Kurosaki Minori, Tosaka Masahiko, Ibe Yoko, Arii Hironori, Tomono Junichi, Tazawa Masayuki, Shimizu Tatsuya, Aihara Masanori, Yoshimoto Yuhei, Wada Naoki
Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Prog Rehabil Med. 2022 Aug 4;7:20220039. doi: 10.2490/prm.20220039. eCollection 2022.
Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia.
This study included 50 patients with Brunnstrom recovery stage I-II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed.
FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (<70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses.
Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.
偏瘫中风患者经康复治疗后有时可在家中或轻度护理机构实现独立生活。本研究调查了重度偏瘫中风患者的康复效果。
本研究纳入了50例中风康复治疗开始时处于Brunnstrom恢复阶段I-II级偏瘫的患者。康复后良好结局定义为功能独立性测量（FIM）评分达到100分或更高且能独立生活。对康复后功能恢复的预测因素进行了统计学分析。
50例患者中有12例（24%）FIM评分达到100分或更高，中风康复后能够独立生活。单因素分析显示，与FIM评分达到100分或更高及康复后预后良好相关的因素包括年龄较轻（<70岁）、因脑内血肿（ICH）导致的瘫痪、无皮质病变、从入院到中风综合住院康复（CIR）的时间较短（1个月内），以及早期康复和CIR开始时状态良好。12例预后良好（FIM≥100）的患者中有11例患有ICH且基底节区有病变但无皮质损伤。病变位置分析表明，许多基底节区ICH病变且皮质受累较少的患者预后良好。
重度偏瘫中风患者在ICH和脑缺血之间的病变分布略有不同。皮质受累可能是重度偏瘫中风患者康复后结局的一个预后因素。对于重度偏瘫患者，尤其是无皮质受累的患者，更积极的康复干预可能很重要。
