Applying the International Classification Of Functioning, Disability And Health (ICF) And Kawa Models In Family Medicine - A Case Of An Adolescent With A Stroke

@#The rehabilitation of a 19-year-old male with a congenital ventricular septal defect who suffered a haemorrhagic stroke from a ruptured mycotic aneurysm, secondary to infective endocarditis is described in this case study. This case study illustrates the application of the International Classification of Functioning, Disability and Health (ICF) model, and Kawa model in the structuring of a holistic, interdisciplinary team management. Application of both models provide clear communication within the interdisciplinary team and aids the team to understand the contextual factors in the interaction of the patient's rehabilitation journey.

Intervenção fonoaudiológica e fisioterapêutica em uma mulher após acidente vascular cerebral isquêmico / Speech therapy and physiotherapy intervention in a woman after ischemic stroke

OBJETIVOS: Relatar um caso em que houve intervenção conjunta entre fonoaudiólogo e fisioterapeuta na reabilitação de uma paciente com acidente vascular cerebral isquêmico. DESCRIÇÃO DO CASO: Paciente de 48 anos de idade, sexo feminino, acometida por acidente vascular cerebral do tipo isquêmico, há sete meses. Apresentou-se com disartrofonia e alterações do sistema estomatognático e sua funcionalidade, comprometimento sensorial, parestesia da mão direita, diminuição da coordenação motora grossa e fina em ambos os membros superiores, dificuldade na preensão palmar e fraqueza da musculatura intrínseca da mão direita, diminuição da consciência corporal e da propriocepção. Foi submetida a 12 sessões com a periodicidade de uma vez por semana de tratamento fonoterápico e fisioterapêutico. Após as intervenções a paciente apresentou aumento dos tempos máximos de fonação; melhora da coordenação pneumofonoarticulatória, da qualidade vocal e do foco de ressonância vertical; adequação e modulação da loudness; modulação do pitch; melhora da coordenação motora grossa e fina, da sensibilidade tátil e dolorosa, da oposição dos dedos, da preensão palmar, da consciência corporal, da propriocepção e da postura corporal global; e aumento da força muscular dos membros superiores. CONCLUSÕES: A intervenção interdisciplinar da fonoaudiologia e fisioterapia proporcionou benefícios à paciente acometida por acidente vascular cerebral isquêmico, sendo que a mesma voltou a exercer sua atividade profissional e suas atividades de vida diária com efetividade e melhorou a comunicação com seus familiares.

AIMS: To report a case of joint intervention between speech therapist and physiotherapist in the rehabilitation of a patient with ischemic stroke. CASE REPORT: A 48-year-old female was affected by stroke of ischemic type seven months ago. The patient presented with dysarthrophonia and alterations of the stomatognathic system and its functionality, sensory impairment, right hand numbness, decreased gross and fine motor coordination of both upper limbs, difficulty in grip and weakness of the intrinsic muscles of the right hand, decreased proprioception and body awareness. She underwent 12 sessions of speech therapy and physical therapy with once a week frequency. After the sessions the patient showed increase of the maximum phonation time, improved pneumophonoarticulatory coordination, as well as improving in vocal quality and focus of vertical resonance; adequacy and modulation of loudness; pitch modulation; improved gross and fine motor coordination, tactile and pain sensitivity, opposition of the fingers, hand grip, body awareness, proprioception and overall body posture; and increased muscle strength of the upper limbs. CONCLUSIONS: The interdisciplinary intervention with speech therapy and physical therapy provided benefits to this patient affected by stroke, allowing her to return to her full professional and daily activities, and improving communication with her family.

Effect of Community-based Rehabilitation Stroke Unit on Functional Recovery of Stroke Patients / 中国康复理论与实践

@#Objective To observe the effect of community-based rehabilitation stroke unit on the function of stroke patients. Methods 94 patients with stroke were divided into intervention group (n=47) and control group (n=47). The control group accepted routine community home care, while the intervention group accepted community-based rehabilitation stroke unit care. They were assessed with modified Barthel index (MBI), simple Fugl-Meyer assessment (FMA) and Social Disability Screening Schedule (SDSS) before and after intervention. Results There was not significant difference between the groups in scores of MBI, FMA and SDSS (P>0.05) before intervention. All the scores improved significantly in both groups (P<0.01) 3 months after intervention, and improved more in the intervention group than in the control group (P<0.05). Conclusion Community-based rehabilitation stroke unit can improve the functional recovery of stroke patients.

