Neurorehabilitation nach Schlaganfall

Abstract

After stroke most patients need to undergo extensive neurological and neuropsychological rehabilitation (neurorehabilitation). It is important to have an individual treatment programme that takes into account that the stroke patient is impaired in terms of his receptive skills, his capacity to act and his personal integrity. Based on the "phase model" of the Austrian Society for Neurological Rehabilitation (OGNR) individual goals have to be agreed and measures have to be taken. After maintaining the vital functions and a stable vegetative state, the remaining abilities have to be stimulated, functions have to be regained and deficits have to be compensated. An interdisciplinary neurological rehabilitation team has, for example, the following responsibilities: treatment of impaired motor skills and balance, treatment of swallowing and breathing impairments, training of activities of daily living, and special concepts for the treatment of cognitive deficits and impaired behaviour. A decisive factor for rehabilitation success is the relationship between therapists and patients and their relatives/carers. Preparation for independent or care-managed life after inpatient rehabilitation is of paramount importance, this means organization of continuing out-patient treatment, out-patient care management, as well as measurement and documentation of rehabilitation success. Regaining quality of life is an active process of analysing and working on the remaining activity limitations and participation restrictions in society. The work of the interdisciplinary neurological rehabilitation team contributes decisively to this process.

Early clinical predictors of post stroke spasticity

“…The clinical standardized examination consisted of a comprehensive neurological examination including the National Institutes of Health Stroke Scale (NIHSS: 0 to 30) for neurologic impairments, modified ranking scale (MRS: 0-5 and 6 for dead) and Barthel Index (BI: 0-100) for degree of disability or dependence in daily activities, as well as the following operationalized standardized examinations: Cranial nerves, range of gaze, increased proprioceptive reflexes, Babinski sign, sensitivity, Scale for Contraversive Pushing (SCP: 0-3) 21 for pushing symptom to one side, Catherine Bergego Scale (CBS: 0-30) 22 for neglect symptom, Active Range of Motion (AROM: 0 for 0% of normal value to 3 for normal) for active movement of joints including, British Medical Research Council scale for muscle strength (BMRC: 0-5) including muscles for main joint movements of limbs, 23 Arm-Hand-Activity scale (AHAs: 1-5), 24 Esslinger Transfer scale (ET: 0-4) 25 for disability of transfer, Functional Ambulation Category (FAC: 0-5) 26 for gait disorder and Mini-Mental State Examination (MMSE: 0-30). 27 AROM was recorded with the grade of active motion as compared with nonaffected side or occasionally standard AROM values; Grade 1 for 0%, Grade 1 for up to 50%, Grade 2 for more than 50%, Grade 3 for the same as non-affected side.…”