Rehabilitation of Hemiplegic Patients through Balneotherapy

Abstract

1) An objective method which included the determination of muscle strength, range of passive joint motion, and also activities of daily living, was used to evaluate physical abilities and disabilities of hemiplegic patients along the course of rehabilitation. The data obtained by this method was statically analysed. 92 patients, who had suffered from a cerebrovascular accident more than 3 months previously, were examined and treated on one month rehabilitation course with balneotherapy.
The results were promissing in spite of the short duration of the treatment.
Group A (patients with duration of hemipiegia for 3-6 months after the cerebrovascular accident) showed 78.6% of the normal A. D. L. at the end of the treatment while the control group showed only 64.4% of normal.
Group A showed a gain of 48.7% in the improvement of A. D. L., group B (duration of hemiplegia for 6-12 months after onset) 40.8%, and group C (over 1 year after the cerebrovascular accident) only 31.6%.
The relationship between the improvement in A. D. L. and the time intervall between the start of the treatment and the onset of the cerebrovascular accident proved statically significant, namely, the earlier was the start of the rehabilitation, the better was the clinical improvement.
The improvement in muscle strength was not so marked as in A. D. L.
The ralationships between improvement in A. D. L., in muscle strength and in the range of passive joint motion all proved statistically significant.
Patients who were under 59 years of age gained significantly more improvement in A. D. L. and muscle strength than the patients who were over 60 years of age. It seems to the authors that this derives from a diminished will of the patient to recover and a decrease in the amount of exercise in the older aged group.
Concerning the range of passive joint motion, group A showed improvement of 47.1%, group B 46.1%, and group C 35.2%. Regarding these remarkable improvements, there was no difference between the older age group and the younger age group. It seems to the authors that the improvement of the range of passive motion of joints derives from the relief from the pain by spa treatment, which resulted from contracture and other pathologic changes around the joints.
The authors conclude that, along with some favorable effects of balneotherapy on the basic disorders of the cerebrovascular accident, an utility of balneotherapy in the rehabilitation of hemiplegic patients lies in this improvement in the range of passive motion of joints as mentioned above which must have favorable effect on active exercise.
2) Improvement in A. D. L. of 21 stroke patients (cerebral hemorrhage -7 cases; thrombosis -8 cases; unclassified -6 cases.) to whom passive exercise of the affected site of extremities was introduced shortly after a stroke, was examined similarly as mentioned above.
In the cases of cerebral thrombosis, passive movement was begun 2 hours after the stroke, and in the cases of cerebral hemorrhage or unclassified cause, 2-3 days thereafter.
Among 6 fatal cases, 5 died within a week after the stroke when the passive movement was not yet introduced.
Among 15 survived patients, 11 cases (73%) got over 75% of normal A. D. L., and only 2 cases (13.3%) remained under 25%.
No case of the second attack was seen through the course of rehabilitation.
3) The repeatedly evoked E. M. G. was studied before and after a thermal bath of Kageyu (simple thermal spring), and plateau level changes were compared with impovement in A. D. L., M. S., and R. P. J. M.
Plateau level changes by thermal bath are considered to be determined by α and γ system conditions, and the improvements of A. D. L. by the spa treatment could not be interpreted by the E. M. G. changes.