Harms versus benefits of antipsychotics in the prevention of delirium.

Delirium is a transient and acute but reversible fluctuation disturbance in the level of cognition, attention and consciousness. Other names for delirium are toxic or metabolic encephalopathy or confusional state.

The cause can be any disorder or drug intolerance.

The diagnosis for delirium is clinical with the use of imaging and laboratory tests to identify the cause. Correcting the cause and other supportive measures are the approach to treating delirium.

Delirium can occur at any stage of life but mostly affects the elderly. Approximately 10% of the elderly patients in the hospital have hallucination and 15-50% experiences the condition at a particular time in their hospitalization. Delirium is also frequent after surgery, among ICU patients and nursing home residents.

It might also affect the younger people usually because of life-threatening systematic disorder or drug use.

Symptoms and Signs of Delirium

These are the primary signs that characterize the presence of fever:

Difficulties in maintaining, focusing or shifting attention

The level of consciousness fluctuates making the patients become disoriented to time, place and sometimes person. The patient might have hallucinations, paranoia and delusions. It is common for the patient to have confusion regarding their daily events and daily routines as well as changes in personality. Delirium might disorganize thinking and speech with exceptional rapidity, slurring, aphasic errors, neologisms or chaotic patterns. Symptoms of delirium keep fluctuating over minutes or hours. They might lessen as the day progresses but become worse at night.

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New Diagnostic Tests

A diagnostic test or procedure is an examination that identifies specific areas of strength and weakness to determine the condition, illness or disease in a person. For instance, physicians may use MRI (Magnetic Resonance Imaging), Electromyography (EMG) or Computer Assisted Tomography (CAT scan to determine if there is impingement of a nerve root by a herniated disc.

The ability and range of diagnostic test continuously evolve as researchers find a way to detect diseases earlier, get more detail and get an accurate diagnosis in many people across all regions of the globe. There are many attempts to find new ways of performing diagnostic tests, but these are the latest developments in the diagnostic technologies.

1. CancerSEEK

Cancer has become such a killer, but researchers have invented another way of testing and detecting eight most frequent types at once. These include the elusive pancreatic and liver cancers that are difficult to detect. As the new technology develops, doctors will one time use it to spot cancers in the early stages even before the onset of symptoms to improve chances of treatment and survival. Cancer SEEK looks for various compounds that could be early signs of cancer from the blood. The compounds it checks include 16 different cancer driver genes with association to tumors and eight proteins.

The intention is to make cancer screening a routine activity so that patients who visit a health facility for an annual physical checkup can get also get a blood screening for cancer at the same time. An additional benefit is that cancer SCREEN appears to have ability for screening for these five cancers for which other screening tests fail to detect.

  • Stomach
  • Ovarian
  • Pancreatic
  • Esophageal
  • Liver

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Are disposable pressure cuffs a safer option?

Blood pressure cuff is a medical device that comprises of a rubber piece or a similar material that a clinician wraps around the arm of a patient and inflates it to measure the blood pressure.

The purpose of blood pressure cuff is to take blood pressure. The cuff has an inflatable bladder made of rubber for fastening around an arm. A pressure meter indicates the pressure off the cuff. A clinician uses a small handheld air pump to inflate the blood pressure cuff.

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Rehabilitation of brain injuries. Discuss mirror therapy

A brain injury is the sort of damage that a blow to the brain caused by an external force but is not of congenital or degenerative nature. It might lead to temporary or permanent impairment of the physical, cognitive and psychological functions. An injury to the brain might generate an altered or diminished state of consciousness to cause these effects that prevent normal functioning as before the injury:

  • Impairment of physical functioning and cognitive abilities
  • Profound disturbances of emotional, cognitive and behavior functioning
  • Permanent impairments that cause partial or full functional disability as well as psychosocial maladjustment

The Brain Injury Association Board adopted the definition of acquired brain injury to add the definition of a brain injury to include other causes that occur because of other nontrauma causes. An acquired brain injury (ABI): An injury to the brain that occurs after birth. It commonly causes a change in neuronal activities that affect physical, metabolic or functional ability of a cell. The causes of ABI include an application of external forces to the head or neck without causing a fracture.

The severity of Traumatic Brain Injury

Moderate traumatic brain injury–Trauma to the head causing a loss of consciousness that lasts 30 minutes to 24 hours. Posttraumatic amnesia can last 24 hours to a week.

Severe traumatic brain injury-this injury is a trauma to the head that causes a loss of consciousness lasting more than 24 hours and an initial Glasgow Coma scale of 3-8. It also creates a posttraumatic amnesia period that goes beyond seven days.

