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Marek K, Zielińska-Nowak E, Redlicka J, Starosta M, Miller E. Intracranial Hemorrhage-Is Very Early Rehabilitation Safe? A Narrative Review. J Clin Med 2024; 13:3776. [PMID: 38999342 PMCID: PMC11242133 DOI: 10.3390/jcm13133776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/14/2024] Open
Abstract
Intracerebral hemorrhage (ICH) is a serious neurological disease with a 30-day mortality rate of 34-50%. Rehabilitation can reduce disability and improve recovery from a stroke; however, it is uncertain whether early rehabilitation is safe. There are many studies and reviews on rehabilitation for chronic conditions, but there is not enough information on the details of rehabilitation in the acute and subacute phases of ICH. We analyzed clinical trials from the electronic databases PubMed, PubMedCentral, Medline, Cochrane Library, Embase, Scopus and PEDro. Based on the data, we determined that early rehabilitation of patients with ICH has beneficial effects on improving ADL scores, motor function, functional independence, quality of life, improved gait, improved trunk control and reduced mortality. Varying the duration and intensity of rehabilitation in patients with ICH may improve health status, functional outcomes and reduce the length of stay in the hospital. The earliest protocol for initiating rehabilitation after ICH included up to 24 h after stroke onset. The medical literature indicates the need for more randomized controlled group trials of early rehabilitation in patients with acute and subacute ICH with a precise timing of rehabilitation initiation. This narrative review aims to summarize the existing evidence and provide insights into the current state of knowledge regarding the safety of early rehabilitation. There is a need for a clear definition of "early rehabilitation" when determining the most appropriate time to begin rehabilitation therapy.
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Affiliation(s)
- Klaudia Marek
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland; (E.Z.-N.); (J.R.); (M.S.)
| | | | | | | | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland; (E.Z.-N.); (J.R.); (M.S.)
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Yang S, Liu Y, Wang S, Peng H, Luo H, Cai Z, Hui X, Yang A. Stereotactic Puncture Surgery for the Treatment of Moderate Volume of Thalamus-Internal Capsule Area Hemorrhage: An Analysis of Real-World Data. World Neurosurg 2024; 186:e213-e226. [PMID: 38537786 DOI: 10.1016/j.wneu.2024.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies. METHODS One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the 2 groups of patients was analyzed by logistic regression analysis and model comparison. RESULTS The primary outcome of this study was to assess the assessment of daily living scores after 6 months of treatment. Based on the analysis of this study, the assessment of daily living of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P < 0.001), and the difference was statistically significant. The amount of residual hematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days, and 2 weeks after the onset of the disease (P < 0.001), and the complication rate was lower than the conservative treatment group (P < 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (odds ratio -0.27, 95% confidence interval: 0.08-0.86, P < 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% confidence interval: 0.09-0.96, P < 0.05) after adjusting for all covariates. CONCLUSIONS For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery.
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Affiliation(s)
- Shiqiang Yang
- Department of Neurosurgery, The First People's Hospital of Yibin City, Yibin, China; Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanwei Liu
- Department of Neurology, The First People's Hospital of Yibin City, Yibin, China
| | - Shiqiang Wang
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Hua Peng
- Department of Neurosurgery, The First People's Hospital of Yibin City, Yibin, China
| | - Hongtao Luo
- Department of Neurosurgery, The First People's Hospital of Yibin City, Yibin, China
| | - Zhonghai Cai
- Department of Neurosurgery, The First People's Hospital of Yibin City, Yibin, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anqiang Yang
- Department of Neurosurgery, The First People's Hospital of Yibin City, Yibin, China.
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Hirano S, Saitoh E, Imoto D, Ii T, Tsunoda T, Otaka Y. Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial. J Neuroeng Rehabil 2024; 21:76. [PMID: 38745235 PMCID: PMC11092154 DOI: 10.1186/s12984-024-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000. METHODS An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score. RESULTS A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively). CONCLUSIONS The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction. TRIAL REGISTRATION This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.
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Affiliation(s)
- Satoshi Hirano
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Daisuke Imoto
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsunoda
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Kawakami K, Tanabe S, Omatsu S, Kinoshita D, Hamaji Y, Tomida K, Koshisaki H, Fujimura K, Kanada Y, Sakurai H. Impact of intracerebral hemorrhage and cerebral infarction on ADL and outcome in stroke patients: A retrospective cohort study. NeuroRehabilitation 2024; 55:41-49. [PMID: 39213103 DOI: 10.3233/nre-240182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND The impact of different stroke types on specific activities of daily living (ADL) is unclear. OBJECTIVE To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM). METHODS Patients with first-stroke hemiplegia (n = 212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed. RESULTS Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups' total FIM motor scores at discharge, whereas the duration from onset affected only the CI group. CONCLUSION Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction.
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Affiliation(s)
- Kenji Kawakami
- Department of Rehabilitation, Kyoto Rehabilitation Hospital, Kyoto, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Sayaka Omatsu
- Department of Rehabilitation, Kyoto Rehabilitation Hospital, Kyoto, Japan
| | - Daiki Kinoshita
- Department of Rehabilitation, Kyoto Rehabilitation Hospital, Kyoto, Japan
| | - Yoshihiro Hamaji
- Department of Rehabilitation, Kyoto Rehabilitation Hospital, Kyoto, Japan
| | - Ken Tomida
- Fujita Health University Nanakuri Memorial Hospital, Tsu, Japan
| | - Hiroo Koshisaki
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation, Nanto Municipal Hospital, Nanto, Japan
| | - Kenta Fujimura
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
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Iwasa S, Uchiyama Y, Tauchi Y, Koyama T, Domen K. Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan. J Rural Med 2024; 19:33-39. [PMID: 38196805 PMCID: PMC10774001 DOI: 10.2185/jrm.2023-033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors. Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed. Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one's spouse were the most powerful predictors of a higher probability of returning home. Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.
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Affiliation(s)
- Saya Iwasa
- Department of Rehabilitation Medicine, Sasayama Medical Center, Hyogo Medical University, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
| | - Yuta Tauchi
- Department of Rehabilitation Medicine, Sasayama Medical Center, Hyogo Medical University, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
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