Stroke Rehabilitation: What is the point?

Motor and functional recovery in patients with post-stroke depression

PURPOSE

Depression is very common following stroke. Correlation between post-stroke depression (PSD) and functional outcome has been shown, but differential impact both on functional and motor recovery has not been deeply investigated. This study evaluates the influence of PSD on motor and functional outcome.

METHOD

One hundred and seventeen acute stroke patients were selected in an intensive rehabilitation department, and divided into two groups according to the presence of PSD (PSD+ and PSD-). Screening measures were DSM-IV criteria, the Geriatric Depression Scale and the Cornell Scale. Outcomes were evaluated on the basis of the Barthel Index (BI) and the Fugl-Meyer Assessment Scale (FMA). Measurements were performed at admission to the department T1), discharge (T2) and follow up (T3) in a whole period of 3 months from stroke.

RESULTS

Both groups showed a significant improvement in all outcome measures. Improvement differences were not significant on FMA scores in either group at each assessment; the PSD group had a significant higher improvement on BI score at follow-up. According to the logistic model, from T1 to T2 and from T1 to T3, only motor recovery shows a significant relation with functional recovery; from T2 to T3 PSD is the only significant factor related to functional recovery.

CONCLUSIONS

PSD is not an influencing factor for motor recovery. Results show a negative impact of PSD on the functional recovery process after discharge and not during hospitalisation. Discharge appears to be critical step for management of PSD.

Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap

OBJECTIVES

(1) To examine the relationships between measures of impairment and disability for the arm and leg with a measure of handicap and (2) to identify the impairment or disability most strongly related to handicap situations.

DESIGN

Prospective cohort study.

SETTING

Intensive functional rehabilitation unit and community.

PATIENTS

One hundred and two persons who had a stroke.

MAIN OUTCOME MEASURES

Arm and leg impairments and disabilities were evaluated with reliable and valid tests at discharge from rehabilitation. Six months later, handicap situations were evaluated with the Assessments of Life Habits (LIFE-H).

RESULTS

Arm and leg impairments and disabilities are correlated with handicap situations. Disability of the leg is more strongly associated with handicap than arm disability. Arm and leg disabilities are not statistically more strongly related to handicap than arm and leg impairments.

CONCLUSIONS

The high correlations found between handicap situations and the impairment and disability measures of the leg provide new information that support the importance of mobility to promote integration after stroke.

Estudo Comparativo entre a Marcha Normal e a de Pacientes Hemiparéticos por Acidente Vascular Encefálico

Este trabalho tem como objetivo comparar os aspectos biomechnicos da marcha normal com os da marcha de pacientes hemiparéticos por acidente vascular encefálico (AVE), em amplo levantamento bibliográfico. As características gerais comumente encontradas na marcha do paciente hemiparético foram: na fase de apoio - aumento da flexão de quadril, aumento ou diminuição do deslocamento lateral pélvico, hiperextensão ou aumento da flexão do joelho, auséncia do contato inicial pelo calchneo, compensaglio ein pronação da articulação subtalar, déficit da plantiflexdo do tornozelo no apoio final, diminuindo a força propulsiva: na fase de balanço - aumento ou diminuição da flexão do quadril, diminuição da flexão na subfase de pré-balanço ou diminuição da extensão do joelho na subfase de balanço terminal e diminuição da dorsiflexão do tornozelo. Os terapeutas necessitam reconhecer as alterações da marcha para poder tratar adequadamente os comprometimentos primários relacionados ao AVE e prevenir os distúrbios musculoesqueléticos secundários (alterações adaptati vas).

Recovery of walking function in stroke patients after minimal rehabilitation

BACKGROUND AND PURPOSE

Independent walking function is a highly desired goal amonst stroke victims, and has been well reported in Western literature. However, few studies have investigated the recovery of gait following stroke in Third World countries, where rehabilitation is often minimal or non-existent.

METHODS

A descriptive survey, using a structured questionnaire, was conducted on stroke victims, 12-14 weeks post-discharge from the Chris Hani Baragwanath Hospital, Soweto, South Africa. Although the questionnaire included a number of aspects of impairment, disability and handicap, this paper only reports on the recovery of walking function.

RESULTS

A total of 361 patients were screened initially. Only 54 fulfilled all inclusion criteria, 38 (70%) were over 50 years of age and 16 (30%) were aged under 50 years. The average length of stay in hospital of the older group was eight days, and in the younger group, 11.5 days. All 54 subjects interviewed were able to walk prior to their stroke. Twelve to fourteen weeks postdischarge, 23 (66%) subjects in the older group and all (100%) of the younger group said they could walk. Half of the older group and nearly all of the younger group could walk outside their homes, unassisted and without appliances. One-third of the subjects experienced knee pain during walking, but only a small percentage said that this pain prevented them from walking. The ability to catch a taxi in Soweto was used as a measurement of the handicap of gait. Twenty (54%) older group subjects and five (31%) of the younger group never caught a taxi.

CONCLUSIONS

Although the recovery of gait in these subjects appears to have been good, the results cannot be extrapolated to the stroke population in general due to the stringent selection criteria of the study. Further studies are required to acquire a broader cross-section of the stroke population, including longer follow-up periods to gain insight into the continuation of walking function. This information is necessary in order to plan effective and appropriate rehabilitation services.

Stroke. 1: A paradigm case in nursing rehabilitation

This is the first of two articles which consider rehabilitation following a stroke. Although stroke is a major cause of morbidity and mortality in the UK there have been relatively few studies describing its long-term effects. Despite relatively good functional recovery, in many cases a number of stroke survivors still experience 'long-term misery'. This article argues for an expanded range of outcomes in stroke rehabilitation and for greater attention to be paid to the psychological needs of stroke survivors and their carers. Areas of deficit in stroke rehabilitation are described, as is the currently poorly developed nursing role.