Efficiency of medical and physical rehabilitation in patients who suffered from cerebral ischemic stroke
DOI:
https://doi.org/10.14739/2310-1237.2019.2.177125Keywords:
stroke, stroke rehabilitationAbstract
Objective. The purpose is to increase the efficiency of medical and physical rehabilitation in patients who suffered from cerebral ischemic stroke (CIS) with the help of differentiated use of rehabilitation measures depending on the severity of neurological disorders and comorbid states.
Materials and methods. In the clinic of nerve diseases of Zaporizhzhia State Medical University we observed 305 patients (213 men and 92 women, average age is 57.93 ± 0.43 years old) in the recovery period of CIS. All patients were clinically and neurologically examined according to a specially designed protocol using modern scales – NIHSS, mRS on the 10th, 30th, 90th and 180th day of the disease and differentiated treatment in accordance with standards and protocols for the assistance to patients who suffer from stroke. Patients with CIS were divided into four groups. The first group included 111 patients (36.4 %) with CIS, among whom the severity of post-stroke disorders was mild (state on NIHSS ≤ 7 points), without comorbid conditions. The second group consisted of 120 patients (39.3 %) also with a mild degree of post-stroke disorders (state on NIHSS ≤7 points) and the comorbidity (heart pathology, diabetes mellitus, chronic obstructive pulmonary disease of the IInd stage). The third group included 36 patients (11.8 %) with CIS, among whom the severity of post-stroke disorders was moderate and obvious (state on NIHSS > 7 points), without comorbidity. The fourth group consisted of 38 patients (12,5 %) with moderate and severe post-stroke disorders (state on NIHSS > 7 points) and comorbid pathology. Statistical analysis was carried out using descriptive statistics methods. The interrelation between qualitative features was evaluated according to the criterion of the Pearson’s chi-square test.
Results. As a result of the treatment among the patients in group I, 97 patients (87.4 %) (index mRS 0–2) had a favorable outcome, relatively favourable one (index mRS ≥3 points) – only 14 (12.6 %); In group II, 104 patients (86.7 %) achieved favorable treatment, relatively favorable one – 16 (13.3 %); in group III – a favorable outcome was recorded in 13 patients (36.1 %), relatively favorable – in 23 (63.9 %), and in group IV – a favorable outcome was revealed in 13 patients (34.2 %), relatively favorable one – in 25 (65.8 %).
Conclusions. The differentiated application of medical and physical rehabilitation in patients with CIS in different groups, taking into account the individual prognosis of the recovery period and selection of methods and ways of treatment, has improved significantly the effectiveness of rehabilitation measures.
References
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., et al. (2018) 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 49(3): e46–e110. doi: 10.1161/STR.0000000000000158
Mishchenko, T. S. (2017) E'pidemiologiya cerebrovaskulyarnykh zabolevanij i organizaciya pomoshhi bol'nym s mozgovym insul'tom v Ukraine [Epidemiology of cerebrovascular diseases and organization of medical care for patients with stroke in Ukraine]. Ukrainskyi visnyk psykhonevrolohii, 25(1), 22–24 [in Russian].
Thrift, A. G., Howard, G., Cadilhac, D. A., Howard, V. J., Rothwell, P. M., Thayabaranathan, T., et al. (2017) Global stroke statistics: An update of mortality data from countries using a broad code of “cerebrovascular diseases”. International Journal of Stroke, 12(8), 796–801. doi: 10.1177/1747493017730782
Nelson, M. L. A., McKellar, K. A., Yi, J., Kelloway, L., Munce, S., Cott, C., et al. (2017) Stroke rehabilitation evidence and comorbidity: a systematic scoping review of randomized controlled trials. Top Stroke Rehabil, 24(5), 374-380. doi: 10.1080/10749357.2017.1282412
Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., et al. (2016) Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Strokе, 47(6), 98–169. doi: 10.1161/STR.0000000000000098
Coleman, E. R., Moudgal, R., Lang, K., Hyacinth, H. I., Awosika, O. O., Kissela, B. M., & Feng, W. (2017) Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep., 19(12), 59. doi: 10.1007/s11883-017-0686-6
Pin-Barre, C., & Laurin, J. (2015) Physical Exercise as a Diagnostic, Rehabilitation, and Preventive Tool: Influence on Neuroplasticity and Motor Recovery after Stroke. Neural Plast, 2015, 608581. doi: 10.1155/2015/608581
Morreale, M., Marchione, P., Pili, A., Lauta, A., Castiglia, S. F., Spallone, A., et al. (2016) Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach. Eur J Phys Rehabil Med, 52(1), 81–89.
Chien, S. H., Sung, P. Y., Liao, W. L., & Tsai, S. W. (2019) A functional recovery profile for patients with stroke following post-acute rehabilitation care in Taiwan. J Formos Med Assoc. doi: 10.1016/j.jfma.2019.05.013
Belagaje, S. R. (2017) Stroke Rehabilitation. Continuum (Minneap Minn). 23(1, Cerebrovascular Disease), 238–253. doi: 10.1212/CON.0000000000000423
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