Effects of Rehabilitation Stroke Unit on Shoulder-hand Syndrome Post Stroke / 中国康复理论与实践

@#Objective To investigate the effects of rehabilitation stroke unit on patients with shoulder-hand syndrome after stroke. Methods 90 stroke patients with shoulder-hand syndrome were divided into two groups: control group (45 cases) was treated with conventional treatment and experimental group (45 cases) was incorporated into the rehabilitation stroke unit. The therapeutic course was 6 weeks.Brunnstrom stage, Fugl-Meyer assessment (FMA) and modified Barthel index (MBI) were used to assess the degree of the motor function of upper limb and hand, and activities of daily living (ADL), and the total clinical efficacy were evaluated. Results The motor function of upper limb and hand and ADL improved in both groups after treatment (P<0.05), while the experimental group was significantly superior to the control group (P<0.05). Conclusion Rehabilitation stroke unit has preferable effect on shoulder-hand syndrome after stroke.

Advance in Cluster Needling of Scalp Acupuncture Combined with Rehabilitation for Stroke (review) / 中国康复理论与实践

@#The researches that stroke was treated by cluster needling of scalp acupuncture combined with rehabilitation in the past 10 years were reviewed, noting that it can significantly reduce the dysfunctions in stroke patients, prompting that the cluster needling of scalp acupuncture and modern rehabilitation techniques was combined, was a new method for stroke rehabilitation treatment.

Structured Periodic Rehabilitation Intervention Sessions To Stroke Patients. A Longitudinal Review

Despite evidence showing that structured rehabilitation after stroke improves functional outcomes, providing seamless rehabilitation from hospital to community has been elusive. The service provided should be able to accommodate variable degree of impairments and needs of the stroke survivors. This study aimed to assess the outcome of a multidisciplinary-based outpatient rehabilitation service for stroke patients living in the community. Patients who were discharged from Universiti Kebangsaan Malaysia Medical Centre after an acute stroke were referred to the Combined Stroke Rehabilitation Clinic (CSRC). Post stroke patients were assigned individually designed programs which were problem based and used task specific activities to achieve desired goals. Patients were reviewed on a regular basis either up to completion of the 2 year-program, or are able to be discharged to the community, whichever is earlier. Modified Barthel Index (MBI) and Berg Balance Scores (BBS) were used for monitoring. A total of 68 patients were managed in CSRC for two years since its initiation, with mean age of 62.4 years (SD 12.4) with the mean duration of stroke when first reviewed in CSRC was 11.5 months (SD 11.9). Majority of patients (64.7%) received either two or three types of intervention. Both MBI and BBS demonstrated significant improvement over 12-months period (p value of 0.006 and 0.017 respectively). CSRC proved that structured rehabilitation intervention was beneficial in terms of functional status and improvement in balance to post-stroke patients.

Application of Acupuncture in Stroke Unit: An Effect and Cost-effectiveness Analysis / 中国康复理论与实践

@#Objective To observe the effects of acupuncture on stroke in stroke unit, and its cost-effectiveness. Methods60 patients were divided into control group (n=30) and treatment group (n=30). All the patients were treated with structural therapy known as stroke unit, and the treatment group accepted acupuncture in addition. They were assessed with National Institutes of Health Stroke scale (NIHSS) and Barthel Index (BI) before, 15 d and 30 d after treatment. Their expenses for hospital were investigated. ResultsThe scores of NIHSS and BI improved in the treatment group compared with those in control group (P<0.05) 15 d and 30 d after treatment. The average cost for a score improved in both NIHSS and BI was less in the treatment group than in the control group (P<0.05). ConclusionThe acupuncture applied in stroke unit is effective and economical for stroke patients.

Functional Electrical Stimulation for Motor Function Rehabilitation (review) / 中国康复理论与实践

@# Functional electrical stimulation (FES) has already used in many aspects of rehabilitation medicine, including the rehabilitation of motor function especially after stroke or spinal cord injury. This paper reviewed the parameters for and the effects on motor function rehabilitation.