Traumatic Brain Injury (TBI)- TBI IS an insult to the brain occurring after an external physical force to produce an altered and diminished state of consciousness interfering with physical or cognitive abilities. TBI can cause altering or diminishing state of consciousness.TBI might cause permanent impairments resulting in partial or full functional disability as well as psychosocial maladjustment.

Head injuries that cause brain injury might be open or closed. A closed head injury is that which does not break the skull. An open or penetrating head injury is that which cracks the scalp o skull to enter the brain. Assessing the severity of the head injury by observation is hard. Some of the injuries on the head can cause much bleeding while other does not cause any bleeding. Head injuries are dangerous, and nobody should take them lightly. It is essential to go for assessment by a doctor quickly.

What is Rehabilitation of Brain Injuries

Brain injuries can affect the way of doing everything from walking, talking or even entire thinking. Brain healing is a process occurring after brain damage. The brain has the resilience to adapt but when cells within can cause significant damage or die for instance after a stroke, there might be formation on those cells or repair might be impossible.

Some TBIs increase the risk of a stroke. The necessity to start healing is the reason for rehabilitation of brain injuries which is a term referring to different types of specialized support and services that attempt at making an emergency or early phase intervention. Some brain injury rehab is a program within a hospital or other clinical settings. Some of them can take place on an outpatient basis. Every patient benefits from rehabilitation after a brain injury with the specific type depending on the unique needs by a person and challenges they face.

Mirror therapy

Mirror therapy is a type of motor imagery therapy that involves using a mirror to convey visual stimuli to the brain through observation of the body part that is still intact after the injury as it performs setoff movements. The underlying principle behind mirror therapy is that visual cues from the functional side of the body will stimulate the action of an affected limb. The thinking behind the therapy is that might be useful among the patients who lose movement or a limb after a brain injury or after suffering a stroke.

Mirror therapy involves using a tabletop mirror for creating a reflection of the unaffected part of the body such as an arm in place of the one that is affected during the therapy. A mirror should stand in line with the middle of the patient’s body. The position allows reflection of the unaffected half. It creates an optical illusion that the week part suck as a leg or hand has regained the ability to move. The initial use of this technique was to help in the rehabilitation of the patients suffering from chronic pain, but now those who are recovering from brain injury and stroke can also benefit. An advantage is that someone can set it up without challenges even when having some form of disability. A patient can even perform the therapy alone at home.

The mirror becomes a tool for performing various rehab exercises by just using the healthy side or part of the body.

Why Use Mirror Therapy for Rehabilitation of Brain Injuries

A reason for therapists, physicians as well as patients or their families to use a mirror to consider using mirror therapy is its ability to fire the neurons. The movement takes place after firing of the motor neurons in the brain that communicate to the muscles to move. Every time a person talks, walk or stands, it is a result of motor neurons in the brain. These motor neurons are in the same area of the brain as the mirror neurons. The difference between motor and mirror neurons is that the former fire up after a person sees the occurrence of a movement. In simple terms, the mirror neuron fire off after watching someone to move. The use of the word mirror is not a coincidence. Mirror therapy triggers firing of mirror neurons after a patient notices an illusion of affected arm as it moves in the mirror. Even though it is a mere reflection of a natural body part such as an arm, studies show that the brain perceives it as an affected part. The mobility improves after moving the affected area to inspire to move the affected.

Neuroplasticity effect

The mirror image tricks the brain into thinking that the affected body side but the truth is that the image is of the healthy part. The conscious mind knows it is a reflection, but the illusion helps the brain to rewire through a phenomenon called neuroplasticity. Plasticity is the ability of a cell to change. Each time a person makes a movement or the brain assumes that there is mobility, it is building connections.

If the brain injury was extremely severe to cause stroke, parts of it might have more damage, and it will begin to form new connections. Damage to the brain that hinders an ability to move a part of the body, the area requires repopulation with healthy connecting neurons to regain a full movement. The brain has a role in repurposing cells that control the other parts and trains them to learn new tasks.

Therapists can harness neuroplasticity to the advantage of a patient in rehabilitation. Approaches like mirrors or visualization utilize neuroscientific principles for rehabilitating areas of the brain for survivors to regain new control of their thinking as well as an independent ability to complete the daily tasks.

A developer of mirror box for use in mirror therapy therapeutic approach to regenerate neural networks that control the limbs as well as other body parts Vilayanur S. Ramachandran had the intention to address phantom limb pain. A mirror box uses mirrors to create an impression in the brain of a user that the movement of an affected body part is taking place whereas it is the one that is not suffering the effects of brain injury. The reflective surfaces in a box trigger patients to perform exercises using the unaffected limbs as the appearance seems as if the exercise is on the affected limb.

