Influence of Reflex Sympathetic Dystrophy on Functional Outcomes of the Upper Extremity in Stroke Patients

OBJECTIVE: To assess the influence of reflex sympathetic dystrophy (RSD) on functional status and recovery of the hemiplegic upper extremity in stroke patients. METHOD: Retrospective chart review was performed in 561 patients. Among 561 stroke patients, 116 subjects were recruited and classified into two groups: patient group, 43 cases with RSD; control group, 73 cases without RSD. Upper extremity function was assessed based on feeding, dressing and personal hygiene scores of the modified Barthel index at the beginning of rehabilitation treatment and at the time of discharge. Causes of stroke and length of stay were recorded. Median nerve-somatosensory evoked potential studies were performed and assessed. RESULTS: The incidence of RSD was 7.7% and the time to development of RSD was 62.3+/-34.1 days after the onset of stroke. There was no significant difference in functional status between two groups at initial and final evaluation. The upper extremity function had improved in both groups although the length of stay was longer in patient group. SSEP abnormalities were more frequent in the patient group. CONCLUSION: The presence of well-managed RSD affected neither the functional status nor the functional recovery of upper extremity in stroke patients.

Clinical Usefulness of Somatosensory Evoked Potentials in Patients with Stroke

OBJECTIVE: To assess the usefulness of the somatosensory evoked potentials in correlating with various clinical features and in predicting the functional outcome in patients with stroke. METHOD: The subjects were 57 patients with first stroke. Somatosensory evoked potential study was performed at the time of transfer to the rehabilitation department. Data of somatosensory evoked potential with median and tibial nerve stimulations were obtained and classified as normal (group 1), abnormal (group 2), and no response group (group 3). Modified Barthel index (MBI), motor and sensory functions were evaluated at the time of transfer and discharge. RESULTS: MBI score was statistically different among the 3 groups based on the findings of median and tibial nerve SSEP at the time of transfer, but not different at the time of discharge. Motor function was statistically different among the 3 groups at the time of transfer and discharge. Sensory function was statistically different among the 3 groups at the time of transfer, but not different at the time of discharge. CONCLUSION: Even though SSEP study reflects the functional status of the patients and correlates well with the findings of brain image, it has limitation in predicting outcome of the patients with stroke.