Bridging performance of adults with hemiparesis: sliding of the paretic limb.

BACKGROUND: Individuals with hemiparesis resulting from cerebrovascular accident often demonstrate uncontrollable sliding of the paretic lower extremity when attempting to lift their pelvis from a hook-lying position (bridging), during bed mobility. This disorder is often attributed to hypertonicity of the knee extensors, though this assumption has not been confirmed experimentally. PURPOSE: To determine the interaction of limb sliding during bridging with impairments of motor control, knee moments, and spasticity. METHODS: Twenty-seven adults with hemiparesis were assigned to 2 groups on the basis of their ability to perform bridging on a smooth surface. The association of the dichotomous parameter of bridging performance (success/failure) with the other parameters was determined by point biserial correlation, and the predictability of limb sliding was estimated from binary logistic regression. A 2-way repeated-measures analysis of variance was used to determine the differences between knee moments. RESULTS: The group that could perform bridging without sliding had higher moments of the paretic knee flexors and a higher level of motor control than the other group (P = .001). The moments of the paretic flexors and the level of motor control were also correlated with limb-sliding occurrence (r = 0.61 and 0.74, respectively) and served as the best predictors of bridging performance. The paretic knee's flexion moment was found to be more affected than the extension moment (P= .04). CONCLUSION: Low level of motor control and reduced strength of the knee flexors are 2 major deterrents of successful bridging in persons with hemiparesis. The predominant decline of the flexors' moment may reflect a more severe disruption of the flexors' cortical innervation or superior recovery of the extensors.

Gait in individuals with chronic hemiparesis: one-year follow-up of the effects of a neuroprosthesis that ameliorates foot drop.

PURPOSE: Foot drop is a common cause of gait impairment in individuals with hemiparesis. The objective of this study was to determine the short-term and long-term effects on functional gait of a neuroprosthesis that provides functional electrical stimulation (FES) to correct footdrop. METHODS: Sixteen individuals (mean age, 55.0 +/- 14.6 years) with chronic hemiparesis (mean years since insult, 5.3 +/- 4.8) were assessed immediately before receiving the neuroprosthesis and two months and one year after using the device. Both follow-up assessments were conducted with FES operating; the one-year follow-up also assessed gait without FES. Outcome measures were gait velocity on an even surface during a 10-m walk, during a six-minute walk, over obstacles, and over a carpet. Foot switches used during the six-minute walk determined stance time, stride time variability, and gait asymmetry. The effect of time and the one-year carryover effect on gait without FES were determined, with significance set at P = 0.05. RESULTS: The neuroprosthesis had a significant short-term and long-term effect on most measured variables. Thus, mean 10-m walk gait velocity improved in two months from 0.67 m/sec to 0.86 m/sec and continued to increase to 1.06 m/sec by the one-year assessment. A carryover effect on gait velocity and stance time without FES were also noted. The 10-m gait velocity without the neuroprosthesis increased by 23.8% by the one-year follow-up assessment. CONCLUSIONS: The neuroprosthesis appears to improve gait performance, and gains were further enhanced over time and carried over to gait even without FES. These results suggest orthotic and therapeutic effects on footdrop after prolonged use of the neuroprosthesis.

Assessment of spatial neglect using computerised feature and conjunction visual search tasks.

The purpose of this study was to assess the diagnostic sensitivity of tasks employing feature and conjunction visual searches in stroke patients with unilateral spatial neglect (USN). Seventy-two stroke patients (right/left hemispheric damage with/without USN) and 39 healthy controls participated in the study. Hit rate and reaction time measures of feature and conjunction searches were tested using a newly developed computerised programme for the assessment of visual spatial attention (VISSTA). In addition, subjects received a set of diagnostic paper-and-pencil tests, and were also assessed for the impact of neglect on activities of daily living. Results indicated that the computerised test clearly differentiated between stroke patients and healthy controls, and between the different patient groups. USN patients showed significant contralesional disadvantage in both feature and conjunction visual search tasks. It is proposed that computerised assessment of visual search capacity is a useful and sensitive adjunct to standard paper-and-pencil tests of USN, with the advantage of testing responses based on attention shifts under a time constraint. The learning effects that limit the usefulness of paper-and-pencil tests in longitudinal studies are less likely to affect a computerised test, making it more suitable for monitoring treatment-induced or natural recovery by way of repeated testing.

