Arrhythmia is a condition in which there is a problem with the rhythm or rate of the heartbeat due to a change from the normal sequence of electrical impulses. The Arrhythmia diagnosis includes the heart beating too slowly, too fast, or with an irregular pattern. Tachycardia is a heart condition in which the heart beats faster than normal. In contrast, bradycardia is a condition where the heart beats too slowly. The common type of arrhythmia is atrial fibrillation that causes a fast and irregular heartbeat.

Diagnosis:

• A common test used for Arrhythmia diagnosis is an electrocardiogram (EKG or ECG). An electrocardiogram records the electrical activity of the heart.

• A treadmill test, also known as a stress test or an exercise stress test can help diagnose people with suspected arrhythmias.

• Chest X-ray: Radiation is used to produce images of the heart.

• Electrophysiology studies also help diagnose arrhythmia.

• Tests such as Holter monitor, Transtelephonic monitor, Tilt-table test, Esophageal electrophysiologic procedure, and Echocardiogram are used for Arrhythmia diagnosis 1,2

Implications: Complications of arrhythmias may include stroke, heart failure, or death. Heart arrhythmias are generally associated with an elevated risk of blood clots. If a clot breaks loose, it can go from the heart to the brain, causing a stroke. A timely diagnosis and treatment will be necessary and that’s why Arrhythmia monitoring is necessary for every patient.

Available treatments: Medications such as anti-arrhythmic drugs, calcium channel blockers, beta-blockers, and anti-coagulants help in treating arrhythmia. In some cases, devices are also used for the treatment of arrhythmia; these include an Implantable cardioverter defibrillator (ICD) and Pacemaker.

Cerebral stroke:

An interruption/reduction in the supply of blood to the brain causes a cerebral stroke. This lack of supply results in the absence of oxygen or nutrients to the brain leading to brain cells death, and the abilities controlled by that area of the brain are lost. Blockage or rupture of the brain artery can affect the blood flow leading to stroke. Cerebral stroke is also known as a brain attack. There are two types of stroke, namely, haemorrhagic stroke and ischemic stroke. A haemorrhagic stroke will be caused by the breakage of a blood vessel in the brain. An ischemic stroke is caused by a clotting of the blood that may block an artery and cut off blood flow to the brain.

Signs and symptoms of stroke:

Trouble speaking, understanding, confusion, slurry words or difficulty in understanding speech.

Paralysis or numbness of the arm, face, or leg. Development of sudden numbness, paralysis in the face, arm or leg, and weakness. This frequently affects just one side of the body. When both the arms are raised over the head at the same time, if one arm begins to fall, it could be an indication of a stroke. Also, one side of the mouth may droop when trying to smile.

Problems with viewing in one or both eyes. Sudden development of blurred or blackened vision in one or both eyes, or double vision.
A sudden, severe headache, accompanied by vomiting, altered consciousness or dizziness.
Trouble walking, stumbling or loss of balance. Sudden dizziness or loss of coordination4

Association between cerebral stroke and arrhythmia

Central nervous system injuries generally affect the autonomic nervous system, which plays an important role in the pathogenesis of atrial fibrillation. Systemic inflammatory response is activated by necrotic cell death from stroke activates, that also plays a role in the origin of atrial fibrillation. Strokes affecting cerebral autonomic centres are particularly associated with new- onset AF that lacks accompaniments of long-standing AF, such as left atrial enlargement. The fraction of strokes caused by atrial fibrillation is raised by age because this arrhythmia is more prevalent around the age of 70 -79. Cardioembolic stroke reports for approximately a quarter of all ischemic strokes, with non-valvular atrial fibrillation as the predominant type

Recent technological advancements about diagnosis and treatments about cerebral stroke

A stroke is a severe and life-threatening condition that occurs when the blood supply to the brain is interrupted. The two main causes of stroke are ischemic and haemorrhagic. The ischaemic stroke occurs when the blood supply is cut off because of a blood clot. Around 85% of stroke cases are ischaemic. The second leading cause haemorrhagic stroke. It occurs when the blood vessel that supplies blood to the brain becomes weakened and suddenly bursts. A Transient ischaemic attack (TIA) is a condition occurs when the blood supply to the brain is temporarily interrupted for a few minutes or hours. Stroke requires urgent diagnosis and treatment to lessen the damage. Symptoms of stroke include an inability to keep both arms lifted and slurred speech and face dropping on one side. Treating a stroke depends on the type of stroke a patient has had and which area of the patient’s brain has been affected. Strokes are most commonly treated using medications such as anti-coagulants (medicines that prevent and dissolve blood clots), anti-hypertensives (medicines that reduce blood pressure) and anti- lipidemics (medicines that lower cholesterol levels). Few patients may also require surgery for the removal of blood clots. Following are the recent technological advancements for the treatment of cerebral stroke

Cone beam imaging: This method allows the accurate detection of occlusion site, haemorrhage, and ischemic core. This test could help result in stroke patients by passing a CT scan or an emergency department and going straight to the Angio suite for appropriate care and imaging

Cerebrotech stroke detecting visor: The device uses low-energy radio waves to detect the blockages and has been designed to detect stroke within seconds. Cerebrotech Visor device helps detect emergent large-vessel occlusion in suspected stroke patients.

