Effect Of Early Rehabilitation On Functional Recovery Of Stroke

Objective: Cerebral vascular accident is a common disease with a high rate of morbidity, mortality and mutilation. In China, the mutilation rate of cerebral vascular is the highest in the numerous iseases, mortality of patients with stroke in Foreign hospital is 30%-40%[1]. The feature with fast developing, slow recovery and high rate of mortality, mutilation take galactic suffering and heavy burden on the patients, their family and society. However, many patients are alive one year after stroke, and 80% of survivors are facing long-term disability. The early rehabilitation training is effective and safe on the patient, could improve motor function and ADL (activities of daily living). Early rehabilitation could prevent and reduce the incidence of complications such as shoulder—hand syndrome. Generally agreed that sooner rehabilitation training to carry out, the greater the function recovery. As long as the patient's vital signs stable, clear consciousness, neurological signs of progress are no longer able to proceed, early comprehensive rehabilitation training should be start[2]. Start within one month after stroke rehabilitation for the early rehabilitation[3]. Early rehabilitation can greatly reduce social spending for a variety of patients with hemiplegia, for patients with stroke functional recovery, reducing disability, improving quality of life to help them return to society of great significance. Our research is to determine time window of rehabilitation after stroke andvalue the effects of early rehabilitation on motor function and ADL, to provide clinical basis for the theory of early rehabilitation.Method: Select 90 cases in September 2008 to October 2009 in Hebei Province People's Hospital inpatient neurology and rehabilitation of stroke patients in this study. Selected conditions: by CT or MRI confirmed the diagnosis of cerebrovascular disease in patients with newly diagnosed or past episodes but despite remaining neurological dysfunction; at the age of 18 to 80 years of age; Glasgow Coma Scale score more than 8 points; willing to accept the rehabilitation treatment, and will facilitate the rehabilitation of the rehabilitation training of physicians. Exclusion criteria for subarachnoid hemorrhage, transient ischemic attack and reversible neurological impairment in patients; got worse, the emergence of new infarction or bleeding; heart, lung, liver, kidney and other important organ dysfunction or failure. 90 patients 35 to 80 years of age diagnosed as cerebral hemorrhage or cerebral infarction were randomly divided into two groups, early rehabilitation group (46 cases), and noearly rehabilitation group (44 cases). Into the group at the time and morbidity were assessed at 3 months. The two groups were assessed by the Fugl-Meyer assessment (FMA)[4], modified barthel index(MBI)[5]and NIHSS[6]. Two groups using the same drug treatment, including the removal of brain edema, brain protection, expansion to improve the blood circulation and other treatment, both groups used mainly Bobath rehabilitation technology, sports and the relearning of daily living training.Results: The evaluation scores of FMA, MBI demonstrated that there wasn't significant difference between early rehabilitation group and no early rehabilitaion group when into the group(P>0.05), but after incidence of 3 months,the gain of scores in the early rehabilitation group were obviously higher than those in the noearly rehabilitarion group(P<0.01or P<0.05 ), there was significant difference between the increased scores of the early rehabilitation group and the no early rehabilitation (P<0.05).The efficient of shoulder-hand syndrome was significant difference between early rehabilitation group and no early rehabilitaion group (P<0.05).Conclusion: Recovery of function afterstroke don't derive from improvement of neurologic function alone, The early rehabilitation training is effective and safe on the patient, to reduce Sequelae of stroke .Could improve motor function and ADL(activities of daily living). Objective: Cerebral vascular accident is a common disease with a high rate of morbidity, mortality and mutilation. In China, the mutilation rate of cerebral vascular is the highest in the numerous diseases. The feature with fast developing, slow recovery and high rate of mortality, mutilation take galactic suffering and heavy burden to the patients, their family and society. However, many patients are alive 1 year after stroke and, 70–80%[1] of survivors are facing long-term disability. Epidemiological studies illustrate, disability following stroke appears in form of neurologicaldys functions(e.g. motor, sensory, visual) and limited ability to perform activities of daily living(ADL), as well as neuropsychological deficits(e.g. attention, memory, language). In addition, neuropsychiatric disturbances (e.g. poststroke depression) are frequently associated with stroke. ICF was published in October 2001 by WHO. The ICF is designed to record and organize a wide range of information about health and health-related states.Since the ICF has been developed in a worldwide, comprehensive consensusprocess over the last few years and was endorsed in May 2001 by the World Health Assembly as a member of the WHO Family of International Classifications, it is likely to become the generally accepted framework to describe functioning and health.he Purpose of the research isTo investigate the validity of International Classificationof Functioning, Disability and Health(ICF)[2] of the in hemiplegia patients.Method: From January 2009 to December 2009 in the Hebei Province People's Hospital, 60 hemiplegic patients were measured by ICF, Fuglmeyer[3], Barthel index (BI)[4] and WHODASII. 6 months later 60 hemiplegic patients were measured by ICF,Fuglmeyer,Barthel index (BI) and WHODASII[5] for the second time. interrelationships among ICF,Fuglmeyer,BI and WHODASII were analyzed. Result : The first measurement: ICF negative correlated sgnificantly with Fuglmeyer, BI and correlated sgnificantly WHODASII ( r= -0.68 , P<0.01; r= -0.65, P<0.01; r=0.41, P<0.01) The second measurement: ICF negative correlated sgnificantly with Fuglmeyer,BI and correlated sgnificantly with WHODASII( r=-0.67,-0.41,0.46, P<0.01). Difference between two measurements: ICF negative correlated sgnificantly with Fuglmeyer,BI and correlated sgnificantly with WHODASII(r=-0.540, P<0.01; r=-0.407, P<0.01; r=-390, P<0.05). The activities and participation Score negative correlated with Fuglmeyer,BI and correlated sgnificantly with WHODASII sgnificantly . (the first measurementr=-0.75, -0.84, 73 P<0.01);( The second measurement r=-0.80,-0.85,0.68,P<0.01)。Body function score negative correlated with Fuglmeyer,BI and correlated sgnificantly with WHODASII sgnificantly .(the first measurement(r=-0.43, P<0.01; r= -0.40, P<0.05; r=0.539,P<0.01); (The second measurement r=-0.37, P<0.05; r=-0.33,P<0.05; r=0.38,P<0.01). Environmental Factors Score negative correlated with Fuglmeyer,BI and correlated sgnificantly with WHODASII sgnificantly .the first measurement( r=-0.44, P<0.01; r=-0.35,P<0.05; r= 0.45, P<0.05); The second measurement( r=-0.42, P<0.01; r=-0.50, P<0.01; r=0.41,P<0.05). Body structures have no correlation with Fuglmeyer,BI and WHODASII.Conclusion: ICF is not quick and simple but administer with good validity, it can be applied to motor functional evaluation among hemiplegia patients, and it fits very well into the routine clinical assessment scheme.