The Effect of Complications of Stroke Patients on Prognosis during Rehabilitation Management

OBJECTIVE: To investigate complications of stroke patients with regard to incidence, predisposing risk factors and their effect on the patients's prognosis during rehabilitation management. METHOD: Two hundred fifty nine patients with stroke admitted to Department of Rehabilitation Medicine were included in this study. We analyzed types of stroke, incidence of complications, outcome of rehabilitation treatment and the length of the hospital stay. RESULTS: Of the 259 patients who had received rehabilitation, shoulder pain occurred in 59 patients (22.8%), depressions in 24 (9.3%), falls in 24 (9.3%) and pneumonia in 21 (8.1%); 112 patients (42.9%) had a total of 174 complications. The incidence of complication was higher in patients who had lower initial FIM score or previous cardiac disease. The patients with complication had longer rehabilitation hospital stay and lower FIM gain and efficacy. CONCLUSION: Early detection and treatment of the complications of acute stroke patients during rehabilitation will shorten the length of the hospital stay and improve the overall prognosis of the patients.

Prevalence of Cerebral Palsy in Very Low Birth Weight Infants

OBJECTIVE: To investigate the survival rate and the prevalence of cerebral palsy in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants as well as the risk factors for the development of cerebral palsy. METHOD: We reviewed medical records of 471 VLBW infants admitted to Asan medical center from 1989 to 1997 retrospectively. RESULTS: Ninety seven infants died before discharge from hospital, 7 died during follow-up, 55 status unknown due to discharge against medical advice, 26 discontinued follow-up. At corrected chronologic age of 2 years old, the prevalence of cerebral palsy was 10.5%, delayed development 4.5% and normal development 85.0%. Survival rate and prevalence of cerebral palsy among survivors remained statistically insignificant with time. Cerebral palsy was found in 8.5% of VLBW and 19.2% of ELBW. Decreasing gestation, abnormal neurosonographic findings, assisted ventilation, bronchopulmonary dysplasia, sepsis were risk factors associated with increased odds for cerebral palsy. CONCLUSION: The prevalence of cerebral palsy in VLBW infants admitted to this hospital were comparable with recent studies from developed countries, and some of the predictors of cerebral palsy, ie, gestation period, neurosonographic findings, history of respirator use and sepsis, were also similar to those of western countries.

Swallowing Disorders Following Head and Neck Cancer Surgery

OBJECTIVE: This study was designed to examine swallowing function of 16 head and neck surgical patients who had postoperative swallowing difficulties and to identify the relationship between the physiologic causes of aspiration and the surgical procedure in each patient. METHOD: Group A was five patients who had partial pharyngolaryngectomy due to hypopharyngeal cancer, Group B was nine patients who had wide excision due to oral cavity cancer, and Group C was two patients who had supraglottic horizontal laryngectomy due to supraglottic laryngeal cancer. Their swallowing function was evaluated with videofluoroscopic swallowing study (VFSS). RESULTS: Aspiration occurred in 40% of patients with partial pharyngolaryngectomy, 44% of patients with wide excision, and 100% of patients with supraglottic horizontal laryngectomy. Group A showed swallowing difficulty because of reduced laryngeal closure and reduced pharyngeal peristalsis. Group B showed swallowing difficulty because of reduced pharyngeal peristalsis, reduced laryngeal function, and impaired tongue control. Group C showed swallowing difficulty for impaired tongue control, reduced laryngeal function, reduced pharyngeal peristalsis, and late swallowing reflex. Most of the patients who had had head and neck cancer surgery can regain normal swallowing function after adequate swallowing rehabilitation. CONCLUSION: Each group of head and neck surgical patients had different cause of swallowing difficulty. The knowledge of the determinant component of swallowing pathophysiology is important for successful swallowing rehabilitation.

Falls in a Rehabilitation Hospital

OBJECTIVE: The present study was prospectively designed to identify the incidence, risk factors and characteristics of falls in a rehabilitation hospital. METHOD: Two hundred nine consecutive admissions to the department of rehabilitation medicine between March 1, 1998 and June 30, 1998, were evaluated. RESULTS: Twenty four (11.5%) experienced at least one fall, and most of the falls occurred in their own room during walking. Risks for falls were associated with the presence of the sensory or cognitive function disturbance, the ability of walking, the use of antihypertensive drug, and presence of caregiver hired by the patient. No injury was observed in 25 (76%) of total 33 incidents, and 8 falls (24%) caused mild injury - pain, and simple contusion. There was no fracture or intracerebral hemorrhage. CONCLUSION: These data suggest that high risk groups of patients who are prone to the falls within the rehabilitation setting can be identified for the prevention, and afterward for preventive measures.

Patient Falls in Stroke Rehabilitation

OBJECTIVE: The present study was prospectively designed to identify the incidence, risk factors and characteristics of falls in a patient with stroke. METHOD: One hundred and three stroke patients admitted to the department of rehabilitation medicine between March 1, 1998 and June 30, 1998, were evaluated. RESULTS: Fifteen (14.6%) have falled at least one time, and most of the falls occurred in their own room while walking. Risks for falls were associated with multiple brain lesion involving both anterior and posterior circulation, the presence of the cognitive function disturbance, and presence of caregiver hired by the patient. Fifteen (78.9%) of total 19 incidents did not cause any problem, but 4 falls (21.1%) caused mild injury - pain, and simple contusion. Severe injury such as fracture or intracerebral hemorrhage were not caused by these falls. CONCLUSION: The incidence of fall in a patient with stroke was 14.6%. And risks for falls were associated with multiple brain lesion, the presence of the cognitive function disturbance, and presence of caregiver hired by the patient.

The Initial Computerized Tomography Findings of the Brain and the Functional Outcome in Traumatic Brain Injured Patients

OBJECTIVES: To investigate the correlation of the initial Computerized Tomography(CT) findings of the brain and the functional outcome, and to suggest the initial CT findings as a functional outcome predictor in the traumatic brain injured(TBI) patients. METHODS: Thirty-nine TBI patients were included in this study. Subjects were divided into groups of non-focal or focal TBI, and with or without a depressed skull fracture according to their initial brain CT findings. RESULTS: The non-focal TBI patients were not significantly different from focal TBI patients in the days from onset to rehabilitation, rehabilitation stay, and initial FIM score. However their outcome in FIM gain and FIM efficiency significantly worse than focal TBI patients. The TBI patients with a depressed skull fracture were not significantly different from the patients without a depressed skull fracture in the days from onset to rehabilitation, rehabilitation stay, and intial FIM score. However their outcomes were significantly worse than patients without a depressed skull fractrue in FIM efficiency. CONCLUSION: The initial brain CT findings were generally useful for the prediction of functional outcomes in TBI patients.