Rehabilitation outcomes in patients with brain tumors and acute stroke: comparative study of inpatient rehabilitation

OBJECTIVES: To investigate functional outcomes after hospital rehabilitation of patients surviving craniotomy for primary brain tumor excision compared with post-stroke patients. DESIGN: The database of the Neurological Rehabilitation Department "C" of Loewenstein Rehabilitation Center was used to investigate primary brain tumors and first ischemic and hemorrhagic stroke patients admitted for hospital rehabilitation during an 11-yr period, between January 1993 and August 2004. Particular attention was paid to age and sex distribution, onset-to-admission interval, length of stay, functional status at admission and discharge, functional gain (DeltaFI change) as measured by the FIM instrument. RESULTS: A total of 168 patients with craniotomy for primary brain tumor excision (128 intracranial meningiomas and 40 cerebral gliomas) and 1660 first-stroke patients were admitted to the department for rehabilitation during the study period. Mean patient age was 59.9 yrs in meningioma group, 54.1 yrs in the glioma group, and 60.4 yrs in the stroke group. In the meningioma and stroke groups, male patients were in the majority (62 and 70%); in the glioma group, there was equal sex distribution. On average, patients were admitted to rehabilitation treatment 13 days after meningioma excision, 34 days after glioma operation, and 21.6 days after stroke. Functional variables during inpatient rehabilitation were found to be similar in the all groups. Average FIM rating at admission was 80.07 in the meningioma group, 68.2 in the glioma group, and 70.4 in the stroke group. Average discharge FIM rating was 90.3 for patients with meningiomas, 80.7 for patients with gliomas, and 87.8 for stroke patients. Functional gain was 17.9 for meningioma patients, 17.2 for glioma patients, and 21.8 for stroke patients. Average length of stay was 24 days for the meningioma group, 23 days for the glioma group, and 75.4 days for stroke patients; 88.1% of stroke patients, 91.7% of meningioma patients, and 82.7% of glioma patients were discharged to their homes, and 5.4, 3.4, and 8.6%, respectively, were discharged to nursing homes. CONCLUSIONS: Patients with brain tumors can achieve good functional outcomes with a shorter length of stay.     

Rehabilitation of mental disturbance in patients with stroke

It is considered now that early rehabilitation interventional mechanism is related to the plasticity of brain that means after injury of neural function,cental nervous system has the ability of compensation and functional recombination.OBJECTIVE：To explore the effects of early rehabilitation on paralysis after cerebral infarction.     

Rehabilitation outcomes in patients with posttraumatic epilepsy

This study investigated 238 consecutive admissions to an adult head trauma unit during six years. Eighty-seven patients with posttraumatic epilepsy (PTE) were identified. Rehabilitation outcome was measured by a locally developed rating scale obtained at admission and discharge for all head trauma patients. The PTE and non-PTE groups were comparable in terms of demographic and medical characteristics except for proportion of men, which was higher in the PTE group (84% vs 66%, p less than .05). Both groups demonstrated significant functional gains on all measures during the course of their hospitalization (p less than .01), although the PTE patients demonstrated lower levels of function at admission and discharge on items rated by physical, occupational, speech, and recreation therapists, and by psychologists. Furthermore, PTE patients required a higher level of nursing care on discharge (p less than .05). It appears that PTE does not impede the rehabilitation process but significantly impacts posthospital rehabilitation plans of patients with blunt head injuries.     

脑卒中后吞咽困难病人的康复护理

[目的]观察康复护理对脑卒中后吞咽困难疗效的影响.[方法]将40例脑卒中后伴吞咽障碍病人随机分为实验组(20例)和对照组(20例),对照组采用常规护理方法,实验组在此基础上采用系统康复护理,两组病人均接受针刺治疗,干预前后分别用洼田饮水实验分级评分表比较两组疗效.[结果]治疗前两组试验评分比较,差异无统计学意义(P＞0.05) ;两组治疗后的实验评分较治疗前均有降低,差异均有统计学意义(P＜0.01) ;治疗后治疗组疗效优于对照组,差异有统计学意义(P＜0.01).[结论]针刺结合康复护理及针刺结合常规护理均能改善脑卒中后吞咽障碍病人的吞咽功能,而针刺结合康复护理组疗效优于针刺结合常规护理组,康复护理在提高脑卒中病人吞咽功能障碍的疗效方面有一定的优势.     

