Aspiration pneumonias are frequent complications of cerebrovascular accidents (CVA). They occur mainly in patients suffering from swallowing disorders following the CVA. These patients can be diagnosed using a bedside swallowing evaluation. This evaluation is based on observation of some components of the oral and pharyngeal stages of the swallowing process and on a drinking test of 50 ml3 of clear liquids. Changing the mode of swallowing and the consistency of the diet according to the swallowing evaluation following CVA can reduce significantly the frequency of aspiration pneumonias. In our patient cohort, consisting of 180 patients admitted for stroke rehabilitation, aspiration pneumonias occurred in 10% and swallowing disorders were found in 28%. The administration of a structured swallowing evaluation was associated with a gradual reduction of frequency of pneumonia from 16% in the first group of 60 patients to 3% in the last group of 60 patients or, if considering only patients suffering from dysphagia, from 27% in the first group of patients to none in the last group of patients.
Post Stroke Depression (PSD) is a frequent and treatable complication of stroke, with significant influence on recovery and mortality (De Weg et al., 1999) but its mechanism is not well understood. While there is some evidence for the organic base of PSD (Robinson et al., 1984), it may also represent an expected emotional reaction to the severe disability imposed by the stroke. The rate of post stroke depression varies according to the mode of assessment between 20% and 70% and therefore it is not clear whether it is higher or equal to the rate of depression found in patients inflicted with other serious medical conditions (Lieberman et al., 1999).The purpose of this study was to investigate the occurrence of PSD and the proportion of patients treated, in 'middle band' stroke patients, that is subjects who remained moderately but significantly impaired and disabled despite their returning to live in the community, during first year post-stroke. In order to investigate the causes of PSD we compared its connection with stroke characteristics and stroke-induced impairment to its connection with stroke-induced disability.Subject population included 65 consecutive middle band stroke patients, returning home, after in-patient rehabilitation. Depression was assessed using the short form of the Geriatric Depression Scale (GDS), 3 and 9 months post stroke (Burke et al., 1991). When 50% or more of relevant statements were positive it was assumed that the subject was suffering from PSD. GDS results were correlated to sociodemographic characteristics including perceived social support, assessed by the Tel Aviv social support scale. Stroke related characteristics and stroke related impairments were recorded and measured with the Fugl-Meyer Scale (FMS) and the Postural Assessment Scale (PASS). Disability and handicap were assessed using the Functional Independence Measure (FIM), Nottingham Extended ADL Index (NEADLI) and London Handicap Scale (LHS). Cognitive status was measured with the cognitive subscale of the FIM and the MMSE. RESULTSMean age was 72 AE 7, 63% male and 72% were married. All subjects were independent, pre stroke, in basic and advanced activities of daily life. Patients spent 45 AE 23 days in in-patient rehabilitation before returning home. At 3 months post stroke, mean GDS scores were 57% AE 26%, and 63% of patients answered positively to 50% or more of statements indicating depression; at 9 months the results were 53% AE 27% and 58% respectively. 28% of the patients received antidepressant medication and this was associated with an increased GDS score, but no relationship was found between taking antidepressants at 3 months post stroke and results of the GDS at 9 months. Higher level of perceived social support and lower level of education were significantly associated with a risk of developing PSD while other sociodemographic characteristics were not. Except for a significant relationship with cognitive measurements the occurrence of PSD was not associated with any of the evaluated stroke-related character...
Effective and efficient conduction of stroke rehabilitation depends on the ability to predict outcome. Complicated impairment and disability scales enable such a prediction but are difficult to implement, particularly at acute care facilities, where such predictions should be performed. We evaluated the use of a relatively simple, previously reported impairment classification on a general unselected stroke rehabilitation patient population. This classification is based on the presence on examination of motor, somatosensory, and visual field deficits. We found that it was able to predict functional level on admission and on discharge, length of stay in hospital, and discharge destination. This impairment classification scale may be used to improve the organization of inpatient stroke rehabilitation.
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