the reduction of disability rate, and the improvement of self-care ability in patients with CI. HBOT-specialized care is also of great significance and widely recognized in the fields of oncology and urology, mainly due to its effectiveness in improving the acceptability and effectiveness of interventions through more scientific and rigorous intervention measures [13, 14, 15, 16]. In the study of Biggs et al. [17] on post-traumatic stress disorder, HBOT-specialized care also had a good effect on the improvement of patients’ psychological state and living standards.

Although there are many nursing programs for CI patients, there is little research data on the LMF and mental state of CI patients with hemiplegia receiving HBOT-specialized care. Accordingly, this study compares the effect of HBOT-specialized care versus routine care on CI patients with hemiplegia, which is expected to provide a new reference for the clinical management of such a patient population.

2. Data and methods

2.1 Patient information

The Ethics Committee of the First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital) approved the study protocol. All eligible patients were diagnosed with CI [18] for the first time after comprehensive examination and received conventional treatment, with hemiplegia sequelae, stable disease, disease duration $\leqslant$ 7 days, neurological deficits of varying degrees, and intact case records. Patients complicated with heart, lung, kidney dysfunction, other malignancies, or those suffering from coagulation dysfunction, autoimmune system defects, mental illness or cognitive dysfunction were excluded.

Finally, 113 CI patients treated in our hospital from March 2020 to March 2022 were selected for clinical analysis. The conventional group ( $n=$ 53) and the research group ( $n=$ 60) received routine care and HBOT-specialized care, respectively. The two groups showed no statistical difference in baseline data ( $P>$ 0.05; Table 1).

Table 1
General information of cerebral infarction patients with hemiplegia

Factors	Conventional group ( $n=$ 53)	Research group ( $n=$ 60)	$\chi^{2}/$ t	$P$
Sex			0.611	0.434
Male	33 (62.26)	33 (55.00)
Female	20 (37.74)	27 (45.00)
Mean age (years old)	63.62 $\pm$ 8.08	62.62 $\pm$ 9.49	0.599	0.550
Average weight (kg)	66.05 $\pm$ 8.97	68.38 $\pm$ 9.53	1.333	0.185
Family medical history			1.142	0.285
No	43 (81.13)	53 (88.33)
Yes	10 (18.87)	7 (11.67)
Residence			0.013	0.908
Urban	35 (66.04)	39 (65.00)
Rural	18 (33.96)	21 (35.00)

2.2 Nursing means

Patients in the conventional group mainly receive the following routine nursing measures: detecting the vital signs of patients; giving drugs such as aspirin for cerebrovascular dilatation and antiplatelet treatment as recommended by doctors; carefully observing and recording the condition of patients; providing patients with dietary guidance and psychological intervention.

The research group was given HBOT-specialized care with the following measures: (1) Disease awareness nursing: The nursing staff explained disease-related knowledge to patients and their families in detail, and taught patients’ families the correct auxiliary training and nursing methods, so that patients can get correct nursing at any time to facilitate their rehabilitation. (2) Dietary care: Patients were advised to reduce salt and fat intake and eat a semi-liquid and liquid diet, and were helped to develop healthy diet plans. Those with dysphagia were given nasal feeding. (3) Posture, living ability and exercise nursing: Rehabilitation training was formulated depending on the patient’s condition. In the early stage, the patient’s posture was changed correctly and regularly (1–2 h/time), with the ipsilateral lateral position, contralateral lateral decubitus position and supine position alternately used. In addition, according to the specific situation in the convalescence period, patients were guided to do sitting-up or standing balance training, bilateral and unilateral bridge exercises in bed, leg-pinching training, urination and defecation training, active turning over training, washing, eating, etc., 1–2 times a day, 20–30 minutes a time. Furthermore, they were encouraged to do autonomous exercise step by step based on their rehabilitation, such as walking and training of going up and down stairs. Besides, they were instructed to take off clothes, decorate themselves, take a bath, and handle defecation by themselves; moreover, they were taught to use correct posture to repeatedly train the skills of holding a pen and writing, as well as fine coordination training of limbs, once or twice a day for 20–30 minutes/time, to improve their self-care ability. During the rehabilitation training, changes in blood pressure were closely observed and safety protection was emphasized to prevent secondary injuries caused by falls. In case of headache, dizziness or limb numbness, the training was stopped immediately and the patient’s condition was observed. When doing bilateral and unilateral bridge exercises in bed, patients were reminded of moderate exertion to prevent cervical spine injury [4]. Psychological care: Psychological nursing was strengthened, and patients were encouraged to express their emotions bravely. Besides, reasonable guidance was given, which was realized through various means such as talking, listening to music, and playing humorous videos, so as to disperse patients’ bad emotions, help them build their confidence in overcoming the disease, and facilitate the smooth implementation of care.