脑卒中心理障碍的康复治疗

Nowintroducingclinicalcommonrehabilitativetreatmentsofmentaldisturbanceasfollowing:Mainmanifestationofmentaldisturbance:(1)Invariousmentaldisturbanceofposthemiplegicpatients,depressivepsycholo-gyismostcommon.(2)Psychologyofself-abased(3)Psychologyofimpatience(4)Psychologyofobstinate.Rehabilitativetreatmentsofmentaldisturbance:(1)Mentalsupportingtreatment:Thismethodisapplicabletovariouspos-themiplegicpatientswithmentaldisturbance,especiallytopes-simisticanddesperatepatients.Theconcretepractic…     

脑卒中后吞咽困难病人的康复护理

[目的]观察康复护理对脑卒中后吞咽困难疗效的影响。[方法]将40例脑卒中后伴吞咽障碍病人随机分为实验组（20例）和对照组（20例）,对照组采用常规护理方法,实验组在此基础上采用系统康复护理,两组病人均接受针刺治疗,干预前后分别用洼田饮水实验分级评分表比较两组疗效。[结果]治疗前两组试验评分比较,差异无统计学意义（P〉O．05）;两组治疗后的实验评分较治疗前均有降低,差异均有统计学意义（P〈O．01）;治疗后治疗组疗效优于对照组,差异有统计学意义（P〈o．01）。[结论]针刺结合康复护理及针刺结合常规护理均能改善脑卒中后吞咽障碍病人的吞咽功能,而针刺结合康复护理组疗效优于针刺结合常规护理组,康复护理在提高脑卒中病人吞咽功能障碍的疗效方面有一定的优势。     

脑卒中前庭功能障碍患者的康复护理

目的 脑卒中后出现前庭功能损害很常见,如果中枢神经系统的代偿功能较差,则患者在缓解期也依然会感到眩晕和平衡障碍.本研究主要是了解前庭平衡护理对前庭功能障碍患者平衡功能的改善情况.方法 40例脑卒中前庭功能障碍患者随机分组分为前庭平衡护理组和对照组.并经过传统的平衡功能三级分法和Berg平衡量表(BBS)的评定,经过1个月的前庭平衡护理,观察2组患者平衡功能改善情况.结果 BBS评分显示前庭平衡护理组较对照组有明显改善(P＜0.01).结论 前庭平衡护理能有效地改善前庭功能障碍患者的平衡功能.     

Rehabilitation needs of community stroke patients

Purpose: The aim was to identify stroke patients not admitted to hospital, to assess their disabilities and the rehabilitation provided.

Method: Stroke patients were notified by General Practitioners, assessed a month after stroke on measures of impairment and disability and the rehabilitation received was recorded. There were 124 patients notified and 93 assessed.

Results: Patients showed an average decline of 1.7 on the Barthel Index and 3.6 on the Extended Activities of Daily Living scale from before to after stroke. There were 27 % with severe mobility problems and 47 % with clinically relevant arm impairment. Many patients had cognitive impairment with only 9% having no deficit. Mood problems were less common with 26% anxious and 13% depressed. Significant stress occured in 15% of carers. The provision of rehabilitation was low and there was poor correspondence between impairments and services provided.

Conclusion: There is an unmet potential for rehabilitation in stroke patients not admitted to hospital.     

对脑卒中偏瘫患者阶段康复护理的体会

BACKGROUND:Because disease course of stroke was long,directed nursing was undertaken to different mental and physiological manifestations to restore function at maximal degree and reduce incidence of disability.     

脑卒中患者饮食行为护理干预的效果观察

目的探讨脑卒中后进食障碍患者的护理干预效果。方法将120例脑卒中后有进食障碍的患者分为2组,每组60例。对所有患者进行饮食指导,在此基础上对试验组患者实施穴位按摩、口腔刺激、舌功能训练、咀嚼训练、吞咽训练,采用自设饮食行为干预调查表评估2组患者饮食行为。结果重复测量方差分析显示组间效应(F=141.52,P<0.05),交互效应(F=19.35,P<0.05),干预后1、2、3、6个月试验组患者饮食行为均优于对照组(P<0.01)。结论对脑卒中后进食障碍患者进行综合康复护理效果较好。     

脑卒中前庭功能障碍患者的康复护理

目的脑卒中后出现前庭功能损害很常见,如果中枢神经系统的代偿功能较差,则患者在缓解期也依然会感到眩晕和平衡障碍。本研究主要是了解前庭平衡护理对前庭功能障碍患者平衡功能的改善情况。方法40例脑卒中前庭功能障碍患者随机分组分为前庭平衡护理组和对照组。并经过传统的平衡功能三级分法和Berg平衡量表(BBS)的评定,经过1个月的前庭平衡护理,观察2组患者平衡功能改善情况。结果BBS评分显示前庭平衡护理组较对照组有明显改善(P<0.01)。结论前庭平衡护理能有效地改善前庭功能障碍患者的平衡功能。     