Vivistim nerve stimulation treatment: The device works by pairing VNS with muscle movement during rehabilitation. The stimulation leads to the strengthening of the neural circuits in the brain associated with memory, motor function, learning. It shortens the recovery period of motor skills for stroke patients via vagus nerve stimulation using a device referred to as Vivistim

Cenovus aneurysm device: The device is now among Cerenovus’s wide-ranging portfolio of devices used in the endovascular treatment of haemorrhagic and ischaemic stroke. The device helps reduces the risk of rupture and a potential haemorrhagic stroke by diverting blood flow from an aneurysm. Its design aims to improve ease of use and lower the length of procedures

Strategies to manage the quality of life of cerebral stroke patients

Stroke is a significant cause of death, loss of independence, and decreased quality of life. Even though care for individuals with stroke was previously focused on the acute phase, there is a notable group of patients who have persistent disabilities many years post-stroke. These dysfunctions can include physical limitations, such as paralysis or fatigue, and/or cognitive and psychological issues, such as depression and/or anxiety. Quality improvement is the combined efforts of patients, their families, healthcare professionals, researchers, payers, planners, and educators to make changes that will lead to better system performance (care), professional development (learning), and patient outcomes (health). Social and recreational activities are minimized for most stroke survivors after they return home. The objective of stroke rehabilitation is to help them relearn skills that are lost when a stroke affects the part of the brain. Stroke rehabilitation can help improve the quality of life. The seriousness of stroke complications and each person’s ability to recover vary widely

Physical activities include:

For Arrhythmia monitoring, these physical exercises should be done by every patient.

Motor-skill exercises. These exercises can help improve muscle coordination and strength.

Mobility training. Learning to use mobility aids, like walkers, canes, ankle braces or wheelchairs. The ankle brace can strengthen and stabilize the ankle to help support the body’s weight whilst relearning walking.

Constraint-induced therapy. An unaffected limb is restrained while practicing moving the affected limb to help improve its function. This therapy is also sometimes called forced-use therapy.

Range-of-motion therapy. Specific treatments and exercises can ease spasticity/muscle tension and help regain motion range.

Technology-assisted physical activities might include:

Functional electrical stimulation. Electricity when applied to weakened muscles causes them to contract. This may help re-educate the muscles.

Robotic technology. Robotic devices can assist impaired limbs with assisting limbs,performing repetitive motions in regaining function and strength.

Wireless technology. An activity monitor may help elevate post-stroke activity.

Cognitive and emotional activities include:

Therapy for cognitive disorders: Speech and occupational therapy can help with lost cognitive abilities, such as problem-solving, processing, memory, social skills, safety awareness, and judgment.

Therapy for communication disorder: Speech therapy can help regain lost abilities in speaking, comprehension, listening, and writing.

Psychological evaluation and treatment: Emotional adjustment may be tested by counselling or participating in a support group.

Medication: Medications like antidepressant might be prescribe by the doctor.

Experimental therapies: Noninvasive brain stimulation: Transcranial magnetic stimulation help improve a variety of motor skills.

Biological therapies, such as stem cells.

Alternative medicine: Treatments like massage, oxygen therapy herbal therapy,and acupuncture may be helpful.

The sooner you begin, the more likely you are to regain lost skills and abilities. However, your doctors’ immediate priorities are to:

Stabilization of medical condition

Control life-threatening conditions

Prevention of another stroke

Limit any stroke-related complications

It is usual for stroke rehabilitation to start as soon as 24-48 hours post your stroke whilst you are in the hospital.

The duration of stroke rehabilitation will be depended on the seriousness of the stroke and related complications. Most people need some form of long-term stroke rehabilitation, lasting possibly months/years after their stroke. The stroke rehabilitation plan will change during recovery as you relearn skills and your needs change

IoT-Enabled Stroke Rehabilitation System

A smart wearable wristband, machine learning algorithms, and a 3D printed robot hand have been deployed as part of an IoT-based stroke rehabilitation system. The SWA was created by integrating a low-power and tiny-sized IoT sensing device with textile electrodes that can measure, pre-process, and wirelessly transmit bio-potential signals. ML algorithms were leveraged to study and discriminate features of different movements of hand, and their performances were appraised by classification complexity estimating algorithms and principal components analysis. A 3D printed five-finger robot hand guided by ML algorithm was developed for recovery from stroke. The real-time guidance from the robot hand can give the patient the feedback of muscle activities and can help them to strengthen their motion patterns, which show the feasibility of robot-assisted active training after suffering from stroke

References:

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