Research On The Beginning Time Of Early Rehabilitation In Acute Cerebrovascular Diseases

Background and Objective:With the developments of modern medical science, the strategies and skills in the diagnosis and treatment of acute cerebrovascular disease have improved greatly. The accident rates of mortality and morbidity were accordingly decreased to a relatively low level. However, a serious challenge is still exist to cope with in respect to the high incidence of disability after brain stroke.80% stroke survivors bear more or less degree of functional impairment, which weighs heavily to the patient, the family and society. Early rehabilitation can reduce the morbidity of cerebrovascular disease, improve the degree of disability and improve activities of daily living. The combined approach based on physical therapy and occupational therapy has become a popular therapeutic tool for its good efficacy in early rehabilitation in general hospital neurologic department. The exact time-point in the initiation of early rehabilitation in acute stroke patients is still not clearly elucidated. To make this time onset clear is of great value, for too early exercise in functional recovery might result in some unfavorable risks while time delay to initiate recovery is easy to lead to a lost of the best opportunity for rehabilitation and apt to induce "misuse" or "disuse" in dysfunctional limb. This study focuses on stroke-relevant early rehabilitation and the efficacy and safety of two managements (early rehabilitation and ultra-early rehabilitation) were investigated.Methods:120 first-onset stroke patients (aged 18-80 years), confirmed by brain CT or MRI scanning, were subjected to a ultra-early rehabilitation program (2 days later after the stability of the primary disease) or an early rehabilitation project (8 days later after the stability of the primary disease) with 60 individuals in every group only when the vital signs were stable, no neurological symptoms progress within 48 h, the score of Glasgow Coma Scale is greater than 8 points and capable to go with the programs of treatment. The daily rehabilitation procedures include 1 h physical therapy (PT) and 1 h occupational therapy (OT) in accordance with the standard of Chinese Rehabilitation Medicine Center. The efficacy was assessed by the scales of NIH Stroke Scale, Fugl-Meyer and modified Barthel index. After a 4-week period of rehabilitation an endpoint evaluation was performed. Data were analyzed by student-t test and chi-square test.Results:No significant differences were found in basal demographic characteristics, disease severity and neural scale evaluations between two treatment groups (P>0.05). A significant improvement was found in both ultra-early rehabilitation therapy and early rehabilitation intervention in the change of the scores in NIHSS, Fugl-Meyer and modified Barthel Index at the end of observation in comparison to the baseline assessment (P<0.05). When the 4-week rehabilitation period was over a great treatment effect appeared in the two projects and the differences were statistic in neurological deficit symptoms, motor function and activities of daily living (P<0.05). Conclusion:The early rehabilitation in acute cerebrovascular disease can reduce the "misuse" and "disuse" syndromes in the relevant treatment and may decrease the occurrence of several failure complications in multiple systems or organs due to long-time lying in bed or fixed position. Furthermore, the reorganization of brain function, activities of daily living and the extent of extremity disability will develop and recover to a better level followed by a 4-week combination of PT plus OT. Our research indicates a more greater efficacy exist in ultra-early rehabilitation therapy compared to early rehabilitation therapy and the treatment was safe. These results indicate an important practical significance to guide the clinical treatment in brain stroke.