A study on the efficiency of the mirror therapy supports confirms that it a supports motor recovery even in post-stroke hemiparesis. The theory behind mirror therapy is that positive visual feedback encourages a neuroplastic change leading to quicker recovery for the survivors. Mirror boxes are on sale, but those with a specific preference might ask for customization.

Mirror therapy works in an almost similar way to another rehab technique whose basis of performance is on the science of visualization. Information on rehabilitation after brain injury and stroke show that visualizing or mental rehearsal of a task can cause the same effects as performing a task. A study on visualization showed that it increases the efficiency of brain recovery when someone performs it together with physical activity rather than rely on conventional rehabilitation or practice on its own. Visualization can boost mirror therapy for rehabilitation of brain injuries because it has powerful effects with richness in sensory details. They show the effect of sights, feelings, and smells. Visualization, for instance, helps a patient who is unable to walk after a brain injury or stroke can have a vivid imagination of strolling in a part while doing rehabilitative exercises.

Does Mirror Therapy Work

Mirror therapy is an efficient way of rehabilitation the brain and helping a patient to achieve the normal functionality of the body after a brain injury. It is more efficient when the injury affects one side of the brain than the other in a similar way to a stroke. It can leave the patient feeling weaker and off-balance on one side. Sometimes the patients are unable to stand upright or use an arm or leg on the affected side. Exercises and physical therapy helps much in the recovery. Mirror therapy still plays some role because they will fire the neurons.

An example is a study by a team of researchers in Germany who undertook 62 studies on mirror therapy as way brain rehabilitation. The study was on 1892 patients, and the outcomes showed that the mirror therapy led to the moderate improvement of the motor action. It also helped in the daily activities. Mirror therapy also helped in the management of complex regional pain syndrome a form of chronic pain that occurs after damage to the nerves usually after complications of brain injury such as stroke. However, the scope of research did not include studying whether mirror therapy helps with neglect that occurs when the people have hard times noticing the things in a visual field of the bad side.

It does not hurt to try mirror therapy for those who want to test means that will help in rehabilitation from brain injury. However, it is not a reason to replace all the efforts of physical therapy and activity.

Mirror therapy is not a replacement to other standard therapies but should be a supplement to what they achieve. It is as a good as other treatments but one of the varieties to try along the recovery training that a patient gets from a therapist. Mirror therapy is a non-pharmacological and alternate treatment strategy that some therapists propose as a way of managing PLP. It is a neuron-rehabilitation technique with a design to re-modulate the cortical mechanisms. MT is a technique that enables patients to perform movements with the unaffected limb while watching a mirror reflection superimposed over the affected limb that is out of the picture in the instance. It provides positive feedback and creates a visual illusion to motor cortex by creating an impression of a movement of the affected limb. This approach offers potential relief through the ocular dominance of the motor and the sensory processes.

Since PLP is very important as well its management, mirror therapy offers clinicians a low cost and a simple to implement rehabilitation technique. The higher weight of evidence about the efficiency of this process show that it has more benefit when in use as a sequential or combined therapy like graded motor imagery but not as a stand-alone modality.

Nonetheless, Mirror Therapy is not something to disregard. A crossover study on the effects of MT -Garry, Loftus & Summers (2004)-on healthy individuals shows that viewing a mirror image of an active hand makes the neurons in the ipsilateral primary motor cortex to be excited more than a direct view without using the mirror. The trend to view a mirror image shows that the patients undergoing rehabilitation of brain injuries will also favor watching their limb or body part move on the mirror. The movement prompts the brain to attempt to start moving the side with mobility difficulties.

Studying the effect of abdominal massage on the gastric residual volume in patients

Gastric residual refers to the volume of fluid that remains in the stomach every time during an enternal nutrition feeding (direct to the stomach). Nurses can withdraw the fluid through a feeding tube by pulling back on a plugger of a large syringe (usually a 60 Ml) at intervals at intervals ranging from 4-8 hours. The nurses or someone in the team that is taking care of the critically ill patient should ensure that they replace the residual fluid into the stomach of a patient to prevent loss of electrolyte, fluid and nutrients.

Gastric abdominal massage is one of the ways to decrease gastric residual volumes. It is an external practice that aims at shifting internal organs that could have changed the location to restrict blood flow, body chi and lymphs .it help to release more than the physical tension by also one that occurs because of spiritual and mental strain. Releasing the tension opens up the energy pathways and flow of chi in the body.

Critically ill patients cannot eat sufficient quantities of food to satisfy the nutritional needs. The doctors at this time may decide that feeding should take place through a tube that is inserted into the stomach or small bowel to provide enough nutrients.

