MANAGING THE EARLY PHASE OF REHABILITATION AFTER ISCHEMIC CEREBROVASCULAR ACCIDENT

Authors

  • Eqrem Gara Physical Medicine and Rehabilitation Clinic, University of Pristina, Kosovo
  • Bekim Haxhiu Physical Medicine and Rehabilitation Clinic, University of Pristina, Kosovo
  • Zheralldin Durguti Physical Medicine and Rehabilitation Clinic, University of Pristina, Kosovo
  • Ardiana Murtezani Physical Medicine and Rehabilitation Clinic, University of Pristina, Kosovo

DOI:

https://doi.org/10.22159/ijpps.2017v9i6.18345

Keywords:

ICA (Ischemic Cerebrovascular Accident), Hemorrhagic, Early phase, Rehabilitation

Abstract

Objective: Ischemic cerebrovascular accident (ICA) is characterised by the rapid deterioration of brain function due to vascularization disorders. The ischemic cerebrovascular accident may arise as a consequence of ischemia or hemhorrage in brain tissue, but the optimal treatment approach is unclear. In this study, we examined ICA rehabilitation goals, implementation of rehabilitation plans, management of sensomotor deficits and functional status, improvement of independence, prevention and treatment of complications, functional status monitoring, and planning recommendations, as well as education of ICA patients and their families.

Methods: This study considered 69 ICA patients who were classified as suitable for rehabilitation intervention among a total of 231 patients who were evaluated for a diagnosis of ICA following hospitalization at the Clinic of Neurology, University Clinical Center of Kosovo (UCCK) in Prishtina. From the statistical parameters, we used the structure index, whereas testing results were evaluated using the Chi-square test with significance established at p<0.05.

Results: For the 69 ICA patients, most ICA incidents occurred in patients who were older than 40 y-old. Mobility decreased from 42.9% to 8.6% when rehabilitation began at release instead of admission. Meanwhile, the ability to perform daily activities decreased from 48.6% to 11.4% when rehabilitation began after release as opposed to immediately after stabilization. Transfers and balance showed similar decreases (48.6% to 11.4% and 48.6% to 11.4%, respectively Chi-test=59.7, p<0.001.). The rehabilitation of patients in the early acute stage after ICA should begin as soon as possible after the diagnosis is made and the patient's condition is stable. During rehabilitation intervention, priority should be given to preventing complications and recurrent stroke, as well as enhancing patient mobility and improving patient morale.

Conclusion: ICA is a medical emergency that can cause permanent neurological lesions and other complications that may be fatal or associated with permanent disability. The most affected age group is individuals older than 40 y old. Neurological deficits can cause motor, sensory, functional and emotional disability in ICA patients. Rehabilitation after ICA should begin immediately after the patient has stabilized to minimze functional losses.

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References

Sims NR, Muyderman H. Mitochondria, oxidative metabolism and cell death in stroke. Biochim Biophys Acta 2009; 1802:80–91.

Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008;371:1612–23.

The World health report 2004. Annex table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002. Geneva: World Health Organization; 2004.

Nor AM, Davis J, Sen B, Shipsey D, Louw SJ, Dyker AG, et al. The recognition of stroke in the emergency room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol 2005;4:727–34.

Coffey CE, Cummings JL, Starkstein S, Robinson R. Stroke-the American psychiatric press textbook of geriatric neuropsychiatry. 2en ed. Washington DC: American Psychiatric Press; 2000. p. 601–17.

Kidwell CS, Warach S. Acute ischemic cerebrovascular syndrome: diagnostic criteria. Stroke 2003;34:2995–8.

Stam J. Thrombosis of the cerebral veins and sinuses. New England J Med 2005;352:1791–8.

Vakati HS, Jebakumar R. Predicting ratings for user reviews and opinion mining analyze for physicians and hospitals. Asian J Pharm Clin Res 2017;10:47-9.

Patil N, Balaji O, Rao KN, Hande HM, Ahmed T, Singhal S. A rare cause of septic arthritis with pleural effusion: Burkholderia pseudomallei. Asian J Pharm Clin Res 2017;10:8-9.

Gresham GE, Duncan PW, Stason WB, Adams HP, Adelman AM, Alexander DN, et al. Post-stroke rehabilitation: assessment, referral, and patient management: Quick reference guide for clinicians. J Pain Symptom Manage 1996;4:57-95.

Bushnell CD, Johnston DC, Goldstein LB. Retrospective assessment of initial stroke severity: comparison of the NIH stroke scale and the canadian neurological scale. Stroke 2001;32:656–60.

Duncan PW, Lai SM, Van CV, Huang L, Clausen D, Wallace D. Development of a comprehensive assessment toolbox for stroke. Clin Geriatr Med 1999;15:885–915.

Roe B, Williams K, Palmer M. Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev 2000;2:CD001308.

Mahmudah RL, Ikawati Z, Wahyono D. A qualitative study of perspectives, expectations and needs of education in chronic obstructive pulmonary disease (Copd). Int J Curr Pharm Res 2017;9:32-5.

Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim LL, Holme I. Benefit of a stroke unit: a randomized controlled trial. Stroke 1991;22:1026–31.

Smith DS, Goldenberg E, Ashburn A, Kinsella G, Sheikh K, Brennan PJ, et al. Remedial therapy after stroke: a randomised controlled trial. Br Med J 1981;282:517–20.

Price CI, Pandyan AD. Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic cochrane review. Clin Rehabil 2001;15:5–19.

Tanguay T, Eichorst C. The braden scale: is your patient at risk for pressure ulcers? Alta RN 2000;56:24–25.

Lawton MP, Moss M, Fulcomer M, Kleban MH. A research and service oriented multilevel assessment instrument. J Gerontol 1982;37:91–9.

Berlowitz DR, Brandeis GH, Anderson JJ, Ash AS, Kader B, Morris JN, et al. Evaluation of a risk-adjustment model for pressure ulcer development using the minimum data set. J Am Geriatr Soc 2001;49:872–6.

Publications committee for the trial of ORG 10172 in acute stroke treatment (TOAST) investigators. low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. The publications committee for the trial of ORG 10172 in acute stroke treatment (TOAST) investigators. JAMA 1998; 279: 1265–72.

Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. The intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet 1999;354:191-6.

Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database Syst Rev 2005;18:CD000443.

Rimmer JH, Riley B, Creviston T, Nicola T. Exercise training in a predominantly African-American group of stroke survivors. Med Sci Sports Exercise 2000;32:1990–6.

Wojkowski S, Smith J, Richardson J, Birch S, Boyle M. A scoping review of need and unmet need for community-based physiotherapy in Canada. J Crit Rev 2016;3:17-23.

Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke 1998;29:895–9.

Langhorne P, Wagenaar R, Partridge C. Physiotherapy after stroke: more is better? Physiother Res Int 1996;1:75–88.

Sutari RC, Kalaichelvan VK. Evaluation activity of leaf extracts of holoptelea integrifolia (Roxb) planch. Int J Appl Pharm 2014;6:6-8.

Published

01-06-2017

How to Cite

Gara, E., B. Haxhiu, Z. Durguti, and A. Murtezani. “MANAGING THE EARLY PHASE OF REHABILITATION AFTER ISCHEMIC CEREBROVASCULAR ACCIDENT”. International Journal of Pharmacy and Pharmaceutical Sciences, vol. 9, no. 6, June 2017, pp. 194-7, doi:10.22159/ijpps.2017v9i6.18345.

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Original Article(s)