Effects of Medical Rehabilitation for Elderly Stroke Patients during Acute Phase: A Randomized Controlled Trial.

Abstract

The purpose of this study was to clarify the effect of acute phase rehabilitation for improving the impairment and disability of aged stroke patients. [Subjects] Subjects were stroke patients admitted within 1st day from onset to the stroke medical center with stroke unit. Inclusion criteria of subjects were a) cerebral infarction of middle cerebral artery (excluding lacunae stroke) and intra-cerebral hemorrhage (putamen or thalamus), b) first stroke over 70 years old, c) clear or mild impaired consciousness at 1st day from admission, d) Brunnstrom stage IV or worse of the arm or leg at that time, e) agreed the informed consent, etc.[Methods] The randomized controlled trial was designed. During two weeks of acute phase, a basic program (20 minutes each per day by PT and OT) was executed to the basic rehabilitation group. The intense program of mobility exercise and ADL exercise (40 minutes each per day by PT and OT) was used to the intense rehabilitation group. From the 3rd week, usual program of PT and OT (40 minutes each per day) were executed to both groups. Main outcome measures were 12-grade function test of hemiplegia (12-grade), FIM, sitting balance evaluated by a sensor mat system (BIG-MAT), etc.[Results] Each patients were included in eleven of both groups. At the beginning of acute phase rehabilitation, there was no statistical difference about age, gender, 12-grade, FIM, and other variables between two groups. 1) The intense rehabilitation group improved in points of the 12-grade test of leg function more during the 2nd to 4th week compared to the basic rehabilitation group (p<0.05). 2) FIM showed no statistical difference between both groups at the 2/4/8/12 weeks. 3) The intense rehabilitation group improved in sitting balance during the 2nd and 4th week (p<0.05), but the basic rehabilitation group showed no statistical improvement in sitting balance during this period. 4) Two cases of the basic rehabilitation group and no cases of the intense rehabilitation group complicated shoulder-hand syndrome. Four cases of the basic rehabilitation group and 3 cases of the intense rehabilitation group complicated orthostatic hypotension.[Conclusion] For stroke patients over 70 years old, the intense rehabilitation programs during the acute phase, such as mobility exercise and ADL exercise, was effective to improve the impairment and sitting balance in acute to subacute phase. (Jpn J Rehabil Med 2003; 40: 196-204)

Characteristics of the pressure ratio of the gluteal and sole regions during sitting in acute stroke patients using a body pressure distribution measuring system

“…For acute stroke hemiplegic patients, it is necessary to acquire ADL at an early stage in addition to getting out of bed and avoiding disuse. Tokumoto et al reported that greater improvement in ADL was observed in acute stroke patients due to the involvement of occupational therapists in the early phase [9,10]. Furthermore, Ezure et al reported that the ADL of post-stroke hemiplegic patients was more strongly related to trunk function than to the functions of the paretic side [11].…”