There is various tube feeding formulas in the market made by different companies with ingredients that meet 100 per cent of the nutritional needs by the patient. This feeding can go on continually for some hours at any time of the day at a specific rate. The delivery is by a pump or sometimes several times of measured amounts within the day. Adequate nutrition depends on right amount and type of formula.

Sickness or injury might cause an increase in the need for energy, protein and metabolic rate to promote healing by providing more nutrients. Muscle damage is also common at this stage because there is a limitation to mobility at this time. Many people with severe injuries such as those of the spinal cord lose a significant amount of muscle when they first get an injury. The body needs for protein and calories will decrease in a few months after the injury and care providers should adjust the tube feedings to prevent unwanted weight gains.

It is important to monitor the body weight and know the weight goals. It is essential for a doctor or registered dietician to provide the tube feeding adjustment instructions after significant weight changes which are a loss or gain of over two pounds in a week. It is also essential to seek the counsel of adjusting the tube feeding after clearance to eat by a specialist.

A healthcare provider has the responsibility to prescribe the feeding schedule, formula and the amount of water necessary for optimal hydration and nutrition.

How Widespread Is Abdominal Massage Practice

It is not many people who know about abdominal massage compared to other types of massage. It is a restorative and healing process that has shown to have many benefits for individuals in need of a holistic approach to the wellbeing.

Role of Abdominal Massage In Decreasing Gastric Residual Volumes In Critically Ill Patients

Gastrointestinal dysfunction is one of the problems that affect critically ill patients during their hospitalization in the intensive care units. Some of them even get constipation that affects their bowel movement.

The increase of bowel dysfunction among the critically ill has become common to the point of reaching up to 50%. Enternal feeding is a primary recommendation for the critically ill and mechanically ventilated patients but still can be a risk factor for aspiration.

More caregivers and health institutions are becoming aware that abdominal massage has the power to reverse such GI issues. The simple technique of massaging the stomach in a clockwise motion is proving to be very useful in helping to relieve the issues. It works better with incorporation of some reflexology point work on the abdomen, intestines and bladder.

Currently, abdominal massage is one of the non-medicinal methods that one can apply with or without therapeutic methods that have much acceptance. To prove the efficiency of abdominal massage on gastrointestinal functions, a clinical trial on 70 patients in intensive care and with an endotracheal tube.

The researchers used a convenience sampling method for random allocation to a control or an intervention group. The intervention group got 15 minutes of abdominal massage two times a day for three days, but the control group only got routine cares. The study team took records of the abdominal circumference, times of bowel movements, the frequency of constipation and gastric residual volume.

The results show that gastric residual volume had a significant decrease in the intervention group that got an abdominal massage. The control group that was receiving support care showed a significant increase in gastric residual volume. The intervention group also had more benefits in the form of an increase in defecation times and a decrease in the prevalence of constipation. The abdominal circumference in the intervention group also reduced more than those in the control group.

The findings show that the abdominal massage helps to improve gastrointestinal functions among the enternally fed patients with endotracheal tubes. The suggestion to those taking care of critically ill patients is that they should consider using abdominal massage as an adjunct therapy to improve gastrointestinal functions in intensive care patients.

Importance of Decreasing Gastric Residual Volumes with Abdominal Massage

Experts in critical patient care recommend early enternal nutrition (EN) as the first line of nutrition therapy in critically ill patients because it alters the outcome in the favor providing the nutritional and even non-nutritional benefits. However, the critically ill patients who are receiving mechanical ventilation are a high risk of pulmonary aspiration, regurgitation, and ventilator-associated pneumonia (VAP) if they stay long in this environment. EN can increase these risks when gastrointestinal dysfunction is present. It has a surrogate parameter in the Gastric residual volume (GRV) as the enternal feeding progresses in the early phase of the critical illness and even beyond. Clinicians who monitor GRV might detect patients with a delayed gastric emptying much earlier and intervene with strategies that will prevent or minimize VAP one of the most significant risks of EN.

The value of periodic GRV measurements regarding reducing VAP incidents is a frequent cause of debate in the past years. An increase of GRV threshold before interrupting the results of gastric feeding will cause marginal increases in the EN delivery.

Benefits of Abdominal Massage To Critically Ill Patients

Abdominal massage plays a significant part in reducing abdominal massage. The abdomen is a critical part of the body as it houses many vital organs including most of the digestive system. The digestive system can develop weaknesses as a result of illness. Living a sedentary lifestyle and failing to exercise enough can also contribute to weakness in the abdomen. Abdominal massage practice helps in toning and strengthening the muscles in the abdomen, and it helps to improve the digestive system tremendously. An abdominal massage helps in detoxification of the body. It is one of the recommendations for the success of a colon cleansing program.

