| Part1Rehabilitation characteristics of the older stroke patientsObjective：Stroke that the incidence is closely correlative with age,seriously threaten the human life and quality of life. That is, along with thegrowth of the age, the incidence of stroke increases exponentially. With thecontinuous progress of modern medicine in recent years, the diagnosis andtreatment of stroke have been significantly improved. The mortality also hasdecreased significantly, but its mutilation rate remain at a high level. Atpresent, there is sufficient evidence that appropriate rehabilitation treatmentcan maximize the recovery of dysfunction of stroke patients, but the curativeeffect is disturbed by many factors, especially for the elderly stroke patients.Age, stroke severity, stroke history, culture, cognition and functional statusbefore stroke have been proved to be affirmative influencing factors, but thereare rare reports to study factors from the perspective of the treatmentprocedure and daily activities. This paper is to analyze the influencing factorsof functional prognosis to elderly stroke patients, focusing on therehabilitation process and daily activities during hospitalization, and tosummarize the characteristics of rehabilitation in elderly patients with stroke,and to search for a better therapeutic scheme for elderly patients.Method: From March2011to January2013,80admitted stroke patientswho received rehabilitation in Hebei Province People’s Hospital, were selected.Selected conditions:①The diagnosis was confirmed, according to thediagnosis of cerebrovascular disease in the Fourth National AcademicConference on cerebrovascular disease, by CT or MRI;②with newly anteriorcirculation stroke, onset-addmision interval≤2months;③vital signs are stable,Glasgow Coma Scale score more than8points;④with apparent motorimpairment, Fugl-Meyer motor function assessment<85points;⑤ADL can not independent, Barthel index≤60points. Exclusion criteria:①severedysfunction of osteoarticular, sensuous, psychical, psychological, visual andaudito-comprehensive;②failure of heart, lung, liver, kidney or otherimportant organs;③a previous history of dementia. According to age,80patients were divided into older（age60,40patients）or younger(age<60,40patients) age-groups. There were no difference between the two groups ingender, onset-addmision interval, lesion side and NIHSS, but the type ofdisease, the score of MMSE and the years of education had significantdifference. Both the two groups were given routine rehabilitation therapy for4weeks. According to the tolerance and cooperation, all patients were trained2-4hours every day and5days a week. All patients were assessed before and2,4weeks after treatment. Motor function was assessed using Fugl-Meyermotor function assessment (FMA), ADL was assessed using Barthel-index (BI)and ability of basic movement was assessed using the ability for basicmovement scale (ABMS). During the period of treatment, we investigated thedaily activities of all the patients using domestic daily activities questionnaire.Result:1There were no difference between the two groups before treatment inFMA and BI (P>0.05). But the ABMS, the younger group was significantlysuperior than the olders.2At the2nd and4th week evaluations, the FMA, BI and ABMS scores inboth groups had significantly increased comparing with those of pre-treatment(P<0.05).3At the2nd week after treatment, no different was found between thetwo groups in FMA and BI (P>0.05); but the ABMS improved obviously morein younger group than that in the older one (P<0.05).4At the4th week after treatment, there were no difference in FMAbetween the two groups (P>0.05); but the BI and ABMS in older groupincreased significantly less than those in younger group (P<0.05).5Both total and active movement time of a day of the older group wassignificantly shorter than those in the younger’s (P<0.05), but passive and active-assistive movement time was obviously longer than those in theyounger’s(P<0.05).6Both positivity and cooperation in the older group was significantlyinferior than those in the younger’s (P<0.05). The expectation of the olderpatients’ family was lower than that in the other group(P<0.05).Conclusion:1Age itself made no difference in recovery of motor function, but madedifference in activity to stroke patients.2The older stroke patients had lower cultural level and cognitivefunction than the younger patients.3Aged patients’ physical effort and endurance capacity were poorer,treatment intensity was less, the time of active movement was shorter, the timeof passive and active-assistive movement was longer than younger patients.4At most of free time, the aged patients were static. The time ofautonomic activity and the total time of daily activity in the older group wasless than those in the younger group.5Both positivity and cooperation in the older group was inferior thanthose in the younger’s. The expectation of the older patients’ family was alsolower.Part2The effect of intensive basic movement training onfunction recovery in aged stroke patientsObjective: Stroke is one of the commonest causes of death and disability.This is an age-related disorder with nearly72%of the subjects being morethan65years old in the Western world. The number of aged stroke patients inour country is increasing year by year with the continuous improvement of oureconomy, constant increase of expectancy of life and the anabatic of aging ofthe population. The number of aged patients with disability is also increasingyear by year. How to improve the function of elderly stroke patients and howto improve their ADL, reduce the burden of family and society is a difficultproblem for us to solve. This study is to observe the effect of intensive basic movement training on lower-limb motor function and ADL in aged strokepatients.Method: From March2011to January2013,45admitted aged strokepatients who received rehabilitation in Hebei Province People’s Hospital, wereselected. Selected conditions:①The diagnosis was confirmed, according tothe diagnosis of cerebrovascular disease in the Fourth National AcademicConference on cerebrovascular disease, by CT or MRI;②with newly anteriorcirculation stroke; age60yrs; onset-addmision interval≤2months;③vitalsigns are stable, Glasgow Coma Scale>8points;④with apparent motorimpairment, Fugl-Meyer motor function assessment<85points;⑤ADL cannot independent, Barthel index≤60points. Exclusion criteria:①severedysfunction of osteoarticular, sensuous, psychical, psychological, visual andaudito-comprehensive;②failure of heart, lung, liver, kidney or otherimportant organs;③a previous history of dementia.45patients wererandomly divided into the study (23cases) or the control (22cases) group. Therandomization was performed using a random number table. There were nodifference between the two groups in gender, onset-addmision interval, lesionside, type of disease, years of education, scores of MMSE and NIHSS. Thereare13cases whose age65in experimental group;12cases in control group.No difference was found between them in the general information. Basicmovement was trained intensively in experimental group whereas routinerehabilitation therapy was given in control group. According to the toleranceand cooperation, all patients were trained2-4hours every day,5days a weekfor4weeks. All patients were assessed before and4weeks after treatment.Motor function was assessed using Fugl-Meyer motor function assessment(FMA), ADL was assessed using Barthel-index (BI) and ability of basicmovement was assessed using the ability for basic movement scale (ABMS).Result:1There were no difference between the two groups in FMA, BI andABMS before treatment (P>0.05).2Compared with pre-treatment, the FMA, BI and ABMS scores in both groups were significantly increased at the4th week after treatment(P<0.05)；ABMS score in experimental group was higher than that in control group(P<0.05), but no difference was found between two groups in FMA andBI(P>0.05).3During the patients whose age65yrs, no difference was found betweenthe two groups in FMA, BI and ABMS before treatment (P>0.05).4At the4th week after treatment, FMA, BI and ABMS in experimentalgroup was increased obviously more than those in control group during thepatients whose age65yrs (P<0.05).Conclusion: Intensive basic movement training is a simple but effectivetherapy. The therapy can improve the lower-limb motor function and theactivity of daily living of aged stroke patients, especially for patients whoseage65yrs. |
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