心脏病人术后精神障碍的原因及护理干预

分析心脏病人术后发生精神障碍的原因以及相应的护理干预策略,提出对心脏病人应进行术前相应的认知和情感评估,以减少心脏病人术后精神障碍的发生。     

早期乳酸清除率评估体外循环心脏手术患者预后

目的探讨早期乳酸清除率与体外循环心脏术后患者预后的关系。方法前瞻性观察并收集我院2006年3月至2010年2月体外循环心脏手术73例患者的临床资料。收集资料包括：（1）术前因素：性别、年龄、术前诊断、术前NYHA分级、APACHE11评分及左心室舒张末期内径。（2）术中因素：手术时间、主动脉阻断时间。（3）术后因素：术后出血量、机械通气时间以及术后6h血流动力学及氧代谢指标：心率（HR）、中心静脉压（CVP）、肺毛细血管嵌顿压（PAWP）、心输出量指数（CI）、动脉血乳酸、6h动脉血乳酸清除率、动脉血氧分压（PaO2）、混合静脉血氧饱和度（SvO2）、氧输送指数（DO2I）、氧耗指数（VO2I）及全身氧提取率（O2ext）。将患者分为存活组和死亡组,高乳酸清除率组（乳酸清除率〉30％）和低乳酸清除率组。首先应用单因素相关分析,筛选出两组有统计学意义的参数,然后再对这些参数进行多元回归分析,从中找出体外循环心脏术后死亡的独立危险因素。结果高乳酸清除率组病死率[4．55％（2／44）]明显低于低乳酸清除率组[34．48％（10／29）],差异有统计学意义（X^2：11．889,P〈0．01）。单因素相关分析显示存活组与死亡组间APACHEⅡ评分[（16．9±2．9）分比（19．2±2．6）分,t=2．537],左心室舒张末期内径[（53．9±5．6）mm比（63．8±4．6）mm,t=5．847],主动脉阻断时间[（101．2±4-34．2）rain比（122．7±22．7）min,t=2．078],术后出血量[（464．0±158．8）ml比（603．2±159．5）ml,t=2．773],机械通气时间[（22．6±5．1）h比（28．8±5．2）h,t=3．857],动脉血乳酸[（3．5±1．3）mmol／L比（5．1±1．5）mmol／L,t=3．912],动脉血乳酸清除率[（38．8±17．4）％比（14．6±9．7）％,t：4．846],Sv02[（69．1±4．2）％比（59．2±6．9）％,t=5．847]差异有统计学意义（P〈0．05或P〈0．001）。多元回归分析昴示动脉向乳酸清除率、芹心宰舒张末期内径县体外循环心脏术后死亡的两个独立危险因素,优势比（OR）分别为7．773（95％CI1．364-44．306,P〈0．05）,15．186（95％CI2．758-83．162,P〈0．01）。结论早期血乳酸清除率可以作为评价体外循环心脏术后患者预后的重要指标。     

脑卒中偏瘫患者的康复护理进展

脑卒中偏瘫是以一侧肢体随意运动不全或完全丧失为主要临床表现的综合征,属于中枢性瘫痪。偏瘫患者在不同的阶段存在着弛缓（肌张力下降）、痉挛（肌张力增高）、异常的运动模式、正常姿势反应及运动控制丧失,有功能形态、能力以及社会环境等多方面的障碍。     

脑卒中并假性球麻痹患者吞咽障碍的康复护理

目的探讨脑卒中并假性球麻痹患者吞咽障碍康复护理的方法和效果。方法将42例患者随机分为两组,对照组20例采用传统的常规护理方法,康复组22例在此基础上采用早期系统化康复护理方法,包括吞咽功能训练、摄食训练、鼻饲。结果康复组患者吞咽功能得到不同程度的改善,与对照组相比有显著性差异(P<0·05)。结论对脑卒中并假性球麻痹患者行早期康复训练,有助于恢复吞咽功能,减少并发症,使患者的精神状态和营养状况得到改善。     

老年脑卒中患者的康复需求及影响因素研究

目的:了解老年脑卒中患者的康复需求,并分析其相关影响因素。方法:对我院门诊收治的100例老年脑卒中患者进行问卷调查,调查患者对健康教育、运动训练、吞咽训练等方面的康复需求。根据调查结果,将其分为需求组和无需求组,采用单因素和多因素Logistic回归分析影响康复需求的相关因素。结果:研究对象对健康教育、运动训练、吞咽训练、针灸按摩、康复支具、心理干预、日常生活能力训练等7个方面的康复需求评分为(3. 07±0. 58)分、(3. 25±0. 67)分、(3. 12±0. 61)分、(2. 98±0. 54)分、(2. 76±0. 51)分、(2. 93±0. 56)分、(3. 02±0. 59)分。以运动训练康复需求得分最高。多因素Logistic回归分析显示,年龄、文化程度、家庭月收入、病程、神经功能缺损评分、日常生活能力评分、残疾程度是影响老年脑卒中患者康复需求的因素(P 0. 05)。结论:老年脑卒中患者的康复需求存在差异,年龄、文化程度、经济状况、病程、神经功能和日常生活能力、残疾程度等为其影响因素。