Rehabilitation and functional prognosis of acute brain infarct complicated with depression

Depressionfollowingbraininfarctionofacutephaseiscommoninclinic,whichinhibitspatients＇appetiteforactiverehabilitation,de－laysrehabilitationtimingandimpacteffectsofearlyrehabilitation．Inordertoemphasizetreatmentofdepressionfollowingbraininfarctionofacutephaseandsubsequentrehabilitation,weobserve３８patientsandreportispresentedhere．１Subjectandmethod１．１Subject３８patientsexperienceddepressionfollowingbraininfarctionofacutephasewererecruitedfrom２０００to２００１．Thesesubjectswereselect…     

丹灯通脑软胶囊对脑梗死恢复期患者功能恢复的疗效观察

目的探讨丹灯通脑软胶囊配合常规康复训练对脑梗死恢复期患者功能恢复的疗效。方法 112例脑梗死恢复期患者随机分为试验组和对照组,试验组58例患者除常规康复训练外加用丹灯通脑软胶囊治疗,对照组54例患者单纯应用常规的康复训练。观察两组患者日常生活活动能力、独立生活能力及肢体运动功能的变化情况。结果治疗4周后,试验组上述各项指标明显优于对照组,差异有显著性(P<0.05)。结论丹灯通脑软胶囊联合常规的康复训练可以有效提高脑梗死恢复期患者的日常生活活动能力、增强其生活的独立性,对脑功能的恢复具有促进作用。     

Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries

OBJECTIVE: This study was undertaken to determine if persons who sustain a spinal cord injury (SCI) and co-morbid brain injury (dual diagnosis [DDS]) evidence smaller functional gains and experience significantly longer rehabilitation lengths of stay than persons with only an SCI. DESIGN: This retrospective comparison study was performed at a 100-bed rehabilitation hospital specializing in acute SCI and traumatic brain injury rehabilitation. Summary scale outcome data of persons who sustained an SCI were compared with outcome data of a group of persons with a DDS. Comparisons were established by matching groups principally on level of SCI and admission Motor FIM trade mark score and secondarily on education, sex, and age. Outcome measures included admission Motor and Cognitive FIM score, discharge Motor and Cognitive FIM score, Motor and Cognitive FIM change, length of stay, and rehabilitation charges. RESULTS: Persons with a DDS evidenced a significantly more impaired Cognitive FIM score at admission and discharge from rehabilitation. Persons with a DDS also achieved a significantly lower Motor FIM change than persons with SCI. There were no significant differences between DDS and SCI groups regarding Cognitive FIM change, length of stay, or rehabilitation charges. Injury severity as defined by the Glasgow Coma Scale or intracranial lesions did not predict response to treatment in the DDS group. CONCLUSION: Persons with a DDS achieved smaller functional gains during rehabilitation than peers with SCI. Brain injuries seem to limit functional gains, although the relationship between brain injury severity and functional change is not linear. Prospective studies are needed to identify factors limiting functional gains in rehabilitation and assist in developing specific treatment programs for persons with SCI and brain injury.     

康复介入时间对急性缺血性脑卒中功能恢复的影响

目的了解急性脑卒中患者康复治疗开始时间对功能恢复的影响。方法对两组各35例急性脑卒中患者进行运动功能康复,一组于发病1周内开始康复,称为早康复组;另一组于发病1～3周开始康复,称为晚康复组,两组均接受同样的康复治疗和常规药物治疗。疗效评定,运动功能选择Fulg-Meyer运动功能测评,ADL测评选择FIM方法中反映上下肢功能的亚项,测评分别于入组时(治疗前)和病程28～30 d进行,比较两组患者病程1个月时的功能状态。结果运动功能积分:治疗前两组间差异无统计学意义(P>0.05),治疗后早康复组手、腕、上肢积分显著高于康复组(P<0.05)。ADL积分:治疗前早康复组上、下肢积分均低于晚康复组(上肢P<0.05,下肢P<0.01),治疗后早康复组上肢积分高于晚康复组差异有统计学意义(P<0.01)。结论急性脑卒中偏瘫康复治疗开展的越早运动功能恢复的越快,尽早康复治疗可以加快恢复进程。     

Functional recovery following rehabilitation after hemorrhagic and ischemic stroke

