| The present thesis researched into three main areas of stroke rehabilitation in the Chinese.; The first area is epidemiology, stroke complications, and prediction of disability. The thesis compared the similarities and differences between the Chinese and western populations in the characteristics of stroke patients undergoing rehabilitation, risk factors, nature, recurrence, and comorbidity of stroke, poststroke cognitive impairment and falls, and the predictors for disability at discharge. Based on retrospective review of a stroke registry in a rehabilitation hospital in Hong Kong, 30% of the Chinese stroke patients undergoing rehabilitation were found to have diabetes, comparable to the highest frequency reported in the Caucasians. 84% of the stroke patients had ischemic stroke whereas 16% had intracerebral hemorrhage, close to the pattern in the Caucasians. These changes may be related to the westernization of the life style and diet of the Chinese, and point to the direction of stroke prevention in the future.; The second area is intervention on poststroke memory impairment. 18% of Chinese stroke patients had cognitive impairment, in addition to 18% who had dysphasia and another 10% who had decreased conscious level or aphasia. These findings highlight the importance of intervention on poststroke memory impairment. The thesis revealed that nimodipine, an L-type voltage sensitive calcium channel antagonist, might facilitate poststroke memory recovery. In future trials, nimodipine could preferably be tested among patients with vascular cognitive impairment but no dementia (vascular CIND) to see whether the effects could be more prominent.; The third area is acupuncture on poststroke motor recovery. Through a randomized controlled trial and a meta-analysis, the thesis demonstrated that acupuncture could not further improve motor recovery in addition to conventional stroke rehabilitation, and any apparent effect was either due to placebo effect or selection bias. The meta-analysis revealed that acupuncture might improve disability when conventional stroke rehabilitation was not available. However, such studies did not use sham acupuncture for control and their qualities were less satisfactory, so placebo effect or selection bias could not be excluded.; The present thesis has attempted to make people understand better where we are in stroke rehabilitation in the Chinese. |