Perfil de risco de perda óssea em pacientes hemiplégicos crônicos / Risk profile of bone loss in chronic hemiplegic patients

INTRODUÇÃO: A perda óssea acelerada é uma das reconhecidas complicações da hemiplegia pós-acidente vascular encefálico (AVE), mas pouco se sabe sobre o ritmo de perda na fase crônica e seus determinantes. O objetivo deste estudo foi avaliar a evolução tardia da densidade mineral óssea (DMO) em pacientes hemiplégicos crônicos, bem como identificar possíveis fatores associados. MÉTODOS: Foi realizado um estudo longitudinal envolvendo pacientes ambulatoriais com hemiplegia há mais de 12 meses. Pacientes com doenças e outras condições associadas à perda óssea foram excluídos. Avaliações clínica e densitométrica foram realizadas no início e após aproximadamente 16 meses, e foram analisados fatores de risco para perda óssea. RESULTADOS: Cinquenta e sete pacientes foram estudados, sendo 40 do sexo masculino, com média de 59,3 anos e tempo médio de hemiplegia de 33,4 meses. Ao comparar os hemicorpos acometido e não acometido, foi observada perda óssea mais acentuada em antebraço acometido (p=0,001), mas não em fêmur acometido. Foi observada perda óssea significativa em 56% dos pacientes em antebraço e 22,6% em fêmur, no lado acometido. Maior tempo de AVE foi protetor para a perda óssea em antebraço (OR = 0,96, IC 95%: 0,92 0,99; p=0,015), e o uso de anticoagulantes e/ou anticonvulsivantes (OR = 5,83, IC 95%:1,25 27,3; p=0,025) e espasticidade moderada/intensa (OR = 8,29, IC 95%:1,10 62,4; p=0,040) foram determinantes para perda óssea em fêmur. CONCLUSÕES: O presente estudo evidenciou que a perda óssea é comum e frequente em antebraço acometido em pacientes com hemiplegia crônica, com tendência à estabilização da perda com o passar do tempo. Espasticidade mais intensa e uso de anticoagulantes e/ou anticonvulsivantes foram associados à perda óssea em fêmur. Estes achados indicam que pacientes hemiplégicos crônicos devem ser monitorados e tratados para perda óssea, com atenção para os determinantes identificados, e que o membro superior acometido...

INTRODUCTION: Accelerated bone loss is a well-known early complication of hemiplegia. However, less is known about chronicphase bone loss and its determinants. The objective of this study was to evaluate long-term changes in bone mineral density (BMD) in chronic hemiplegic patients, and investigate possible related factors. METHODS: A longitudinal study involving chronic stroke-related hemiplegic patients was conducted. Clinical and densitometric evaluations were performed at baseline and after approximately 16 months, and risk factors for bone loss were analyzed. RESULTS: Fiftyseven patients were studied (40 males) with a mean of 59.3 years and with mean time since hemiplegia of 33.4 months. Decrease in BMD was more pronounced in affected forearms compared to the nonaffected forearms (p=0.001). No difference was found between affected and non-affected femurs. Bone loss was observed in 56% of the affected forearms and 22.6% of the affected femurs. Longer time since stroke was protective for bone loss in the forearm (OR = 0.96, 95% CI: 0.92 0.99; p=0.015), and the use of anticoagulation/antiepileptic drugs (OR = 5.83, 95% CI: 1.25 27.3; p=0.025) and moderate/severe spasticity (OR = 8.29, 95% CI: 1.10 62.4; p=0.040) were associated to bone loss in the femur. CONCLUSIONS: Bone loss is common and more frequent in the affected forearm in chronic hemiplegic patients with tendency to stabilize over time. Greater spasticity and use of anticoagulation and/or antiepileptic drugs were proved to be associated with bone loss at the femur. Our findings indicate that chronic hemiplegic patients should be monitored and treated for bone loss, with attention to the identified determinants, and that the upper paretic limb should be included in BMD evaluation.

Effect of Community Rehabilitation on Stroke Patients during Convalescence / 中国康复理论与实践

@#Objective To observe the effect of community rehabilitation on the motor function and activities of daily living(ADL)of stroke patients.Methods 155 stroke patients were randomly divided into the exercises group(n=76)and control group(n=79)and evaluated with simple Fugl-Meyer Assessment(FMA),Modified Barthel Index(MBI)and Functional Comprehensive Assessment(FCA)before treatment and 1 and 3 months after treatment.Results The evaluations of FMA,MBI and FCA were not different between two groups before treatment.One month later,the scores of MBI and FCA of the exercises group improved significantly(P<0.01),but simple FMA not improved even to 3 months after treatment(P>0.05).In the control group,the simple FMA score not improved(P>0.05),the scores of MBI and FCA had a declined tendency with disease course prolong.Conclusion The effect of community rehabilitation on the motor function of stroke patients during convalescence is not significant,but community rehabilitation may improve ADL and the quality of life.

