FUNCTIONAL OUTCOME OF MULTIDISCIPLINARY REHABILITATION IN CHRONIC STROKE PATIENTS
Ichiro Miyai, MD, Tsuneniko Suzuki, MD, Katsumasa Kii, RPT, Jin Kang, MD, Ichiro Kajiura, MD (Toneyama National Hospital, Bobath Memorial Hospital, Osaka, JAPAN)
Purpose: To evaluate the efficacy of multidisciplinary rehabilitation (MDR) in chronic stroke patients.
Methods: We evaluated the functional outcome of MDR by neurodevelopmental treatment (Bobath) in 136 consecutive initial single stroke patients. Based on the duration after the onset of stroke patients were divided into two groups (<90 days: early group (E), n=47, >90 days: late group (L), n=89). Functional status (disability) was evaluated using Functional Independence Measure (FIM). Statistical analysis was performed using ANOVA and Chi square analysis.
Results: The mean duration after the onset of stroke was 64 days in E and 291 days in L. There was no significant difference in age (E: 57, L: 58) between the two groups. The mean FIM at admission and discharge was 88 and 103, respectively in E, and 88 and 97, respectively in L. Both groups improved significantly at the time of discharge. Mean length of stay was 138 days in E and 114 days in L. In spite of shorter length of stay, L had comparable functional outcome as E. For further analysis patients were assigned to three groups based on their admission FIM score (severe: FIM 18-53, moderate: FIM 54-89, mild: FIM 90-126). There was no significant difference in gain of FIM between E and L in these subgroups.
Conclusion: MDR is equally effective for improving functional outcome of stroke patients regardless of start point of MDR and regardless of severity of disability.
FORCED USE IN THE HEMIPLEGIC UPPER EXTREMITY TO IMPROVE ABILITIES IN STROKE PATIENTS: A PROPOSED STUDY
G.J. Lankhorst and J.H. Rengelink-van der Lee
Department of Rehabilitation Medicine, University Hospital Vrije Universiteit, P.O.Box 7057, 1007 MB Amsterdam, The Netherlands
Usual therapy of hemiplegic patients concentrates on 'impairment level' (i.e. neuromuscular level). However, transfer of effects on impairment level to the 'level of disabilities' (i.e. level of daily life functioning) seems to be minimal. Some studies indicate that daily life functioning has to be specifically trained to improve functional recovery. The 'learned non-use' theory hypothesizes that functional recovery of the hemiplegic arm is inhibited by the ease and efficiency with which the functional activity is performed by the non-hemiplegic arm. Immobilization of the non-hemiplegic arm supplemented with functional therapy of the hemiplegic arm can overcome this learned non-use and lead to an improvement of the functionality of the hemiplegic arm. In a randomized controlled trial including 60 patients the forced use therapy (immobilization of the healthy arm and functional therapy during two weeks) is compared with a placebo therapy consisting of bimanual functional training. We attempt to relate functional changes to changes in the EEG.