F-3-12-09
RECOVERY OF STROKE HEMIPLEGIC GRADE IN CHRONIC STAGE: OUTCOME THROUGH NEUROSURGICAL INTERVENTION
Hikaru Muramatsu (Kasugai Rehabilitation Hospital, Yamanashi, Japan); Toshiro Shimura, Masahiro Matsumoto, Kazuo Isayama and Akira Teramoto (Nippon Medical School, Tokyo, Japan)
It is a general clinical tenet that recovery of motor function occurs mainly within the first few months after stroke onset. We evaluated quantitatively the further recovery from impairment and disability in the hemiplegic stroke survivors who required late neurosurgical intervention (NI).
Eight first-ever stroke patients (mean±SEM age, 57.8±3.0 years) out of 348 survivors (2.3 %) required delayed (between 4 and 10 months after the onset) NI during continuous rehabilitation (RH) therapy. Five patients required cranioplasty (CP) for hemicraniectomy and three received ventriculo-peritoneal shunts (VPS) for normal pressure hydrocephalus with later complications. Recovery grade (1-12) of hemiplegia and Barthel index (BI) were assessed monthly before (the 1st RH) and after the NI (the 2nd RH). The recovery grade of leg movements significantly increased in the 1st and 2nd RH (from 3.9±1.3 to 4.9±1.1 in the 1st, P<.05; and to 8.3±0.7 in the 2nd RH, P<.001). Arm grade significantly increased only in the 2nd RH (from 4.1±1.3 to 6.3±1.3, P<.05). Change in the leg grade was significantly larger in the 2nd RH (1.0±0.4 in the 1st vs. 3.4±0.6 in the 2nd RH, P<.05). The relationship between the interval to NI (4-10 months) and the difference of the leg grade change in the 1st and the 2nd RH were highly correlated (+1 grade/1.3-months). BI increased significantly only in the 2nd RH (from 53±7 to 91±3, P<.005); all patients regained the ability to walk independently.
Conclusion: Substantial recovery of motor function (hemiplegic grade) occurred even in the chronic stage of stroke through NI. This demonstrates indications for CP or VPS to expect the further improvement of disability, especially of locomotion (gait ability), in the chronic stage.
F-3-13-01
THE ASSESSMENT AND THERAPEUTIC MANAGEMENT OF LEPROTIC PLANTAR ULCER
Wen-Chung Tsai; Ngok-Kiu Chu; Fuk-Tan Tang (Chang Gung Memorial Hospital, Taiwan)
Twenty-seven leprosy patients were recruited in this study for assessment and therapeutic management of their plantar ulcers. They were randomly separated into three groups. Patients in group A (control) received only changing dressing of their ulcers daily, and patients in group B and C were given a pair of total contact healing sandal in addition to wound care. And low level laser was applied to plantar ulcers of the patients in group C. The foot pressure distribution was measured by EMED in-shoe foot pressure measuring system. The results of this study indicate that low level laser has good therapeutic effect on the patients' plantar ulcers. And foot pressure redistribution, preventing progression of ulcers and improving ambulation ability can be achieved by wearing total contact healing sandal.