2.3 Outcome measures

In this study, the LMF, neurological function, and mental state of patients were primary outcome measures, while self-care ability and nursing effect were secondary measures.

(1)
LMF. We used the Fugl-Meyer Assessment (FMA) [19] to assess patients’ LMF. On a scale score ranging from 0 to 100 points, higher scores are associated with better LMF recovery.
(2)
Neurological function. The National Institutes of Health Stroke Scale (NIHSS) [20], a measure with a score range of 0–42 and the score in inverse connection with the patient’s neurological function, was employed for neurological function assessment.
(3)
Mental state. The pre- and post-care anxiety and depression of patients were assessed using the Self-rating Anxiety/Depression scale (SAS/SDS) [21]. Both scales have 20 items and a full score of 80, with the score directly proportional to the degree of anxiety and depression.
(4)
Self-care ability. The assessment of pre- and post-care self-care ability of patients employed the Barthel index (BI; score range: 0–100) [22]. The score is proportional to the self-care ability.
(5)
Nursing effect. Nursing efficacy. is mainly assessed based on the improvement of clinical symptoms and self-care ability of patients. A marked response refers to significantly improved clinical symptoms in patients and the ability to take care of themselves; obvious improvement in clinical symptoms and the need for help from family members in daily life is regarded as a response; barely changed clinical symptoms and poor self-care ability is regarded as non-response. Nursing effective rate is the percentage of the sum of the number of marked responses and responses in the total number of cases.

2.4 Statistical methods

The Graphpad Prism 7.0 software package was used for statistical analysis and image rendering. Categorical variables and quantitative data were denoted by the number of cases/percentage ( $n$ /%) and Mean $\pm$ SEM, respectively, of which the former was analyzed using the $\chi^{2}$ test, and the latter was analyzed with the independent samples t-test (between groups) and the paired $t$ -test (within groups). Statistical significance was indicated by $P$ -values $<$ 0.05.

3. Results

3.1 General information of two groups

As can be seen in Table 1, the two groups of patients were not statistically different in sex, mean age, average weight, family history and residence ( $P>$ 0.05).

3.2 Influences of HBOT-specialized care on LMF of CI patients with hemiplegia

As indicated by the FMA results (Fig. 1), the post-care FMA scores of both groups elevated markedly and were even higher in the research group compared with the conventional group ( $P<$ 0.05).

Figure 1.

Impacts of hyperbaric oxygen therapy-specialized care on motor function of cerebral infarction patients with hemiplegia. ^{* P<} 0.05.

3.3 Impacts of HBOT-specialized care on neurological function of CI patients with hemiplegia

The analysis of patients’ neurological function by the NIHSS scale revealed a marked reduction in NIHSS scores in both groups after nursing, with even lower scores in the research group versus the conventional group ( $P<$ 0.05; Fig. 2).

Figure 2.

Impacts of hyperbaric oxygen therapy-specialized care on neurological function of cerebral infarction patients with hemiplegia. NIHSS: National Institutes of Health Stroke Scale; ^{* P<} 0.05.

3.4 Effects of HBOT-specialized care on mental state of CI patients with hemiplegia

We used SAS and SDS to evaluate patients’ mental state (Fig. 3) and found marked decreases in both scales in the two groups after care, with even lower scores in the research group ( $P<$ 0.05).

Figure 3.

Impacts of hyperbaric oxygen therapy-specialized care on mental state of cerebral infarction patients with hemiplegia. A. SAS scores. B. SDS scores. Note: SAS/SDS: Self-rating Anxiety/Depression scale; ^{* P<} 0.05.

3.5 Impacts of HBOT-specialized care on self-care ability of CI patients with hemiplegia

We assessed patients’ self-care ability using the BI scale (Fig. 4); evidently elevated BI scores were found in both case series after care, with a more significant increase in the research group ( $P<$ 0.05).

Figure 4.

Impacts of hyperbaric oxygen therapy-specialized care on self-care ability of cerebral infarction patients with hemiplegia. ^{* P<} 0.05.

3.6 Impacts of HBOT-specialized care on nursing efficiency of CI patients with hemiplegia

The evaluation of the nursing efficiency determined noticeably higher nursing efficiency in the research group after nursing compared with the conventional group ( $P<$ 0.05; Table 2).

