Neglect in elderly stroke patients: A comparison of five tests

Abstract  Neglect is a disabling state in stroke patients. Five tests for visuo-spatial neglect, star cancellation, line crossing, line bisection, draw a clock and copy a cross, were compared in 57 elderly patients. Sensitivity and intercorrelations between the tests were determined. Patients with neglect were studied as regards their activities of daily living, motor activity and cognition. Left-hemisphere neglect in patients with right-hemisphere lesions was more severe than right-sided neglect in patients with left-sided lesions in the star cancellation test. Sensitivity of the tests was moderate for star cancellation, line bisection and draw a clock, and low for line crossing and copy a cross. Significant correlations existed between the tests and cognitive and functional ability. Intercorrelations between the tests were moderate. Neglect patients showed a slower recovery after 6 and 12 months. Draw a clock and copy a cross displayed no sensitivity for neglect in patients with hemianopia, which may be due to the fact that these tests also evaluate constructional apraxia. The cancellation tests were influenced by hemianopia and there is evidence that hemianopia exacerbates neglect. This study shows that a battery of neglect tests is required to diagnose the neglect syndrome.     

早期康复治疗对急性脑卒中患者运动功能和生活能力的影响

目的探讨早期康复治疗对脑卒中患者运动功能和日常生活活动能力(ADL)的影响。方法将50例脑卒中偏瘫患者随机分成康复组(25例)和对照组(25例)进行临床对照研究,两组均进行常规神经内科药物治疗,康复组加以运动疗法,每例患者入组时、治疗第30d分别用Fugl-Meyer运动功能(FMA)量表测试运动功能和改良Barthel指数量表(MBI)测试ADL。结果MBI值:康复组治疗前、后分别为:20.68±8.98、72.36±17.39,对照组治疗前后分别为:21.24±12.59、51.29±18.52。FMA值:康复组治疗前、后分别为33.84±12.63、68.46±20.45,对照组治疗前、后分别为32.13±11.26、44.25±18.86。康复组和治疗组组间及组内比较差异具有显著统计学意义。结论康复治疗对偏瘫患者运动功能和日常生活活动能力具有良好的促进作用。可明显降低患者的依赖程度,提高其生活质量。     

Efficacy of milnacipran on poststroke depression on inpatient rehabilitation

Post-stroke depression (PSD) has a negative impact on rehabilitation following stroke. No satisfactory antidepressant treatment for PSD has yet been developed. The present study examined the effect of milnacipran, a serotonin and norepinephrine reuptake inhibitor, on PSD patients. Eleven PSD patients taking milnacipran in a rehabilitation hospital were compared to age-matched, sex-matched, and severity of depression at admission-matched PSD patients hospitalized during 2001 who did not take any antidepressant as historical control. Severity of depression was measured using self-rating depression scale for depression (SDS) assessed at admission and discharge after 3 months inpatient rehabilitation. Activities of daily living (ADL) and quality of life (QOL) were measured, respectively, by the functional independence measure (FIM) and a self-completed questionnaire for QOL (QUIK) as outcomes of rehabilitation. For the SDS score, the group taking milnacipran showed significant improvement compared to the control group in our study. FIM was improved in both groups. In the end QUIK did not change significantly in either group. We found no major side-effects of milnacipran among the patients. These results suggest that milnacipran is a safe and effective treatment for PSD for inpatients undergoing rehabilitation.     

早期综合康复治疗对急性脑卒中患者运动功能的影响

目的:探讨早期康复治疗对急性脑卒中患者运动功能的影响。方法:将219例急性脑卒中患者随机分为康复治疗组和对照组。康复治疗组116例,对照组103例。两组患者均采用常规药物治疗,而康复治疗组在患者生命体征稳定24-48小时内采用神经肌肉促进技术、功能性电刺激、心理治疗等综合康复治疗措施,于治疗前及治疗3个月时采用Fugl-Meyer(Fugl-Meyer Assessment,FMA)评分评定患者的运动功能;用Barthel指数(Modified Barthel Index,MBI)评定患者的日常生活活动功能(ADL)。结果:康复治疗组患者的FMA评分及MBI评分均较对照组明显提高,其差异具有非常显著性意义(P<0.01)。结论:早期康复治疗可明显改善急性脑卒中患者的运动功能及日常生活活动能力。     

Stigma experienced by Chinese patients with stroke during inpatient rehabilitation and its correlated factors: a cross-sectional study

Background: Stroke-related stigma can have a negative effect on patients, and is associated with stereotyping, prejudice, and discrimination; however, the exact stigma experienced by patients remains ambiguous.

Objectives: To evaluate the stigma experienced by patients with stroke, determine associated factors, and explore relationships between stigma and early rehabilitation.

