Factors Influencing Stroke Rehabilitation

Abstract

Quantitative and semiquantitative methods have been used to evaluate the clinical improvement of 62 patients with completed stroke who were admitted to a rehabilitation hospital. Improvement in motility and leg strength on the paretic side was minimal and was not influenced by facilitation exercise techniques. Observed changes in strength and motility occurred to about the same degree on both the nonparetic and paretic sides. Patients who had a short interval between onset of stroke and admission to the rehabilitation program improved significantly more on the paretic side than those with a longer interval. Practically no improvement in motility and leg strength was found two months following a stroke. Hemiplegia and hemiparesis were defined quantitatively on the basis of motility test scores. Patients with hemiparesis showed greater improvement in motility and self-care status in about half the time of hospital stay when compared with patients with hemiplegia. In spite of relatively static neurological deficits, all patients showed evidence of functional improvement as assessed by a self-care rating scale. The poorest functional outcome was seen in patients who had hemisensory losses in addition to hemiplegia. The observations indicate that early, functionally oriented stroke rehabilitation programs offer the best chance of aiding patients. Behavioral and sociological influences on final outcome are important and must be carefully evaluated to insure maximum chances of successes in rehabilitation.

Muscle Strength Changes in Hemiparetic Stroke Patients During Inpatient Rehabilitation

“…This study, like others before it (4,11,13,14,23), demonstrated that strength increases over time in hemiparetic stroke patients. This study, however, went a step further.…”

“…Over the past 10 years, an increasing number of reports have been published in which the muscle strength of patients with stroke has been measured quantitatively by hand grip (3,4), fixed (5-7), hand-held (8)(9)(10)(11)(12)(13), or isokinetic dynamometers (3,(14)(15)(16)(17)(18)(19)(20)(21)(22). What is known from these reports is that: (a) strokes do cause weakness, not only of the side contralateral to the brain lesion but also of the side ipsilateral to the lesion (3,14,15,17,18); (b) all muscle groups are not affected equally, and the relative involvement of specific muscle groups may differ from that traditionally expected (6,13); (c) normal mechanisms that alter muscular strength such as length/tension and force/velocity relationships may explain, in part, the limitations in strength noted under specific conditions (18)(19)(20); (d) significant relationships such as normally exist between muscle strength and independent variables, such as age, weight, and gender, are maintained on the nonparetic but not on the paretic side (12); (e) muscle strength is related to function (3,10,21,22); (0 muscle strength tends to increase with time following a CVA (4,11,13,14,23); and (g) strength soon after stroke is a predictor of strength at a later time (4,…”

Motor Impairment as a Predictor of Functional Recovery and Guide to Rehabilitation Treatment After Stroke

“…Key Words: Stroke—Motor recovery—Rehabilitation—Outcome. (2,4,(6)(7)(8), cognitive deficits (2,8), urmary mcontinence (9), mterval from stroke to rehabilitation (2,10), and postural balance (5,(11)(12)(13) also are important.…”

Stroke Unit Versus General Medical Wards, II: Neurological Deficits and Activities of Daily Living

“…4,6 Early mobilization is expected to be essential, but few studies have focused on early activation, and only one experimental and two quasi-experimental studies focusing on early activation reported positive effects. 13,15,16 The results of many studies have been restricted by small samples, late inclusion of patients, a selected stroke population, and/or outcome measures with unknown validity or reliability, unblinded studies, or studies without an experimental design. [17][18][19] On the basis of these studies it is impossible to document with certainty that the acute medical treatment is of benefit.…”