Unit of Physical and Rehabilitative Medicine, South-East Tuscany Regional Health Service, Grosseto, Italy.
Tuscany Rehabilitation Clinic, Montevarchi, Arezzo, Italy.
Eur J Phys Rehabil Med. 2023 Jun;59(3):284-293. doi: 10.23736/S1973-9087.23.07716-X. Epub 2023 May 15.
The recovery of independence in activities of daily living is a fundamental goal of rehabilitation programs in subjects affected by subacute stroke. Rehabilitation is focused both on motor and cognitive aspects, and some evidence has reported cognitive deficits as prognostic factors of motor recovery. However, rehabilitation is a dynamic process during which executive functions and motor functions should be improved.
The aim of the study is to evaluate the relationships between impairments in cognitive functions and recovery of functional independence in stroke patients during the subacute phase.
Multicenter observational study.
Intensive rehabilitation units.
A sample of 319 stroke patients in subacute phase (70.6±11.6 years, 40.4% females), consecutively admitted from November 2019 to July 2021 at sixteen rehabilitation centers were enrolled in this observational, prospective and multicentric study with longitudinal assessments.
Cognitive and functional assessments were performed at hospital admission and discharge, including Oxford Cognitive Screen, modified Barthel Index, Functional Independent Measure, Fugl-Meyer assessment scale and National Institutes of Health Stroke Scale.
A regression analysis identified five predictors (out of about 200 tested variables) of functional recovery related to four aspects assessed at admission: functional status (P<0.001), lower limb functioning (P=0.002), attention (P=0.011), and executive functions (P=0.017). Furthermore, patients who recovered deficits in executive functions had the same recovery of those without deficits, whereas those who maintained deficits had a smaller recovery (P=0.019).
The relationship between cognitive and motor deficits is increasingly highlighted and the recovery of executive functions deficits seems to contribute to motor recovery.
Our results suggest that the recovery of executive functions may promote the recovery of the functional outcome of the patient with subacute stroke. Future treatment protocols may benefit from paying more attention to the recovery of executive functions.
在亚急性卒中患者中，日常生活活动独立性的恢复是康复计划的基本目标。康复既关注运动方面，也关注认知方面，一些证据表明认知缺陷是运动恢复的预后因素。然而，康复是一个动态的过程，在此过程中，执行功能和运动功能都应该得到改善。
本研究旨在评估亚急性期卒中患者认知功能障碍与功能独立性恢复之间的关系。
多中心观察性研究。
强化康复病房。
本观察性、前瞻性和多中心纵向研究纳入了 2019 年 11 月至 2021 年 7 月期间来自 16 个康复中心的 319 例亚急性卒中患者（70.6±11.6 岁，40.4%为女性）。
在入院和出院时进行认知和功能评估，包括牛津认知筛查、改良巴氏指数、功能独立性测量、Fugl-Meyer 评估量表和美国国立卫生研究院卒中量表。
回归分析确定了 5 个与入院时评估的 4 个方面相关的功能恢复预测因素（在大约 200 个测试变量中）：功能状态（P<0.001）、下肢功能（P=0.002）、注意力（P=0.011）和执行功能（P=0.017）。此外，恢复了执行功能缺陷的患者与未恢复缺陷的患者具有相同的恢复程度，而保持缺陷的患者则恢复程度较小（P=0.019）。
认知和运动缺陷之间的关系日益受到重视，执行功能缺陷的恢复似乎有助于运动功能的恢复。未来的治疗方案可能受益于更多地关注执行功能的恢复。
我们的研究结果表明，执行功能的恢复可能促进亚急性卒中患者的功能结局恢复。未来的治疗方案可能受益于更加关注执行功能的恢复。