OBJECTIVES: To quantify recovery after rehabilitation therapy and to identify factors that predicted functional outcome in survivors of intracerebral hemorrhage (ICH) compared with cerebral infarction. DESIGN: Retrospective study of consecutive ICH and cerebral infarction admissions to a rehabilitation hospital over a 4-year period. SETTING: Free-standing urban rehabilitation hospital. PARTICIPANTS: A total of 1064 cases met the inclusion criteria (545 women, 519 men; 871 with cerebral infarction, 193 with ICH). INTERVENTIONS: Not applicable.Main Outcome Measures: Functional status was measured using the FIM trade mark instrument, recorded at admission and discharge. Recovery was quantified by the change in FIM total score (DeltaFIM total score). Outcome measures were total discharge FIM score and DeltaFIM total score. Univariate and multivariate analyses were performed. RESULTS: Total admission FIM score was higher in patients with cerebral infarction than in patients with ICH (59 vs 51, P=.0001). No difference in total discharge FIM score was present. Patients with ICH made a significantly greater recovery than those with cerebral infarction (DeltaFIM total score, 28 vs 23.3; P=.002). On multivariate analysis, younger age, longer length of stay, and admission FIM cognitive subscore independently predicted total discharge FIM and DeltaFIM total score. The severity of disability at admission, indicated by total admission FIM score, independently predicted total discharge FIM score, but not DeltaFIM total score. The ICH patients with the most severely disabling strokes had significantly greater recovery than cerebral infarction patients with stroke of similar severity. CONCLUSIONS: The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity. Initial severity of disability, age, and duration of therapy best predicted functional outcome after rehabilitation.     

现代综合促进技术治疗急性脑卒中

对120例急性期脑卒中患者随机分为康复组及常规组各60例。康复组又按临床神经功能缺损程度积分分为轻、中、重3型。康复组及常现组均给以常规药物治疗，康复组同时配合以促进技术为主的综合运动疗法进行早期康复干预。采用FIM躯体功能评分及Fugl-Meyerr积分评估运动功能。结果显示：康复组患者两项指标均有显著改善，与常规组比较，差异明显P＜0．01．康复组中轻、中型预后好，轻型患者康复干预影响因素较少些，自然恢复比重大，中、重型之间疗效差异显著，中型患者康复效果最高，另外脑出血恢复优于脑梗塞。     

Functional outcome following traumatic brain injury: the Turkish experience

The objectives of this study were to describe the demographic characteristics and the nature of the functional recovery in a group of Turkish survivors of traumatic brain injury (TBI) who were referred for inpatient rehabilitation and identify variables correlated with discharge functional status as measured by the Functional Independence Measure (FIM). There were 40 patients in the study, 32 (69.6%) male and eight (17.4%) female, mean age 28+/-9.8 years. Motor vehicle accidents accounted for 62.5% of injuries, 22.5% of injuries occurred from violence and 15% resulted from falls. The mean durations of acute hospital stay, coma, and rehabilitation stay was 68, 26.7, and 78.4 days, respectively. Extracranial injuries including bone fractures were the most common associated injuries and medical complications such as spasticity and contractures were present in more than half of the patients.TBI survivors in this study made statistically significant functional improvements. Discharge FIM were significantly correlated with the admission FIM, durations of acute hospital stay and coma, and time since TBI. Multiple regression analysis of the data disclosed that FIM score obtained at the time of discharge from rehabilitation service was best predicted by two variables, time since brain injury and the FIM score at admission (multiple R=0.78, R=0.60, P<0.001). This sample of Turkish TBI survivors showed significant functional improvements after rehabilitation and admission functional status and the time since TBI had the most impact on discharge functional outcome.     

不同发病性质和部位的脑卒中对患者功能损伤和恢复的影响特点

目的：探讨脑卒中不同病变性质和半球损伤对患者早期认知、平衡能力和功能独立性的影响;早期康复治疗后功能恢复特点及其相关性。方法：将住院的75例脑卒中患者分为A组（左侧出血）14例;B组（左侧梗死）21例,C组（右侧出血）15例和D组（右侧梗死）25例,均进行针对性康复治疗1个月。治疗前后作认知功能评定（MMSE）、平衡能力评定（Fugl-Meyer,FMA）及功能独立评定（FIM）。结果：4组患者康复治疗前及康复治疗1个月后MMSE、FMA平衡及FIM评分均低于正常值。其中A组FMA平衡治疗前、FIM治疗前后评分均低于B组（P〈0.01或0.05）。康复治疗后除D组MMSE评分无提高外,其它组评分均有提高（P〈0.01,0.05）。相关性检验和多元线性回归分析显示,左脑出血患者功能独立性提高与平衡功能提高相关,右脑出血功能独立性提高与认知功能提高相关;而脑梗死患者无论左右侧病变,功能独立性提高与认知、平衡功能提高均有关。4组治疗后FIM评分分别与各自FMA平衡或MMSE呈正相关（P〈0.05或0.01）。结论：脑卒中患者早期认知、平衡和功能独立性均有下降,其中左脑出血较左脑梗死患者表现更明显;早期康复均能提高患者的上述功能。脑出血患者早期平衡和功能独立性的能力能预测其康复后早期功能独立性的能力;左脑梗死早期认知功能和功能独立性、右梗死早期功能独立性恢复的程度能预测康复后早期功能独立性恢复的能力。     

Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture

OBJECTIVE: To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture. SETTING: Geriatric rehabilitation center. PARTICIPANTS: One hundred thirty-three older patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS). RESULTS: Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home. CONCLUSIONS: Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.