Effect of Additive Application of Repetitive Facilitation Exercise to Conventional Rehabilitation in Hemiplegic Stroke Patients in the Recovery Stage: A Controlled Clinical Trial on Motor Functional Recovery in Hemiplegia and Activities of Daily Living / The Japanese Journal of Rehabilitation Medicine

Objective : To study the effect of repetitive facilitation exercises (RFE) on motor functional recovery in stroke patients with hemiplegia. Subjects and Methods : Fifty-two stroke patients in the recovery stage were divided randomly to receive RFE (RFE group) or conventional therapy (CT group) for 17 weeks. Motor functional recovery and activities of daily living (ADL) were evaluated using Ueda's motor paresis grading system and functional independence measure (FIM), respectively. ADL evaluations were done blindly. Results : The baseline characteristics of the RFE and CT groups did not significantly differ. After the intervention, the RFE group showed not significantly larger improvements than the CT group in Ueda's grades for the upper limb, hand, and lower limb. But isolated joint movement from synergy was observed more frequently in the RFE group than in the CT group (<i>p</i><0.05). Furthermore, improvement in FIM in the RFE group was greater than that in the CT group, especially in both the total and motor FIM of subjects who underwent lower limb RFE (<i>p</i><0.05), and in the subscore for self-care in subjects receiving RFE to their fingers (<i>p</i>=0.075). Conclusion : There is a possibility that RFE might promote the functional recovery of the hemiplegic upper limb, hand, and lower limb to a greater extent than CT.

A Study of the Liaison Critical Pathway for Stroke between an Acute Hospital and a Convalescent Rehabilitation Ward and the Effect of Clinical Factors on Outcome / The Japanese Journal of Rehabilitation Medicine

We examined the effect of the liaison critical pathway for stroke among the inpatients in an acute hospital (AH) from 2007 to 2008. The average length of hospital stay in the AH was reduced by 5.7 days compared with 2006 by means of the critical pathway. Among 155 patients who had been transferred from the AH to a convalescent rehabilitation ward (CRW), 148 were discharged from the CRW. Ninety-seven patients returned home and 44 patients were transferred from the CRW to a nursing home type unit or an institution. One patient died in the CRW, six were returned to the AH. From among the clinical factors, that included sex, age, modified Rankin Scale (mRS), total, motor and cognitive scores of Functional independence measure (FIM) at discharge from the AH, total FIM scores and FIM gain at discharge from the CRW, mRS at discharge from the AH and total FIM scores at discharge from the CRW exerted an influence on outcome. Patients living with their spouses and / or children before the onset of stroke were more inclined to return home.