Relevant Research Between Balance Function And Ability Of Daily Living In Acute Stroke Patients

Partâ… :Analysis on correlation between balance function and self-care ability in acute stroke patientBackground:Balance function is an important function of human being. The performance of every action in daily living such as dressing, beautifying, eating, bathing and toileting depends on body's balance function. And balance function is the basis of seating, standing and walking. It is because the damage of artery blood supply system that induces vascular spasticity, occlusion or angiorrhexis. As a result, it induces blood circulation disturbance and the damage of organizational structure or function in brain, then brings out the sequelas of sick side's powerless, muscle spasticity, perception anesthesia and visual defect to affect patient's balance function. As a result, the disturbance of balance function is a common damage to the stroke patient and has a severe influence on the recovery and living quality to the patient. It is has a crucial meaning to make assessments on the balance function of the stroke patient with hemiplegy to determine the order of severity of the cerebrovascular disorder, make judegement on prognosis and make out rehabilitation planning. At present, the staple methods to assess balance function include clinical assessment and lab test. The main clinical assessments are observation method and scale method, while that of the lab test is the use of balance tester. The scale method is commonly used in the clinical application because it doesnot need special devices, can make scores, is easy to quantify and contrast and has good reliability and validity. According to the statistics, there are above ten kinds of balance scales in the rehabilitation assessment of stroke. In them, Berg balance scale(BBS) and balance subscale of the Fugl-Meyer test(FMB) are the most commonly used. Now there are few researches on the balance function after the stroke. Morever, it is fewer on BBS and FMB to the value of clinical practice. And the clinical application is objective and lack of objective foundation. The balance function has a sensitive relationship with the comprehensive motor function and it could influence the dependency of daily living. The related literatures report that the balance function has a correlation with the ability of daily living, but the reports on it are few and it remains to be researched further.Objective:It is helpful of the assessment on the balance function of stroke patients to determine the order of severity of the cerebrovascular disorder, make judegement on prognosis and make out rehabilitation planning. This paper intends to observe the clinically practical value of BBS and FMB on the patient with cerebrovascular disorder with hemiplegy, discuss the correlation between balance function and ability of daily living, provide academic foundation to assess the balance function of stroke patient and make out therapy plan on balance rehabilitation.Methods:It used the method of retrospective study and selected 38 qualified stroke patients with hemiplegy. All patients were treated with common medicine in neurology department and they began to make rehabilitation therapy after 48 hours' steady of neural syndrome and vital sign. The methods of rehabilitation mainly used electro-stimulating on hemiplegy side, Bobath techinique, PNF, training of body controlling ability, balance training (balance coordinating training of positions of seating, kneeling, standing and from seating to standing and walking training) and ability training of daily living activity. And they were carried out step by step according to the features of function recovery in patients with hemiplegy. The therapy was performed one to one, once each day,45 minutes once and five times each week. Before the selection and three weeks after the rehabilitation therapy, it respectively used BBS, FMB and modified Barthel Index(MBI) to make assessments. It made statistical analysis on the obtained information.Results:After three weeks' therapy, the scores of BBS, FMB and MBI for patients were all increased. It had significant meanings on every score differentiation before and after the therapies. They were t=26.352, P=0.000, t=17.286, P=0.000, and t=32.864, P=0.000 respectively. The related coefficencies between BBS and FMB scorings before patients' recovery and MBI scoring before recovery were 0.369(P=0.023) and 0.525(P=0.001) respectively. The related coefficencies between BBS and FMB scorings before patients' recovery and MBI scoring after recovery were 0.324(P=0.047) and 0.432(P=0.007) respectively.Conclusions:The assessment scales of balance function of BBS and FMB both can reflect the balance ability of acute stroke patients and have good coherence on the assessment of balance function. But FMB has a more sensitive assessment and highly clinical practice in acute period. The balance function has a positive linear correlation with the self-care ability. The defect of