Construction And Feasibility Study Of Simple Daily Activity Functional Training Program For Acute Hemiplegic Stroke Patients

ObjectivesThe present study aimed to construct an early task-oriented functional training program and apply it to acute hemiplegic stroke patients to observe its effects on neurological deficits,motorfunction,and activity of daily living(ADL)and patients' feelings about the program.This program,focused on simple but important daily living activities,was built based on the investigation of motor function in hemiplegia patients with acute cerebral infarction and literature review.Through this study,we wish to provide scientific evidences for guiding motor rehabilitation in hemiplegia stroke patients.Methods1.The construction of simple daily activity functional training program for hemiplegic stroke patients include three steps: firstly,motor function in hemiplegia stroke patients of acute cerebral infarction was investigated and analyzed;secondly,the first draft of a task-oriented simple daily activity functional training program was developed based on the results of our investigation and literature review combined with the guidance of rehabilitation experts;thirdly,the first draft of the program was modified and improved according to a pilot study in six hemiplegia patients with acute cerebral infarction to form the final version of early functional training program.2.For the feasibility study,25 hemiplegic patients with acute cerebral infarction accepted simple daily activity functional training program intervention for 8 weeks.The effects on neurological deficits,motor function,and ADL were observed through the assessments before(Pre)and after 4 and 8weeks of training.Patients' compliance to the program was analyzed based on exercise diaries.11 patients were invited to share their feeling about the programe after they completed 8 weeks program.Results.1.The investigation demonstrated that hemiplegic patients with acute cerebral infarction suffered from different degrees of neurological deficits,motor dysfunction and decline in ADL.Multiple regression analysis showed that functional ambulation category scale(FAC)(P < 0.0001)and action scores during reaching and drinking from a glass(P < 0.01)were statistically significant prognostic factors for ADL.2.Firstly,the process of the early training program intervention and the assessments in these patients were performed smoothly and safely without any unexpected accident,complication or side effects.After applying the simple daily activity functional training program to acute hemiplegic stroke patients,we found that many parametersimproved significantlyat after 4 and 8 weeksintervention compared with Pre(P<0.025)and these parameters include NIHSS score,hemiplegic upper limb grip strength,action scores during reaching and drinking from a glass,balance function,walking ability(walk on plat ground and climb stairs),BI and all items within BI(except bowels and bladder).Action scores during reaching and drinking from a glass,balance function,walking ability(walking on plat ground and climbing stairs)and two items in BI(dressing and mobility)improved significantly after 8 weeks compared with the data after 4 weeks(P<0.025).In addition,patients had high compliance with the training program,and their feelings about the programe are :first,self-perceived benefits from early functional training program;second,facilitators for hemiplegia patients to participate or persist in exercise;third;professional guidance were needed when encountering obstacles.Conclusions.1.Hemiplegic patients with acute cerebral infarction suffered from different degrees of neurological deficits and motor dysfunction,which lead to decline in ADL.FAC and action scores during reaching and drinking from a glass are the most important factors of ADL.2.This early simple daily activity functional training programis proved to be safe,acceptable,feasible and effective(evidenced by the improved neurological deficits,motor function,and ADL)in hemiplegia patients with acute cerebral infarction.It is suitable for patients with mild to moderate dysfunction during early hospitalization and for the patients back at home after discharge,and it can also be used in the severely dysfunction patients intheir transitional period from hospitalization to enter into rehabilitation center.Besides,Hemiplegia patients with acute cerebral infarction are facing with facilitators as well as barriers when they started to participant and persisted in early functional training.As medical staff,we should take advantage of patients' keen anticipation for rehabilitation,pay attention to health education and enhance their confidence in recovery.Additionally,we should guide the "double-edged sword" factors reasonably,identify barriers and start interventions early,and modify the training program according to patients' acceptance during rehabilitation process.Only in this way can we help patients to take up and persist in functional training.