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.

View full abstract

It is widely accepted that early rehabilitation programs are required for patients with spinal cord injury (SCI) immediately after injury. However many patients with SCI are admitted to rehabilitation facilities only after a long interval in Japan. The purpose of this study was to investigate how early rehabilitation contributes to improve their activities of daily living (ADLs) in Japan. The present multicenter study examined the status of SCI rehabilitation in Japan, and sought to determine the natural course of SCI and the effect early intervention has on rehabilitation. Sixteen Rosai hospitals and one college of medicine participated in our study. One hundred twenty-three SCI patients (admitted between April 1994 and March 1997, 104 men, 19 women; mean age, 48.8±17.7yr) were divided into an early rehabilitation group and a delayed group and were retrospectively assessed by using the American Spinal Cord Injury (ASIA) and International Medical Society of Paraplegia (IMSOP) classification of ASIA/IMSOP 1992 version. The motor recovery rate (MRR) was defined as (ASIA motor score at discharge-ASIA motor score at admission)/(100-ASIA motor score at admission). The regression lines for FIM^TM instrument score and ASIA motor score were determined for 6 subgroups (early or delayed tetraplegia, central cord injury, paraplegia) by the MRR staging. The regression lines for physical or cognitive FIM score and ASIA motor score were also determined for 6 subgroups. Three stages were obtained: acute stage: 2 weeks postinjury; recovery stage: 2 weeks to 6 months postinjury; and chronic stage: more than 6 months postinjury. Regression lines showed that rehabilitation improved physical functional independence for ASIA motor score, especially in the early rehabilitation subgroups. There was no correlation between cognitive FIM score and ASIA motor score in 6 subgroups. The present findings suggested that SCI rehabilitation contributed to good ADLs for motor function and early SCI rehabilitation hastens and promotes improvement in ADLs by enhancing ADLs for function.

View full abstract