The influence of positioning upon cerebral oxygenation after acute stroke: a pilot study

Abstract

Sir—Passive postural changes may have an effect on a number of physiological parameters after stroke [1]. For example, standing, sitting or even elevating the head after stroke might reduce cerebral blood flow due to poor collateral circulation and an inability to regulate and augment cerebral blood flow in ischaemic regions of the brain [2–5]. Optimal positioning for patients in the acute stage after stroke is still unknown [6–8]. Variation in clinical practice is evident in the literature [5–9] and has been observed [10]. This variation could be because of the paucity of experimental findings to inform a scientific rationale for positioning early after stroke. For example, traditionally, people who have suffered a large hemispheric stroke have been managed with head elevation between 30° and 45° [5], a practice generalised from clinical experience with head trauma patients despite differences in pathophysiology [11].