Table 2
Impacts of hyperbaric oxygen therapy-specialized care on nursing efficiency of cerebral infarction patients with hemiplegia

Factors	Conventional group ( $n=$ 53)	Research group ( $n=$ 60)	$\chi^{2}$	$P$
Marked response	23 (43.40)	30 (50.00)	–	–
Response	20 (37.74)	27 (45.00)	–	–
Non-response	10 (18.87)	3 (5.00)	–	–
Nursing efficiency	43 (81.13)	57 (95.00)	5.316	0.021

4. Discussion

The treatment and rehabilitation of CI, a common cerebrovascular disease, has always been a research hotspot in clinical medicine [23]. In addition to a rising incidence in younger age groups in recent years, CI is also a critical condition among the middle-aged and elderly [24]. The decline of physical function in middle-aged and elderly people often leads to clinical symptoms such as aphasia and hemiplegia, seriously compromising patients’ daily lives [25]. This research selected 113 CI patients with hemiplegia and assigned them to two groups for comparative study. We first evaluated the LMF of patients, as up to 80% of CI patients are reported to suffer from lower limb motor dysfunction in the acute stage [26]. The FMA score of patients in the research group who received HBOT-specialized care was found to be significantly higher, indicating that HBOT-specialized care has a more significant impact on the recovery of LMF in CI patients with hemiplegia. This may be attributed to the series of rehabilitation training under the HBOT-specialized care program for patients in the research group, with corresponding exercise training adopted in different stages based on patients’ conditions, contributing to better recovered LMF and coordination of the limbs. CI can lead to the acute loss of neurons and glial cells in the brain, resulting in neurological impairment in patients [27]. Therefore, we also evaluated patients’ neurological function, and found a more significant reduction in the NIHSS score in the research group after care, indicating better neurological function recovery in patients receiving HBOT-specialized care. Geng et al. [28] believed that early application of rehabilitation exercises in CI patients is beneficial to their neurological function recovery, consistent with our results. Later, we evaluated the mental state of patients during rehabilitation by SAS and SDS. Both groups of patients showed significantly mitigated anxiety and depression after care, with even lower SAS and SDS scores in the research group, suggesting that HBOT-specialized care is more effective in alleviating patients’ negative emotions. CI patients are more susceptible to anxiety, irritability and other unhealthy emotions due to the disease, which will reduce their willingness to live and their nursing compliance. While HBOT-specialized care can help patients establish correct disease awareness and provide psychological counseling and care, which facilitate the relief of negative emotions and enhancement of treatment compliance, thus laying a solid foundation for subsequent exercise and dietary care. In terms of self-care ability, the BI score results revealed markedly higher post-care scores in the research group versus the conventional group, suggesting that HBOT-specialized care has a significant positive effect on the improvement of daily living ability of CI patients, similar to the findings of Wei et al. [29]. Finally, nursing efficiency was investigated and statistically higher treatment efficiency was determined in the research group compared with the conventional group (95.00% $>$ 81.13%), demonstrating that HBOT-specialized care is more effective than conventional nursing for CI patients, which supports the above results on LMF and neurological function.

The novelty of this study lies in the analysis of the application of HBOT-specialized care in CI patients with hemiplegia from multiple dimensions such as LMF, neurological function, mental state, self-care ability, and nursing effect, confirming its effectiveness in the care of such patients. The significance of this study is not only to provide clinical evidence for the management optimization of such patients, but also to shed new light on the future exploration and optimization of this clinical field. However, this study still has certain limitations. First, this is a single-center study that is prone to information bias. Second, the study did not focus on assessing treatment outcomes, so it is unclear whether the mode of care or HBOT is responsible for the treatment outcomes. Finally, long-term prognostic analysis needs to be supplemented to further understand the effect of HBOT-specialized care on the long-term prognosis of CI patients with hemiplegia. In the future, we will continue to improve the research project from the above aspects.

5. Conclusion

HBOT-specialized care applied to CI patients with hemiplegia has significant nursing effects, which can enhance patients’ LMF and neurological function, mitigate negative emotions, and improve their self-care ability, providing an effective scheme for the management optimization of CI patients and is worthy of clinical promotion.

Footnotes

Conflict of interest

None to report.

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Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Data and methods

2.1 Patient information

Table 1 General information of cerebral infarction patients with hemiplegia

2.3 Outcome measures

3. Results

3.1 General information of two groups

3.2 Influences of HBOT-specialized care on LMF of CI patients with hemiplegia

Table 2 Impacts of hyperbaric oxygen therapy-specialized care on nursing efficiency of cerebral infarction patients with hemiplegia

5. Conclusion

Footnotes

Conflict of interest

References

Table 1
General information of cerebral infarction patients with hemiplegia

Table 2
Impacts of hyperbaric oxygen therapy-specialized care on nursing efficiency of cerebral infarction patients with hemiplegia