EL-3-07-01
DISABILITY AND REHABILITATION NEEDS IN STROKE PATIENTS
Gunnar Grimby (Department of Rehabilitation Medicine, Goeteborg University, Sweden)
In assessing the need for rehabilitation it is useful to approach the problems from the disability level and then for understanding the various mechanisms (sensorimotor, cognitive, communicative etc) to analyse the various impairments. In order to give priority and to be directed by the patients 'perceived goals' aspects on the handicap and life satisfaction must be taken into account. In stroke patients various aspects has to be placed on the level of disability, depending on the type and the degree of impairments, and different environmental factors.
Methods for disability assessments will be reviewed. Functional Independence Measure (FIM) has been extensively used in patients for rehabilitation and on a large international basis, and can be used for comparison between nations and between different rehabilitation settings. The structure of FIM has been studied with Rasch analysis. It has also been used for follow-up studies, using ratings from interviews. Methodological problems will be reported. For out-patients instrumental ADL-activities may dominant the disability problems and sensitive methods have to be developed for clinical use. Different activity areas must be covered to identify rehabilitation needs. An instrument called Instrumental Activity Measure (IAM) with similar construct as FIM has been developed. Both the level of dependence and the perceived difficulty are rated. Sex differences are analysed with respect to item difficulty. At a follow-up study of "younger" stroke patients (average age 52 years) 2 years after onset, unattended need for social support and contacts, and leisure activities were identified. Some personal care areas, as also social integration, indicated increased dependence compared with at discharge, which could not be explained on medical grounds. Thus, regular rehabilitation measures are necessary followed by periods of training and support also in the patients' home and directed to near-by persons.
EL-3-08-01
Muscle Pathophysiology in Rehabilitation - Experimental Study on Disuse Atrophy of Skeletal Muscle -
Kyozo L. Yonemoto. (Dept. of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan)
Muscle atrophy is often caused by a long period of lying in bed and alse by restricted activities under plaster cast. One of the most important subjects in rehabilitation medicine is to solve this problem, especially in these days of aging society. I'd like to present the results of my experimental studies up to now.
1). Disuse atrophy by immobilization changes not only quantity but also quality in the muscle tissue.
2). Degree of atrophy is different, according as whether the muscle is immobilized stretched or relaxed.
3). Training effect for the atrophy is found in old age, though less in adult age.
4). Daily rehabilitation exercise is effective on prevention of muscle atrophy and recovery.
5). Longer rehabilitation period is necessary in old age.
