[Neurological Reha-Score. An instrument to measure outcome and expenditure of neurologic rehabilitation]

BACKGROUND

A new measurement instrument was developed to combine common scores with the parameter of effort for rehabilitation, the latter being a control instrument for medical professionals and rehabilitational health organisations.

METHODS

The Neurological Rehabilitation Score (NRS) contains 61 items (including the ten from the Barthel Index) resulting in scores of 0 (worst patient condition) to 600 (best). The items are grouped into seven categories: activities of daily life (13), mobility (8), communication and social skills (7), arm and hand function (7), orientation and cognition skills (10), strength and pain (8), and coping and miscellaneous (8). We investigated 8,139 patients and determined reliability (kappa statistic) and responsivity (standardised response means). In 100 consecutive patients, we also measured the Functional Independence Measure (FIM) and Scandinavian Stroke Scale (SSS) to address validity.

RESULTS

With an average kappa value of 0.86 (range 0.62-0.98), the NRS showed excellent inter-rater reliability. There was a good correlation between NRS, FIM, and SSS. Response was good at 0.84. The ceiling effect was also less than 1%, compared to 17% in the Barthel Index.

CONCLUSION

The NRS was shown to be effective for evaluation of outcome and expenditure in neurological rehabilitation.

Cerebral microembolism and the risk of ischemia in asymptomatic high-grade internal carotid artery stenosis

BACKGROUND AND PURPOSE

Previous work has shown that cerebral microembolism detected with transcranial Doppler sonography distal to internal carotid artery stenosis occurs more frequently in recently symptomatic compared with asymptomatic patients. It has remained unclear whether cerebral microembolism also indicates a higher risk of future cerebral or retinal ischemia.

SUMMARY OF REPORT

Sixty-four asymptomatic patients with unilateral 70% to 90% internal carotid artery stenosis were investigated prospectively (mean follow-up, 72 weeks). Five patients developed ischemic symptoms attributable to the stenosis (transient ischemic attack, 2 patients; stroke, 3 patients). A microembolic rate of > or = 2 per hour in the ipsilateral middle cerebral artery was associated with a substantially increased risk of developing ischemia of the corresponding carotid territory (odds ratio, 31; 95% confidence interval, 3 to 302; P = .005).

CONCLUSIONS

This prospective pilot study suggests that cerebral microembolism detected with transcranial Doppler sonography may define a high-risk subgroup among patients with asymptomatic high-grade internal carotid artery stenosis.

Cheyne-Stokes respiration in ischemic stroke

We monitored breathing pattern and arterial oxygen saturation in 32 conscious patients with acute ischemic stroke. Seventeen (53%) had Cheyne-Stokes respiration with concomitant drops in oxygen saturation, unrelated to infarct location. The ventilatory disturbance promptly reversed after intravenous theophylline ethylenediamine or oxygen inhalation. The therapy is a simple way of improving arterial oxygenation in a large subgroup of patients with acute ischemic stroke.

Cerebral hemodynamics in obstructive sleep apnea

We have investigated cerebral blood flow velocity (CBVF) in 14 patients with marked obstructive sleep apnea syndrome using transcranial Doppler ultrasonography during sleep. The CBFV increased during apnea, with a mean acceleration of 0.9 cm/s2, followed by a rapid decrease during snoring. The same effect was obtained by voluntary apnea in healthy subjects, showing a smaller acceleration rate (0.6 cm/s2). These results provide evidence for a normal CO2 regulation of cerebral vessels during sleep apnea and do not support the notion of cerebral hypoperfusion during sleep being a risk factor for stroke.