Effects of a foot drop neuroprosthesis on functional abilities, social participation, and gait velocity.

DESIGN: Prospective, single group, repeated measures 1-yr follow-up of 16 patients (aged 55 +/- 14.6 yrs) with chronic hemiparesis who used a neuroprosthesis for 1 yr and were available for follow-up. Outcome measures included the Short Version of the Stroke Impact Scale, the Participation domain of the Stroke Impact Scale, and the gait velocity. RESULTS: Significant increases of 18.0% in physical functioning and of 25.2% in participation in community life were attained 2 mos after the application of the neuroprosthesis. The gains were maintained at the 1-yr follow-up. Gait velocity increased significantly by 29.2% by 2 mos, with significant further increases of 22.6% observed at the 1-yr follow-up. CONCLUSIONS: Use of the studied neuroprosthesis to correct foot drop significantly enhanced functional abilities, social reintegration, and gait velocity. These results support the prolonged use of the neuroprosthesis in patients with chronic hemiparesis.

High frequency vibration conditioning stimulation centrally reduces myoelectrical manifestation of fatigue in healthy subjects.

OBJECTIVE: Vibration conditioning has been adopted as a tool to improve muscle force and reduce fatigue onset in various rehabilitation settings. This study was designed to asses if high frequency vibration can induce some conditioning effects detectable in surface EMG (sEMG) signal; and whether these effects are central or peripheral in origin. DESIGN: 300 Hz vibration was applied for 30 min during 5 consecutive days, to the right biceps brachii muscle of 10 healthy males aged from 25 to 50 years. sEMG was recorded with a 16 electrode linear array placed on the skin overlying the vibrated muscle. The test protocol consisted of 30% and 60% maximal voluntary contraction (MVC) as well as involuntary (electrically elicited) contractions before and after treatment. RESULTS: No statistically significant differences were found between PRE and POST vibration conditioning when involuntary stimulus-evoked contraction and 30% MVC were used. Significant differences in the initial values and rates of change of muscle fibre conduction velocity were found only at 60% MVC. CONCLUSIONS: 300 Hz vibration did not induce any peripheral changes as demonstrated by the lack of differences when fatigue was electrically induced. Differences were found only when the muscle was voluntarily fatigued at 60% MVC suggesting a modification in the centrally driven motor unit recruitment order, and interpreted as an adaptive response to the reiteration of the vibratory conditioning.

Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking.

OBJECTIVES: We sought to compare the effects of a radio frequency-controlled neuroprosthesis on gait stability and symmetry to the effects obtained with a standard ankle-foot orthosis (AFO). METHODS: A total of 15 patients (mean age: 52.2 +/- 3.6 years) with prior chronic hemiparesis resulting from stroke or traumatic brain injury (5.9 +/- 1.5 year) whose walking was impaired by footdrop and regularly used an AFO participated in the study. There was a 4-week adaptation period during which participants increased their daily use of the neuroprosthesis, while using the AFO for the rest of the day. Gait was then assessed in a 6-minute walk while wearing force-sensitive insoles, by using the neuroprosthesis and the AFO in a randomized order. An additional gait assessment was conducted after using the neuroprosthesis for a further 4 weeks. Gait speed and stride time (inverse of cadence) were determined, as were gait asymmetry index and swing time variability. RESULTS: After the 4-week adaptation period, there were no differences between walking with the neuroprosthesis and walking with the AFO (P > .05). After 8 weeks, there was no significant difference in gait speed, whereas stride time improved from 1.48 +/- 0.21 seconds with the AFO to 1.41 +/- 0.16 seconds with the neuroprosthesis (P < .02). Swing time variability decreased from 5.3 +/- 1.6% with the AFO to 4.3 +/- 1.4% with the neuroprosthesis (P = .01). A gait asymmetry index improved by 15%, from 0.20 +/- 0.09 with the AFO to 0.17 +/- 0.08 with the neuroprosthesis (P < .05). CONCLUSIONS: Compared with AFO, the studied neuroprosthesis appears to enhance balance control during walking and, thus, more effectively manage footdrop.

