Using a University of Pennsylvania-designed device to noninvasively and continuously monitor cerebral blood flow (CBF) in acute stroke patients, researchers from Penn Medicine and the Department of Physics and Astronomy in Penn Arts and Sciences are now learning how head of bed (HOB) positioning affects blood flow reaching the brain.

In research published in Stroke, Penn scientists found blood flow to the brain hemisphere where the stroke damaged tissue was reduced by 9 percent when the HOB was elevated 15 degrees, and 17 percent lower when elevated 30 degrees. But in 29 percent of the patients, the optical method showed a “paradoxical” improvement in CBF when the bed was elevated. A prior study found almost the same proportion of “paradoxical” responders to HOB positioning, and in the combined cohort no clinical or radiological differences predicted an expected versus a paradoxical response.

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