# Rehabilitation after Aneurysmal Subarachnoid Hemorrhage (SAH)

- Link: https://sifsof.com/clinical-apps/rehabilitation-after-aneurysmal-subarachnoid-hemorrhage-sah/
- Published: 2021-08-22T18:29:14+00:00
- Author: Monica

A [cerebral or intracranial aneurysm](https://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/What-You-Should-Know-About-Cerebral-Aneurysms_UCM_310103_Article.jsp)
is an abnormal focal dilation of an artery in the brain that results from a weakening
of the inner muscular layer (the intima) of a blood vessel wall. The vessel develops
a “blister-like” dilation. This defect can produce pressure on nearby structures,
causing problems such as double vision or [changes in pupil size](https://www.verywellhealth.com/what-can-my-pupil-eye-size-tell-me-about-my-health-3421861).
It can become thin and rupture without warning. The resultant bleeding into the 
space around the brain is called a [subarachnoid hemorrhage](https://www.neuroendomke.com/brain-tumors-other-brain-disorders-and-brain-surgery/subarachnoid-and-intracranial-hemorrhages/)(
SAH). This kind of hemorrhage can lead to a stroke resulting in disabilities, coma
and/or death.

Thus a subarachnoid hemorrhage is a medical emergency and immediate treatment is
essential to help reduce the risk for permanent brain damage. Today there are two
treatment options for people who have been diagnosed with a brain aneurysm:

 * Surgical clipping.
 * Endovascular therapy.

**Surgical clipping:**
An operation to “clip” the aneurysm is performed by doing
a craniotomy (opening the skull surgically), and isolating the aneurysm from the
bloodstream by placing one or more clips across the neck of the aneurysm.  This 
eliminates further blood flow into the aneurysm, significantly reducing the risk
of rupture.  After clipping the aneurysm, the skull bone is secured in its original
place, and the wound is closed.  Surgical clipping of an aneurysm is always performed
by a trained and licensed neurosurgeon.

**Endovascular Treatment:**
A less invasive technique called endovascular treatment,
does not require a craniotomy. This technique uses existing spaces within the artery
to deliver implants that can seal off the weakened aneurysm wall from any further
contact with pulsatile arterial blood flow.  Access into the blood vessels is via
a small incision at the groin crease.  Under X-ray guidance, a microcatheter is 
used to reach and deliver coils into the aneurysm to induce stagnation of blood 
flow in the sac, leading to thrombosis (clotting) of the aneurysm.

Endovascular treatment sometimes requires the use of an additional device such as
an intracranial stent.   This device enables treatment of a broader scope of aneurysms
that may be difficult to treat with coils alone.  Stenting with coiling utilizes
a small flexible cylindrical mesh tube that provides a scaffold for the coiling.
Lower porosity stents or flow diverters achieve aneurysm occlusion without placing
coils into the aneurysm sac.  These devices function by redirecting flow to stay
within the parent vessel, also inducing thrombosis in the aneurysm sac.

Recovering from a brain aneurysm or a Subarachnoid Hemorrhage is a major life event
that continues long after discharge from the hospital.  Following a brain injury,
patients often face a myriad of physical, emotional and cognitive changes, ranging
from minor setbacks to major challenges with long-lasting impact. Rehabilitation
can significantly influence long-term recovery by helping patients learn new ways
to compensate for abilities that may have been lost or impacted by their brain injury.
Rehabilitation services include physical, mental and emotional treatments that help
the injured brain make new connections.

Most rehabilitation programs focus on three types of therapies:

 * Physical therapy
 * Occupational therapy
 * Speech therapy

In this article we will address physical rehabilitation and hand rehabilitation 
in particular.. The debilitating effects on hand function from the neurological 
damage that may ensue from Subarachnoid Hemorrhage and cerebral aneurysm surgery
has given rise to the development of rehabilitative robotic devices aimed at restoring
hand function in these patients.

Conventional robotics are composed of metal which provide a rigid framework in order
to assist in motor function. It is possible that the rigid structures of these devices
is impeding the therapeutic potential of robotics by reducing their biomimetic qualities.
This may include reducing motion in unactuated directions such as finger abduction
or could include having rigid axes of rotation that become misaligned with the finger’s
anatomic axis during motion.

In contrast, we adopt soft robotics which are fabricated from easily deformable 
materials such as fluids, gels, and soft polymers that have better biomimetic qualities
due to their increased compliance and versatility while conforming to the contours
of the human body. The lack of rigid components removes constraints on non-actuated
degrees of freedom and also reduces joint alignment issues, which could prevent 
joint damage. Additionally, soft robotics may be lighter and have simpler designs,
making them more likely to be portable and opening up the possibility of at-home
rehabilitation.

 Our rehabilitation products meant for clinics like the [SIFREHAB-1.2](https://sifsof.com/product/rehabilitation-robotic-gloves-sifrehab-1-2/)
puts emphasis on  cross-over between information technologies, data science, material
science and neuroscience, while the overlaps in our consumer electronic goods like
the [SIFREHAB-1.0](https://sifsof.com/product/portable-rehabilitation-robotic-gloves-sifrehab-1-0/)(
home use) are, mainly in the area of material science, communication, navigation
and gaming.

Surgical clipping Endovascular coiling of an aneurysm is always performed by a trained
and licensed neurosurgeon or a trained and licensed neurointerventionalist.

Reference: [Brain Aneurysm Foundation (bafound.org)](https://bafound.org/)