ABSTRACT
The multidisciplinary assessment of health problems after stroke should take into account not only motor, speech disorders, disability, but also postural balance, type and level of mental disorders, degree of working hand dysfunctions, cortical motor neuron functional indicators, and risk factors for recurrent stroke. OBJECTIVE: To develop a methodology for the integrated assessment of health problems and the effectiveness of stage rehabilitation in patients after ischemic stroke (IS) and risk factors for recurrent stroke. MATERIAL AND METHODS: Examinations were made in 101 patients (mean age 59.78±8.63 years) after IS in the middle cerebral arterial bed in the early recovery period. Of them, 62 patients were examined in the early and late recovery periods of stroke. The investigators assessed neurological disorders using National Institutes of Health Stroke Scale (NIHSS), Ashworth Spasticity Scale, dysarthria scale, Medical Research Council Scale and wrist dynamometry, