Recovery and rehabilitation following subarachnoid haemorrhage. Part I: outcome after inpatient rehabilitation

Abstract

SAH patients receiving inpatient rehabilitation make functional gains, although the rate of gain is less than for TBI or stroke. These SAH patients represent a subgroup with more severe SAH at onset than the total population of SAH survivors. The presence of hydrocephalus negatively impacts on outcome. Further detailed study of functional and neuropsychological outcome in SAH survivors is needed.

Delay in initiation and termination of muscle contraction, motor impairment, and physical disability in upper limb hemiparesis

“…More than 700,000 strokes occur annually in the United States, with a prevalence of approximately 3 million 3. Nearly one third of all stroke survivors will have significant residual disability, with older individuals generally experiencing slower functional recovery 12, 25. Hemiparesis may be a consequence of stroke, and significant hemiparesis is often the primary indication for intensive stroke rehabilitation 32.…”

Aneurysmal subarachnoid haemorrhage: outcomes of early rehabilitation after surgical repair of ruptured intracranial aneurysms

“…This pathology accounts for 5%-10% of all strokes, affecting mostly people in the 5th decade of life, at the peak of their productivity. [1][2][3][4] The consequences of SAH are motor and cognitive impairments which result in social and vocational disabilities, and these have a significant impact on the quality of the patient's life and his or her social integration. [5][6][7] By its nature, SAH involves the likelihood of diffuse disruption of the brain cortex, at least in the period immediately after haemorrhage.…”

Independent living following a ‘Do Not Resuscitate’ order after subarachnoid haemorrhage

“…In addition, the differential clinical benefit of early (within 3 days following initial bleed) vs. late clipping (after at least 7 days) in preventing re-bleeding has not been realized from observational studies to date [9]. After acute intervention, a retrospective study of functional outcomes following SAH highlighted a median total hospital stay of around 11 weeks, comprising acute care (26 days) and rehabilitation (49 days) with most patients (88%) discharged to home [10]. SAH patients made functional gains on the Functional Independence Measure (FIM) but the rate of aggregate gain was typically less than for traumatic brain injury or stroke patients and those with worse Hunt and Hess [11] scores at onset tended to have poorer FIM ratings on discharge [10].…”

“…After acute intervention, a retrospective study of functional outcomes following SAH highlighted a median total hospital stay of around 11 weeks, comprising acute care (26 days) and rehabilitation (49 days) with most patients (88%) discharged to home [10]. SAH patients made functional gains on the Functional Independence Measure (FIM) but the rate of aggregate gain was typically less than for traumatic brain injury or stroke patients and those with worse Hunt and Hess [11] scores at onset tended to have poorer FIM ratings on discharge [10]. Typically, the degree and duration of impaired consciousness, which is reflective of the severity of underlying brain insult, provides a clinical indicator of likely prognosis.…”