Additionally, it also provides these other benefits.

1.The holistic and complete attention of the organs

Most people have never got an opportunity to receive abdominal or anterior chest work. Abdominal massage is an opportunity for the huge sections of the body that have not got attention to get of addressing their problems through touch. Clients who get the massage even at the commercial outlet when they are not ill say they feel lighter, calmer, more energized and with more integration. Patients get more benefits because their movement at the time is restricted.

2.Enhances intestinal functional

Some studies show that massage promotes peristalsis, helps to improve or prevent symptoms of constipation and soothes the minor intestinal discomforts. The partly mechanical effects help in moving intestinal contents for those people with various conditions including:

  • Parkinsonism
  • Neurological gut control
  • Spinal cord injury
  • High-stress level
  • Anxiety proneness

It also has neurologically and reflex-mediated effects to support simplicity and efficiency of the intestinal function.

3.Helps with other physical, mental and spiritual conditions

Abdominal massage provides benefits that go beyond the abdomen because the effect of massage reaches another region of the body to help with reducing anxiety, depression as well as eating disorders. Some of those who went for abdomen therapy due to GI issues also report that it reliefs lower back pain, post-childbirth syndromes and posture abnormalities showing that abdomen work has therapeutic qualities.

It is important to consider then contradictions and cautions of abdominal therapy. It is essential to do a study about the appropriateness of the massage therapy by examining the scope of practice and collaboration with other health practitioners as well as using the correct techniques for the practice.

More focus on the fact is essential considering the effects in the previous points which show strong indications that abdominal massage helps to manage and overcome various disorders above decreasing gastric residual volumes.

The Connection between Abdominal Massage, Gastric Residual Volumes And Wellbeing

The abdominal massage was until recently a new thing but fascination new information is now filtering through, and scientists are taking more time to learn about an enteric nervous system that is drawing a lot more interest due to connection and role. There might not much reach data massage connection with abdominal organs, but there is enough information to stimulate the thought process.

The enteric nervous system predates much development and independent features with some connection to the brain.

Limitations of Abdominal Massage Techniques

Although abdominal massage has numerous benefits for the critically ill patients who need everything that can reduce their gastric residual volumes, it is not everyone.


People with certain gastrointestinal tract disorders should not get an abdominal massage. It should also not take place in the presence of inflammatory intestinal conditions such as celiac disease, ulcerative colitis and celiac disease during the flare-ups.

Light, soothing abdominal massage helps but it should be without pressure to the abdomen if the recipient is hypersensitive. The touch should be lighter on someone who is in the first trimester of pregnancy. Some pregnancies are a no-go zone if they have elements such as placenta précis or anything that makes it high-risk pregnancy.

ii.Reproductive and high risk conditions

Some of the reproductive conditions including severe endometriosis and unstable ovarian cysts do not permit abdominal massages. It is always essential to consider if a medical condition is too risky for other procedures including the non-invasive massage.

Presence of less acute reproductive or gastrointestinal disorders such as abdominal surgeries, high –risk pregnancies or aortic complications require consultation and working in collaboration with a physician. Abdominal massage in such instances involves input by a massage practitioner who understands the medical repercussions and the necessary care but not someone who has primary massage education.

iii.Emotional and psychological factors

Some people have reservations about massage on their belly for other non-medical reasons. For instance, some people feel that it is undesirable or uncomfortable for someone to touch their abdomen because they consider it to be more of a private body part. Such arguments might seem weak in the face of the benefits that abdominal therapy can bring, but massage therapists have to respect these stances.

This list might not exhaust everything about the use of abdominal massage to decrease gastric residual volumes but with a little research and common sense will decide on the suitability of the procedure to be straightforward.

If a client who should benefit from the abdominal massage techniques or the family sets any boundary, the first step should be to provide information about the pros. The details and answers to questions might change the attitude after an increase of awareness and trust for the therapist. However, it would be unethical to pressurize the patient or family into accepting abdominal massage by portraying like it is the only way to promote healing.

Lessons about Abdominal Massage and GRV

Abdominal massage can decrease gastric residual volumes (GRVs) and abdominal circumference over time in select population in the critical care unit. Research and standardization for abdominal massage practice might provide clinicians with some additional tools to improve gastrointestinal (GI) functions and feeding among the critically ill.

It is a fair rating that many of the persons who have not got an abdominal massage during a critical illness that compels doctors to feed them via a tube is because the therapist s did not suggest the option. It could also be that their physicians were uncomfortable with the procedure due to real or overblown safety worries.