Effect of rehabilitation intervention on reconstruction of brain and limb function of patients with hemorrhagic cerebral arteriovenous malformation after embolization

Sheng LI; Liping GUO; Baomin LI; Xiangyu CAO

ABSTRACT

BACKGROUND:

Functional injury of brain and limb induced by hemorrhage of cerebral arteriovenous malformation could be restored by rehabilitative treatment

OBJECTIVE:

To investigate the curative effect of rehabilitation on restoration of the functional injury of the brain and limbs induced by bleeding of hemorrhage cerebral arteriovenous malformation (AVM) after embolization.

DESIGN:

Case analysis.

SETTING:

Department of Interventional Medicine of General Hospital of Chinese PLA.

PARTICIPANTS:

From January 1996 to December 2001, a total 56 patients who were diagaosed as cerebral hemorrhage or intraventricle hemorrhage by CT or MRI scanning was selected from General Hospital of Chinese PLA.

METHODS:

All 56 patients with cerebral arteriovenous malformation were diagnosed by DSA. Rehabilitative treatment was performed with α-butyl cyanoac-rylate or radian surgery. Rehabilitative therapy were as follow [1] Electric stimulate S J-Ⅱ type nerve-muscle therapy instrument was used to stimulate the muscles (flexor and extensor) of limbs in the involved side, intensity of which is from weak to strong and frequency of which was from 2 to 3 or 4 per day; [2] Acupuncture The selected points areFengchi, Fengfu, Yintang, Shangxing, Baihui, Quchi, Waiguan, Hegu,Huantiao, Zusanli, Yanglingquan, Sanyinjiao, Taichong, et al. In those who suffered aphasia, lianquan, Jinjin, Yuye were selected. Once a day and a period of treatment was 2 weeks; [3] physical training the passive movement on the joint in the involved limbs were performed in grade 0 to 1 of muscle strength, the balance training of sitting on bed or standing beside the bed in grade 1 to 2, walking training in grade 2 to 3. The training intensity should be from weak to strong gradually. The items of observation were the improvement in speaking, sense and activity in limbs in the involved side. Evaluation of myodynamia was referenced to 6 grading method of Lovett.MAIN OUTCOME

MEASURES:

[1] the degree of embolism; [2] the degree of speaking fluency, the sense of limbs and the strength of the muscles of the limbs.

RESULTS:

Totally 56 cases entered the final analysis without any loss. [1]Degree of embolism Among 56 cases, 100% focus was eliminated for 77% in 43 cases, 90% was eliminated for 12% in 7 cases and 60%-80% was eliminated for 11% in 6 cases. [2] Fluency of language Before the treatment of rehabilitation, they suffered different degree impediment of speaking in 14 cases, improvement in 14 cases and obvious improvement in 11 cases. [3] Sense of limbThe sense of limbs was improved in 23 cases and 18 of them improved obviously. [4] Strength of muscles The strength of muscles in 0 to 1 grade in 3 cases, 1 to 2 grade in 11 cases, 2 to 3 grade in 15 cases. But after the treatment of rehabilitation, speaking ability was improved in 14 cases, and 11 of them improved obviously. The strength of muscles was. resumed to 2 or 3 grade from 0or 1 grade in 2 cases, and to 4 grade in 21 cases and 5 grade in 6 cases.

CONCLUSION:

Endovascular embolization is a minimal traumatic, the rehabilitative therapy which is secure and effective method for treatment of high risk cerebral AVM, can promote motion function, language function and ability of activity of daily living, and quality of life of patients with cerebral arteriovenous malformation after embolism.