COMORBIDITIES IN STROKE PATIENTS AS ASSESSED WITH OUR NEWLY DEVELOPED SCALE.
Meigen Liu, Kazuto Tsujiuchi, Tetsuya Tsuji, Naoichi Chino, Hiroshi Takagi, Masahiro Kamikozuru (Saitama Prefecture General Rehabilitation Center and Keio University, Saitama and Tokyo, Japan)
[Objective] To analyze comorbidities (CM) in stroke patients with our newly developed CM scale.
[Methods] The subjects were 106 stroke inpatients, age 56.5±13.2 years, with median duration of illness of 199 days. 30 age-matched patients with orthopedic problems served as controls. Using a CM scale that grades CM from 0 to 5 according to the need for treatment and limitations on activities, we analyzed CM and obtained the comorbidity index (CI), or the total number of CM, and the weighted comorbidity index (w-CI), or the sum of the weighed scores. We also studied their relationships to demographic data, Stroke Impairment Assessment Set (SIAS), Mini-Mental State Examination (MMSE), Functional Independence Measure (FIM) and the degree of diagnostic and therapeutic interventions.
[Results] 1) The medians of CI and w-CI were 5 and 10 for stroke group and 2 and 3 for the orthopedic group, a significant difference (Man-Whitney test, P<0.01). 2) Hypertension ranked first, but was usually graded as 1 or 2 (no limitation for rehabilitation). Conditions graded 5 (active rehabilitation contraindicated) included pneumonia, sepsis, ventricular arrhythmia, congestive heart failure and acute pancreatitis. 3) CI and w-CI were not significantly different between sexes, types of stroke and sides of lesion. 4) They correlated positively with age, days from onset to admission, LOS, deviation in tape bisection task, total numbers of medications, laboratory studies, consultations and days of interruption of the programs. They correlated negatively with admission and discharge FIM scores, SIAS motor scores, grip strength and MMSE scores (Spearman's rank correlation method).
[Conclusion] Our CM scale contributed to characterize CM in stroke patients.
QUANTITATIVE EVALUATION OF ALTERNATE FOREARM MOVEMENTS USING DIADOCHO-METER
Noriaki Hisamatsu, Shigenobu Ishigami (National Defense Medical College, Saitama, Japan) and Hedeo Tomita (Tokyo Denki University, Saitama, Japan)
Clinically, evaluation of alternative forearm movements (pronation and supination) are often used as diagnosis of disdiadochokinesia and important in stroke rehabilitation as assessment of impairment level in upper extremities. Method: We examined quantitative evaluation of alternate forearm movements using by potentiometer (diadocho-meter) in 15 healthy persons and 13 stroke patients. Subjects tried to move on two conditions. Under Time constant condition (T-cond), subjects were asked to rotate their forearms as large as they can to the pacing sound with 0.2 sec intervals. On the other hand, under Amplitude constant condition (A- cond), maximum range of motion was decided as target angle and beep sounds when they reached that angle. Subjects were asked to rotate their forearm to the target angle as fast as they can. Examinations were performed by only one hand or both hands during 30 seconds at each condition and these data was analyzed. Results: Mean values of cycles on T-cond were greater in patients than in normal groups and keeping rhythm is more difficult as time passed. Averaged cycles on A-cond were shorter on both hands than one hand. Mean values of cycles and angles on A-cond were greater in older people (above 65 years old). Conclusion: This study suggested the utility of diadocho-meter as quantitative evaluation of disdiadochokinesia in stroke patients and index of aging in normal persons.