CONDUCTIVE EDUCATION APPROACH FOR THE RETRAINING OF FUNCTIONAL PERFORMANCE IN ADULT HEMIPLEGIC PATIENTS
Tiecheng Guo, Yanping Xia (Tongji hospital, Wuhan, P.R.C.)
Abstract: Conductive Education (CE), a holistic intervention based primarily on the educational and psychologic principles, has been recognized as an effective approach to the management of cerebral palsied children. Few have reported the use of CE for neurologically impaired adults. This paper is to describe a pilot CE program for adult hemiplegic patients we set up and to report it's effectiveness.
Participated in were 11 hemiplegic patients caused by acquired brain injury or stroke at 2-12 months before admission. They followed a highly structured daily session which included task series such as hand task, sit to stand task series. All involved a functional task such as practicing eating, drinking and putting on socks etc. The motor function and dependence (ADL) were evaluated with Motor Assessment Scale and Barthel Index, respectively at admission and 1 month after entry.
Significant improvement in performance of motor skills and functional activities was found, as indicated by the standardized evaluation. It was also found that all patients developed greater awareness of quality of movement and need to control unwanted muscle tone.
We conclude that the CE approach is a feasible strategy for fetraining functional performance of hemiplegic patients and should be incorporated into the existing approaches.
THE DETERMINANTS OF ONSET TO ADMISSION, LENGTH OF STAY AND FUNCTIONAL MEASURES IN FIRST STROKE ADMISSIONS 1992-1996
Haim Ring, Marina Motin, Ada Tamir (Loewenstein Hosp Rehabilitation Center & Tel Aviv University Medical School and Epidemiol & Statistics Unit, Technion Medical School, Haifa, Israel)
Clinical, demographic and functional data as measured with the Functional Independence Measure (FIM) for first stroke admission during the period of 1992 to 1996 was registered in the computerized data base of the neurological rehabilitation ward #3 of the Loewenstein Rehabilitation Center and further on analyzed. 108 parameters for each patients were consistently recorded. The total number of first stroke patients was 596, about 70% male, of average age 60 years, jewish and urban. Patients were admitted about one month after the stroke and were mostly provenient from near-by hospitals, although significant proportions came from home or else. The length of stay, under the prevailing rehabilitation policy of "up to plateau", was about three month although special clinical syndromes such as neglect and aphasia prove to exert a significant influence on the rehabilitation period. The length of stay was inversely related to the FIM admission score. The FIM gain was directly related to the length of stay in a linear fashion, mainly in the above mentioned syndromes. Patients with a cortical infarct had, in general, the highest functional improvement. At the end of the rehabilitation process 92% of the patients were discharged home, 88% walked in one way or another (70% without any supportive device), 50% had full or partial hand function and 38% of the urinary incontinent patients regained continence. The detailed categorial data can serve as basis for comparative studies, program evaluation and policy determinations.