Axillary nerve conduction changes in hemiplegia.

AIM: To prove the possibility of axillary nerve conduction changes following shoulder subluxation due to hemiplegia, in order to investigate the usefulness of screening nerve conduction studies in patients with hemiplegia for finding peripheral neuropathy. METHODS: Forty-four shoulders of twenty-two patients with a first-time stroke having flaccid hemiplegia were tested, 43 +/- 12 days after stroke onset. Wasting and weakness of the deltoid were present in the involved side. Motor nerve conduction latency and compound muscle action potential (CMAP) amplitude were measured along the axillary nerve, comparing the paralyzed to the sound shoulder. The stimulation was done at the Erb's point whilst the recording needle electrode was inserted into the deltoid muscle 4 cm directly beneath the lateral border of the acromion. Wilcoxon signed rank test was used to compare the motor conduction between the sound and the paralytic shoulder. Mann-Whitney test was used to compare between plegic and sound shoulder in each side. RESULTS: Mean motor nerve conduction latency time to the deltoid muscle was 8.49, SD 4.36 ms in the paralyzed shoulder and 5.17, SD 1.35 ms in the sound shoulder (p < 0.001). Mean compound muscle action potential (CMAP) amplitude was 2.83, SD 2.50 mV in the paralyzed shoulder and was 7.44, SD 5.47 mV in the sound shoulder (p < 0.001). Patients with right paralyzed shoulder compared to patients with right sound shoulder (p < 0.001, 1-sided for latency; p = 0.003, 1-sided for amplitude), and patients with left paralyzed shoulder compared to patients with left sound shoulder (p = 0.011, 1-sided for latency, p = 0.001, 1-sided for amplitude), support the same outcomes. The electro-physiological changes in the axillary nerve may appear during the first six weeks after stroke breakout. CONCLUSION: Continuous traction of the axillary nerve, as in hypotonic shoulder, may affect the electro-physiological properties of the nerve. It most probably results from subluxation of the head of the humerus, causing demyelinization and even axonopathy. Slowing of the conduction velocities of the axillary nerve in the paralyzed shoulders may be related also to the lowering of the skin temperature and muscular atrophy in the same limb. The usefulness of routine screening nerve conduction studies in the shoulder of hemiplegic patients seems to be advocated.

Publishing in physical and rehabilitation medicine.

This paper presents the panel discussion from the 'Meet the Editor' symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2007. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the USA, despite the fact that journals currently published in these regions are distributed worldwide.

Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel.

OBJECTIVE: To investigate predictive factors for disposition after acute stroke. DESIGN: A nationwide survey (2004 National Acute Stroke Israeli Survey). SETTING: All 28 primary general medical centers operating in Israel. PARTICIPANTS: Acute stroke patients (n=1583) admitted during February and March 2004 and discharged from the primary hospital. INTERVENTIONS: Data collected on baseline characteristics, stroke presentation, type and severity, in-hospital investigation and complications, discharge disability, acute hospital disposition, and mortality follow-up. MAIN OUTCOME MEASURE: Hospital disposition to home, acute rehabilitation, or nursing facility. RESULTS: Among patients, 58.9% (n=932) were discharged home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) to nursing facilities. Admission neurologic status was a good predictor of hospital disposition. Patients with severe strokes were mostly discharged to rehabilitation facilities. Patients with significant functional decline before the index stroke, resulting from a previous stroke or another cause, were sent to inpatient rehabilitation less frequently. Disability level at discharge from acute hospitalization had high predictive value in hospital disposition after stroke. In the northern region of Israel, a higher proportion of patients were sent home and a lower proportion to rehabilitation and nursing facilities, probably because of lower availability of rehabilitation care in this region of Israel. CONCLUSIONS: This nationwide survey shows that most stroke survivors in Israel are discharged home from the acute primary hospital. Good functional status before the index stroke is an important predictor for being sent to acute inpatient rehabilitation. Severity of neurologic impairment and level of disability after the stroke at discharge from the primary hospital are strong predictors for disposition after stroke in Israel. Our data may be useful in discharge planning for stroke patients by policy-makers and health care providers in Israel.

Publishing in physical and rehabilitation medicine.

This article presents the panel discussion from the "Meet the Editor" symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2006. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer-reviewed journals, important considerations in submitting a manuscript, the peer-review process, the effect of electronic publishing (which leads to shorter publication times and the opportunity to preview articles), and the trend toward more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the United States, despite the fact that journals currently published in these regions are distributed worldwide.

Publishing in physical and rehabilitation medicine.

This paper presents the panel discussion from the "Meet the Editor" symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2007. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the USA, despite the fact that journals currently published in these regions are distributed worldwide.

Transient reversal of anoxic brain injury-related minimally conscious state after zolpidem administration: a case report.

Zolpidem is a unique nonbenzodiazepine sedative hypnotic drug that selectively binds to omega-1 gamma-aminobutyric acid receptors in the brain. Although used for years in Israel and abroad for insomnia, there have been periodic reports of unusual or remarkable neurologic effects in patients with various brain pathologies. Here, we report on a 50-year-old woman 18 months after severe anoxic brain injury in a minimally conscious state. Residual deficits included mutism, athetoid movements of the extremities, and complete dependence for all personal care. After the administration of 5 to 10mg of zolpidem, within 45 minutes, the patient's condition improved markedly, including the cessation of athetoid movements, regained speaking ability, and ability to perform various tasks including self-feeding. These effects lasted 3 to 4 hours, after which the patient returned to her former state. This effect was repeatable on a daily basis. Existing evidence and possible mechanisms to explain zolpidem's effects in brain injury are described.

Effects of a new radio frequency-controlled neuroprosthesis on gait symmetry and rhythmicity in patients with chronic hemiparesis.

OBJECTIVE: To assess the effects of a new neuroprosthesis (NESS L300) designed to ameliorate foot drop on gait symmetry and rhythmicity during walking. DESIGN: Twenty-four patients (mean age: 54.0 +/- 13.5 yrs) with chronic hemiparesis (5.8 +/- 5.2 yrs) whose walking was impaired by foot drop. Subjects walked for 6 mins while wearing force-sensitive insoles, once with and once without the neuroprosthesis, in randomized order. Additional assessments with the neuroprosthesis were conducted after using the device for 4 and 8 wks. Walking speed, swing, and stride time were determined, along with a gait asymmetry index and stride time variability-both markers of gait stability and fall risk. RESULTS: While wearing the neuroprosthesis, the gait asymmetry index instantly improved by 28% (from 0.58 +/- 0.30 to 0.42 +/- 0.22) and by 45% (to 0.32 +/- 0.20; P < 0.001) after 8 wks. Stride time variability decreased by 23% immediately (from 5.7 +/- 2.9% to 4.4 +/- 1.3%) and by 33% (to 3.8 +/- 1.4%; P = 0.002) after 8 wks. Walking speed improved initially by 17% (from 0.53 +/- 0.24 to 0.62 +/- 0.22 m/sec) and after 8 wks by 34% (to 0.71 +/- 0.25 m/sec; P < 0.001). CONCLUSIONS: The studied neuroprosthesis enhances gait and improves dynamic stability in chronic hemiparetic patients, supporting the idea that this is a viable treatment option in the rehabilitation of patients with foot drop.

Use of medical technologies in rehabilitation medicine settings in Israel: results of the TECHNO-R 2005 survey.

BACKGROUND: With the development of computer technology and the high-tech electronic industry over the past 30 years, the technological age is flourishing. New technologies are continually being introduced, and questions regarding the economic viability of these technologies need to be addressed. OBJECTIVES: To identify the medical technologies currently in use in different rehabilitation medicine settings in Israel. METHODS: The TECHNO-R 2005 survey was conducted in two phases. Beginning in 2004, the first survey used a questionnaire with open questions relating to the different technologies in clinical use, including questions on their purpose, who operates the device (technician, physiotherapist, occupational therapist, physician, etc.), and a description of the treated patients. This questionnaire was sent to 31 rehabilitation medicine facilities in Israel. Due to difficulties in comprehension of the term "technology," a second revised standardized questionnaire with closed-ended questions specifying diverse technologies was introduced in 2005. The responder had to mark from a list of 15 different medical technologies which were in use in his or her facility, as well as their purpose, who operates the device, and a description of the treated patients. RESULTS: Transcutaneous electrical nerve stimulation, the TILT bed, continuous passive movement, and therapeutic ultrasound were the most widely used technologies in rehabilitation medicine facilities. Monitoring of the sitting position in the wheelchair, at the bottom of the list, was found to be the least used technology (with 15.4% occurrence). Most of the technologies are used primarily for treatment purposes and to a lesser degree for diagnosis and research. CONCLUSIONS: Our study poses a fundamental semantic and conceptual question regarding what kind of technologies are or should be part of the standard equipment of any accredited rehabilitation medicine facility for assessment, treatment and/or research. For this purpose, additional data are needed.

Return to work following traumatic brain injury: trends and challenges.

PURPOSE: The aim of this paper is to present the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI). METHOD: Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful RTW, and (b) current concepts in rehabilitative strategies for successful RTW. RESULTS: The functional consequences to the victim of traumatic brain injury (TBI) can be severe. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility. An otherwise successful medical rehabilitation may end unsuccessfully because of the failure to return to work, with profound consequences to the individual and family, both economic and psychosocial. Even mild TBI may cause lasting problems in tasks calling for sustained attention. There appears to be a complex interaction between pre-morbid characteristics, injury factors, post injury impairments, personal and environmental factors in TBI patients, which influences RTW outcomes in ways that make prediction difficult. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW. Several medical, psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work. CONCLUSION: Accurate prediction of whether a particular TBI patient will successfully return to work is not feasible, with RTW rates in the 12 - 70% range. A significant proportion of TBI patients, including those who are severely injured, are able to return to productive employment if sufficient and appropriate effort is invested. A comprehensive approach - medical and psychosocial - eventually entailing adequate vocational rehabilitation with supported employment can improve outcomes.

Activities, participation and satisfaction one-year post stroke.

PURPOSE: To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset. METHOD: A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS). RESULTS: One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from 'life as a whole'. The lowest satisfaction rates were noted for 'vocational situation' (14%), 'leisure situation' (34%) and 'ability in self-care' (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression. CONCLUSIONS: Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.

Survey on the use of function assessment and outcome measures in rehabilitation facilities in Israel (SUFA 2004).

BACKGROUND: Measurement of function is an essential component of routine rehabilitation work (mainly for quantifying function at different phases in the rehabilitation process), rehabilitation policy (admission and discharge criteria, length of stay in rehabilitation), goal setting, and outcome measurement. OBJECTIVE: To explore the scope of the scales used for function assessment by the various disciplines of rehabilitation medicine in rehabilitation facilities. METHOD: A structured questionnaire was sent to 36 rehabilitation facilities. Respondents were asked to specify the scales they use for functional assessment for each of 15 selected pathologies. Also examined were satisfaction with the scales, as well as the existence of a computerized database of routine function assessment in the facility and the willingness to create a national agreed "common data set" of the assessments. RESULTS: The general response rate was 86.1% (31 of 36 questionnaires were returned). For the sake of data presentation, rehabilitation facilities were classified into four categories: general, geriatric, pediatric, and community. Most facilities performed function assessment using a total of 125 scales. Heterogeneity was found between facilities and between pathologies. The highest number of scales was found in the area of neurologic pathologies. For most pathologies, assessment of impairment was used more than assessment of disability. Most facilities in the survey did not have a computerized database of function assessments. CONCLUSIONS: A common data set of function assessments in everyday clinical work would ensure standardization without necessarily limiting the use of additional scales and at the same time significantly minimize the current heterogeneity.

Orthostatic hypotension and cerebral blood flow velocity in the rehabilitation of stroke patients.

The objective of this study was to investigate the results of transcranial Doppler monitoring during tilt table tests in stroke patients with and without orthostatic hypotension. In stroke patients without orthostatic hypotension, the mean flow velocity was almost similar in both middle cerebral arteries and was stable during the test. In patients with orthostatic hypotension symptoms, a significant difference was found between the two hemispheres. Mean flow velocity in the damaged middle cerebral artery was lower in the supine position and stayed almost the same at 80 degrees standing. In the non-damaged middle cerebral artery, however, the mean flow velocity was much higher when supine and dropped in the standing position. These findings suggest that the appearance of orthostatic hypotension symptoms may be associated in post-stroke patients with decreased blood velocity in the damaged middle cerebral artery. Those patients are at a high risk of developing syncopal reactions and should be treated on the tilt table with caution, especially at the beginning of the rehabilitation.

Rehabilitation outcomes in patients with brain tumors and acute stroke: comparative study of inpatient rehabilitation.

OBJECTIVES: To investigate functional outcomes after hospital rehabilitation of patients surviving craniotomy for primary brain tumor excision compared with post-stroke patients. DESIGN: The database of the Neurological Rehabilitation Department "C" of Loewenstein Rehabilitation Center was used to investigate primary brain tumors and first ischemic and hemorrhagic stroke patients admitted for hospital rehabilitation during an 11-yr period, between January 1993 and August 2004. Particular attention was paid to age and sex distribution, onset-to-admission interval, length of stay, functional status at admission and discharge, functional gain (DeltaFI change) as measured by the FIM instrument. RESULTS: A total of 168 patients with craniotomy for primary brain tumor excision (128 intracranial meningiomas and 40 cerebral gliomas) and 1660 first-stroke patients were admitted to the department for rehabilitation during the study period. Mean patient age was 59.9 yrs in meningioma group, 54.1 yrs in the glioma group, and 60.4 yrs in the stroke group. In the meningioma and stroke groups, male patients were in the majority (62 and 70%); in the glioma group, there was equal sex distribution. On average, patients were admitted to rehabilitation treatment 13 days after meningioma excision, 34 days after glioma operation, and 21.6 days after stroke. Functional variables during inpatient rehabilitation were found to be similar in the all groups. Average FIM rating at admission was 80.07 in the meningioma group, 68.2 in the glioma group, and 70.4 in the stroke group. Average discharge FIM rating was 90.3 for patients with meningiomas, 80.7 for patients with gliomas, and 87.8 for stroke patients. Functional gain was 17.9 for meningioma patients, 17.2 for glioma patients, and 21.8 for stroke patients. Average length of stay was 24 days for the meningioma group, 23 days for the glioma group, and 75.4 days for stroke patients; 88.1% of stroke patients, 91.7% of meningioma patients, and 82.7% of glioma patients were discharged to their homes, and 5.4, 3.4, and 8.6%, respectively, were discharged to nursing homes. CONCLUSIONS: Patients with brain tumors can achieve good functional outcomes with a shorter length of stay.