balance function has a significant effect on the self-care ability of stroke patient. The improvement of patient's self-care ability is beneficial to enhance the balance function. rehabilitationPartâ…¡:The influences of balance function and ability of daily living for the disease characteristic and part of acute strokeBackgroud:Balance is a basic ability to control action in a daily life.To keep normal balance,brain needs introduce sensory information from visual sustem, vestibular system and proprioceptive sense of body,and brain accordingly sends out signal to propotional muscle group which keeps on balance of bearing surface.Balance function is governed by central nervous system,central nervous system introduces sensory information from visual system,vestibular system,and proprioceptive sense of body into central nerve with multistage equilibratory sensations,which are spinal cord,vestibular nuclei,fasciculus longitudinalis medialis, reticular formation of brain stem,cerebellum,cerebral cortex,etal.Then, central nervous system,that is brain,sends signals to homologue muscle groups, so that center of gravity can be maintained within support tope.After stroke,nerve synapse connection is destructed,cranial nerve structure is deficiency,upper center loses the control of lower center,emerges complicated balance syndromes.Patients with stroke do not control body and limbs,no steadiness of standing and walking,unselfcare of daily activity. Clinically,balance function is also thought highly by rehabilitation field.Many literatures have showed that balance exercise obviously improved balance function and ADL of stroke, furthermore, rehabilitation is undertook earlier,treatment effect is better.Along with clinical assessment and training are carried out,there is a outstanding questiuon,the impairments of balance function and ADL are distinct in acute stroke with difference disease characteristic and disease position,we whether or not should consider difference disease characteristic and disease part when we work out banlance rehabilitation programme.However,there are few literatures on this field.Therefore.it is very important for us to evaluate the balance function of patients with stroke,and know the effects of disease characteristic and disease part in acute stroke on balance function and ADL for stroke patients,which can be used to confirm disease severity,establish rehabilitation project and judge outcom.Objective:It is a complicated locomotion technique to control balance,balance function and ADL are controled by nerve centre system.The objective of this article was to explore the effects of characteristic and position in acute stroke on balance function and ADL for stroke patients,so that we could better carry out balance rehabilitation for distinguished type stroke patients.Method:This article was used Retrospective Studies,and performed with 50 stroke patients. All patients were randomly dividede into 4 groups according to the disease characteristic and position of stroke,the group 1(ischemic stroke on left) 14 cases,the group 2(hemorrhagic stroke on left) 9 cases,the group 3(ischemic stroke on right) 17 cases,and the group 4 (hemorrhagic stroke on right) 10 cases.They were assessed after 48 hours in the stabilization of nerve symptom and life sign. Balance function was assessed with the balance subscale of Fugle-Meyer test(FMB),and the activities of daily living(ADL) was assessed with Modified Barthel Index(MBI). Statistics analysis was conducted with all the parameters.Result:It was found that the scores of FMB and MBI in the hemorrhagic stroke patients were lower than those in the ischemic stroke patients, there were a significant difference(t=5.888 P=0.000, t=3.504 P=0.001,repectively). Factor Analysis was used. It showned that there was interaction between disease characteristic and disease part of stroke for the scores of FMB(P=0.525),the score of FMB in the difference disease characteristic (hemorrhagic or ischemic) of stroke patients was significant difference (P<0.05),while the score of FMB in the difference disease part (left and right) of stroke patients was no significant difference(P>0.05); there were interaction between disease characteristic and disease part of stroke for the scores of MBI (P=0.534),the score of MBI in the difference disease characteristic (hemorrhagic or ischemic) of stroke patients was significant difference(P<0.05),while the score of MBI in the difference disease part (left and right) of stroke patients was no significant difference (P>0.05).Conclusion:Patients with hemorhagic stroke had more poor balance function and ADL than those with ischemic stroke;Hence,we should distinguish disease characteristic when we carried out rehabilitation treatment for acute stroke patients. The impairments of balance function and ADL on left hemisphere stroke had as consistent degree as those of right hemisphere stroke;so,we should not distinguish disease part when we implemented rehabilitation treatment for patients with acute stroke.