Methods: Overall, we examined 288 patients with stroke. Patient characteristics were determined through medical records and investigations, while stigma status (comprising total stigma, internalized stigma, and enacted stigma), depression level, functional independence, and functional outcome were also assessed. Demographic and clinical characteristics were evaluated through univariate analysis, and significant variables were further analyzed through linear regression. The relationships between stigma and early rehabilitation (depression, functional independence, and functional outcomes) were also analyzed.

Results: The sample’s total stigma, internalized stigma, and enacted stigma scores were 47.76 ± 18.00, 30.07 ± 12.25, and 17.69 ± 6.37, respectively. Employment status before stroke, caregivers, physical impairment, and number of impairments were all relevant to all types of stigma (P< .05). The regression analysis showed that caregivers and physical impairment are the two main predictors of total, internalized, and enacted stigma (P< .01). The correlation analysis revealed that stigma is associated with depression (r = 0.671 ~ 0.690, P< .001), functional independence (r = ?0.562~?0.707, P< .001), and functional outcomes (r = 0.436 ~ 0.637, P< .001).

Conclusions: Stigma was moderate, and internalized stigma may be more apparent; therefore, physicians should pay more attention to patients who report or show signs of experiencing stroke-related stigma.     

The aftermath of rehabilitation for patients with severe stroke

OBJECTIVE: The study evaluates the aftermath of stroke in patients with very severe disability after their first ever stroke and dismissed after rehabilitation. MATERIALS AND METHODS: Sixty-nine inpatients were studied, who were highly disabled at discharge with a Functional Independence Measure (FIM) score in the range of 18-39. Their rehabilitation program had lasted 60 days. The degree of functional independence was measured by means of the FIM at the beginning of treatment, at discharge and at follow-up. The data collected were examined by using parametric and distribution-free statistical methods. The role of age in the process of recovery was also evaluated. RESULTS: All patients were discharged home after 2 months. At 6 month follow-up, 15 patients (21.7%) were lost, 27 (39.1%) had died and 27 (39.1%) lived at home. Among stroke survivors a clear trend toward an improvement was detected during the 6 months observation period. Indeed, the third quartile changed from 33 to 63 and a patient approached to independence (FIM 87). None underwent a rehabilitation program at home beside the relatives' assistance. CONCLUSIONS: Highly disabled stroke patients are probably to undergo unfavourable outcome but unexpected recovery cannot be ruled-out on the basis of cut-off parameters measured after the acute phase of stroke. Multivariate statistical methods can identify factors which can interfere with functional recovery but are error-prone in setting individual prognosis. Moreover the recovery process may develop in a long period of time. Taking into consideration the spontaneous recovery observed during the follow-up period after the dismissal from rehabilitation ward, a suitable rehabilitation at home might be fruitful in these patients, who should not be considered as "lost".     

Cognition assessments to predict inpatient falls in a subacute stroke rehabilitation setting

ABSTRACT

Background: Stroke-related falls occur at especially high rates in rehabilitation settings. Inpatient-hospital falls have been identified as one of the most common medical complications after stroke, negatively influencing recovery, nevertheless, the role of cognition in relation to falls during inpatient rehabilitation is largely unexplored.

Objective. We aim to predict inpatient falls in a subacute stroke rehabilitation setting using previously reported variables such as stroke severity, gender, age, ataxia, hemiparesis, and functionality in activities of daily living, further extending them with specific cognition variables assessing memory, verbal fluency, attention, and orientation.

Methods: This observational study included 158 stroke patients admitted to a rehabilitation center between 2007 and 2019, with less than 30 days since stroke onset to admission. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Four logistic regressions were performed including NIHSS, age, sex, ataxia, and hemiparesis plus one of the following: (1) Functional Independence Measure cognitive (C-FIM) and motor (M-FIM) subtests. (2) individual C-FIM items, (3) Ray Auditory Verbal Memory Test (RAVLT) and (4) verbal fluency test (PMR), Digit Span from Wechsler Adult Intelligence Scale (WAIS III), and Orientation from Test Barcelona.

Results: Neither NIHSS, age, sex, ataxia nor hemiparesis predicted falls. C-FIM was a significant predictor (AUC:0.891), but not M-FIM. The problem solving C-FIM item (AUC:0.836), the RAVLT learning subtest (AUC:0.879), and PMR verbal fluency (AUC:0.871) were significant predictors for each model, respectively.

Conclusions: Cognition assessments, i.e., one FIM item, one RAVLT item, or a one-minute verbal fluency test are significant falls predictors.     

