International journal of rehabilitation research. Internationale Zeitschrift für Rehabilitationsforschung. Revue internationale de recherches de réadaptation
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We evaluated quantitatively the recovery from impairment and disability in hemiplegic stroke survivors who received cranioplasty in the chronic stage. Seven first-ever stroke survivors with hemiplegia (mean age 56+/-3 years) who required delayed (3-9 months after the onset) cranioplasty during continuous rehabilitation therapy were studied. Recovery grade (1-12) of hemiplegia and Barthel index were assessed monthly before (the first rehabilitation) and after the cranioplasty (the second rehabilitation). ⋯ Changes in the upper and lower extremity grades were significantly larger in the second rehabilitation (1.0+/-0.3 in the first vs. 2.4+/-0.7 in the second rehabilitation for upper extremity, P=0.007; 1.4+/-0.4 in the first vs. 3.4+/-0.7 in the second rehabilitation for lower extremity, P=0.002). Increase in the Barthel index was larger in the second rehabilitation (23+/-8 in the first vs. 33+/-5 in the second rehabilitation); all patients regained the ability to walk. Significant recovery of functional grade and recovery from disability occurred after the cranioplasty in the chronic stage (>or=3 months) of stroke.
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Complex regional pain syndrome type I is a disorder of the extremities with disability and pain as the most prominent features. This paper describes the results of cognitive behavioural therapy combined with mirror box therapy in three patients with chronic complex regional pain syndrome type I. Before, during and at follow-up the following measurements were assessed: pain (visual analogue scale, 0-100), range of motion, muscle strength, and the areas of allodynia and of hyperalgesia. ⋯ Two patients felt that their affected limb still belonged to them, one did not. Cognitive behavioural therapy combined with mirror box therapy for patients with chronic complex regional pain syndrome type I may facilitate rehabilitation. Measuring whether the affected limb still belongs in the patient's body scheme could be of prognostic value in the treatment of chronic complex regional pain syndrome type I patients.
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The purpose of this study was to describe mechanical ventilation weaning outcomes for children with chronic respiratory failure discharged from one of six post-acute rehabilitation facilities. Demographic, clinical and outcome data were collected from the medical record. Forty-four children were included in this prospective series; 20 (45%) were weaned off the ventilator at discharge. ⋯ Hourly use on the ventilator decreased from admission to discharge for the full cohort and for the subgroup who required a ventilator at discharge. Seventy-five percent of the children discharged with a ventilator had a portable unit. We conclude that nearly half of the children using mechanical ventilation achieve weaning during a postacute rehabilitation admission, whereas others have positive outcomes in severity, hours off the ventilator or portability of equipment.
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The aim of the study was to evaluate the outcome 6 years after completing a multiprofessional 8-week rehabilitation programme regarding the following objectives: (1) return to work, (2) level of activity and (3) pain intensity. Of 149 patients attending a rehabilitation programme, 122 were followed up after 6 years, through a structured telephone interview, and their present work situation, level of activity, sleeping habits, their estimated pain intensity and consumption of analgesics were recorded. The questions presented were the same as they had answered before entering the programme. ⋯ A pain reduction was experienced by 58% of the patients (P<0.001) and 47% of the patients had decreased their consumption of analgesics (P<0.001). In conclusion, after completing the structured 8-week rehabilitation programme, the return-to-work rate was higher at a 6-year follow-up than in a control group. Furthermore, they had a higher level of activity and lower level of pain intensity than before entering the programme, indicating that the rehabilitation programme had a long-term positive effect on the return-to-work-rate, activity and pain as well as on the analgesic consumption.
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The objective of this study was to investigate the incidence, and the factors influencing the development, of complex regional pain syndrome-I in the upper extremity in hemiplegic patients within the first 28 weeks following a stroke. We followed up 82 stroke patients. All patients were evaluated at weeks 2, 6, 14 and 28 after suffering a stroke. ⋯ Significant correlation was found between complex regional pain syndrome-I and the presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stage and depression score (r=0.259, P=0.019; r=0.271, P=0.014; r=-0.393, P<0.001; r=-0.385, P<0.001; r=0.293, P=0.008, respectively). In this study, there was a relationship between complex regional pain syndrome-I and subluxation, loss of range of motion, spasticity of shoulder muscles and muscle strength. In order to prevent the development of complex regional pain syndrome-I, exercises directed at increasing the range of motion for the glenohumeral joint, strengthening shoulder muscles and reduction of spasticity will establish the integrity of the shoulder joint.