Effect of Supervised Rehabilitation on Functional Recovery in Hemiplegia after Stroke / 中国康复理论与实践

@#Objective To observe the effect of supervised rehabilitation on functional recovery in hemiplegia patients after stroke.Methods 65 patients with acute stroke were divided into supervised rehabilitation group and no-supervised rehabilitation group. They were assessed with Ueda Test and Barthel Index before and after treatment. Results The scores of the Barthel Index in supervised rehabilitation group were significantly superior to those of the not supervised rehabilitation group (P <0.05), while the scores of Ueda Test between these two groups were not significantly different (P>0.05). Conclusion Supervised rehabilitation can improve the function recovery, especially in activities of daily living.

Effect of Multi-disciplinary Rehabilitation Therapies on Prognosis of Patients with Stroke Hemiplegia / 中国康复理论与实践

@#ObjectiveTo observe the effect of multidisciplinary rehabilitation on prognosis of patients with stroke hemiplegia.Methods100 patients with stroke hemiplegia were divided into the rehabilitation group and control group with 50 cases in each group. The patients of the rehabilitation group were treated not only with routine medication,but also with rehabilitation therapy, which included nerve-muscle promoting technology, functional electric stimulation and Channel Balance-Inducing instrument therapy, and etc, over six mouths. The cases of the control group were treated only with routine medication. The motor function of patients was assessed with Fugl-Meyer Assessment (FMA), and activities of daily living (ADL) was assessed with Barthel Index (BI) before and after treatment.ResultsThe FMA and BI scores of the patients in the rehabilitation group increased obviously, having a significantly difference with that of the control group (P<0.01).ConclusionThe prognosis of patients with stroke hemiplegia treated with multidisciplinary rehabilitation is superior to that with simple medication.

Comparison of Activity Patterns between Rehabilitation Stroke Unit and Mixed Rehabilitation Ward for Stroke Patients

OBJECTIVE: To determine if the physical design and organizational structure of rehabilitation stroke unit (RSU) is related to the amount of patients' activity pattern. METHOD: An observational study was conducted using behavioral mapping method. Time samples of the motor activity of patients following stroke were taken at 10-minute interval, between 7 AM and 7 PM both on weekdays and weekends. At each observation, physical activity patterns, location in which the patients spent their time, and other person present were recorded. RESULTS: RSU patient spent less time in non-therapeutic activity and more time in therapeutic activity (p<0.05). There were significant differences in the locations of patient's position between the two types of ward (p<0.05). RSU patients had significantly more interaction with formal carerand less time disengaged (p<0.05). The proportion of time in therapeutic activity was low in all location, with patients spending many hours in bed and doing nothing. There was no significant differences in total Functional Independence Measure (FIM) scores at admission and on discharge, FIM gain, and FIM efficiency between RSU and mixed rehabilitation ward (p<0.05). CONCLUSION: In spite of quantitative difference, the two wards had similar patterns of treatment activity and deployment of staff. These maybe resulted in similar treatment experiences for patient and no functional differences between two wards. It appears that strategies are required so that patients can be practicing at an more appropriate level.

Effects of three-month rehabilitation on motor function in hemiplegics after stroke / 中国康复理论与实践

@#ObjectiveIn order to study the effect of three-month rehabilitation on motor function in hemiplegics after stroke. Methods125 patients were randomly divided into two groups, rehabilitation group (72 cases)and control group(53 cases).Patients in the rehabilitation group were given clinical treatment,electric stimulation therapy(EST) and regularly physical therapy, while those in control group were given clinical treatment and unguided self-training, and the evaluation was done in pre-treatment and post-three-month respectively. Motor function was assessed in Fugl-Meyer Assessment(FMA).ResultsMotor scores in each group had a more significant difference(P<0.001)before and after treatment, the process of scores in the rehabilitation group was obviously superior to that in the control group(P<0.001). Conclusions Rehabilitation training on hemiplegics after stroke may obviously improve motor function, depressing the disability and increasing the living quality.