急性脑卒中患者的早期中西医结合康复治疗

目的探讨3个月运动康复结合针灸治疗对急性脑卒中患者临床神经功能缺损程度(CNFD)以及日常生活能力(ADL)的影响。方法将105例急性脑卒中患者随机分为对照组、运动康复组、运动康复 针灸组,每组35例,进行3个月的康复治疗。治疗前后各进行一次临床神经功能缺损程度、日常生活能力评价。结果治疗前3组的临床神经功能缺损评分及日常生活能力评分差异均无统计学意义(P>0.05)。治疗后3组的临床神经功能缺损评分、日常生活能力评分均较治疗前差异有统计学意义(P<0.01),运动康复 针灸组的临床神经功能缺损评分最低、日常生活能力评分最高。结论3个月的运动康复结合针灸治疗能有效降低急性脑卒中患者的神经功能缺损程度,并促进日常生活活动能力的提高。     

院外延伸康复护理模式对脑卒中患者的效果

目的研究对于脑卒中患者实施院外延伸康复护理模式的应用效果。方法将我院2014-03—2015-03收治的69例脑卒中患者为对照组,采取常规院内康复指导及功能锻炼,选取2015-05—2016-07收治的69例脑卒中患者为干预组,实施院外延伸康复护理模式,比较2组经护理干预后神经功能、日常活动能力、心理抑郁、生活质量等评分结果。结果出院时2组NIHSS评分结果比较差异无统计学意义(P0.05);出院后6个月、1a后对照组NIHSS神经功能评分均高于干预组(P0.05)。出院后6个月、1a后对照组Barthel指数评分均低于干预组(P0.05)。对照组日常生活质量等指标评分均低于干预组(P0.05)。护理干预后,干预组SDS评分低于对照组(P0.05)。结论院外家庭延伸康复护理指导模式可显著提高脑卒中患者生活质量评分,减轻神经损伤状态,改善患者心理抑郁状态,值得临床应用。     

脑卒中偏瘫患者家庭康复护理干预及效果评价

目的探讨家庭护理干预对脑卒中患者运动能力及日常生活活动能力的影响。方法选择经治疗好转出院80例脑卒中偏瘫患者，随机分成两组，干预组每月上门随访指导，对照组回家自行锻炼或休养，运动能力采用功能独立性评分（FIM）、日常生活活动能力（ADL），采用Barthel指数评分。结果6个月后干预组FIM及Barthel评分明显高于对照组（P〈0．01）结论家庭康复护理干预能明显改善脑卒中患者的运动能力和提高日常生活自理能力。     

Cognitive impairments and mood disruptions negatively impact instrumental activities of daily living performance in the first three months after a first stroke

Abstract

Background:

Cognition and mood play crucial roles in post-stroke recovery; however, the stroke literature is unclear as to how impairments in both domains influence performance of instrumental activities of daily living (IADL).

Objective:

(1) Evaluate the extent to which mood and cognition at two weeks post-stroke predict performance three months post-stroke. (2) Assess performance differences in patients with impairments in both cognition and mood to patients with impairments in either cognition or mood.

Methods:

Inpatients with a first-ever ischemic or hemorrhagic stroke were assessed at 2 weeks (n?=?52) and at 3 months (n?=?41) post-stroke. Patients completed a battery of neuropsychological tests, self-report measures and performance-based tests. Cognitive impairments and mood disruptions were assessed at 2 weeks and three months and IADL performance, as assessed by the Executive Function Performance Test, was evaluated at three months.

Results:

Complete data from the 41 patients assessed at both time points were analyzed. Regression analysis showed that composite cognition and composite mood variables at two weeks post-stroke predicted 48% of the variance in IADL performance at three months (F_3,37?=?12.04; adjusted R²?=?0.48, P?<?0.001). Statistically significant differences were found in performance scores for patients with a single impairment (M?=?7.86, SD?=?7.81) and for those with impairments in both mood and cognition (M?=?19.2, SD?=?13.2) (t(39)?=???3.41, P?=?0.008).

Conclusion:

The results of this study suggest that cognitive and mood impairments at two weeks post-stroke are important predictors of performance in complex activities required for full independence at home and should be routinely assessed in stroke rehabilitation.     

Sex differences in health-related quality of life among adult stroke patients in Northeastern China

Inconsistent results have been reported for the impact of sex on stroke outcomes. We investigated the differences in health-related quality of life between adult male and female stroke survivors in Northeastern China. Information on background variables was collected during hospital stay. Follow-up data were obtained through a phone interview 6 months after discharge, which included the Barthel Index and a 36-Item Short-Form Health Survey (SF-36) reflecting overall health status. The independent effects of sex on activities of daily living independence (Barthel Index ⩾95) were analyzed. Our results showed that female stroke patients were older than male stroke patients and were more likely to have transient ischemic attack and hypertension. Male stroke patients were more likely to have a history of smoking, heart disease and dyslipidemia, while female patients were less likely to achieve daily living independence. The mean scores of physical functioning, bodily pain, vitality, social functioning, emotional role, and mental health in the SF-36 survey were significantly higher in men than woman. Regression analyses confirmed that female sex was adversely associated with overall health status at discharge. In conclusion, our data demonstrated that there were sex differences in stroke recovery and quality of life among Chinese stroke survivors at 6 months post-discharge, with an overall worse stroke outcome for female stroke survivors.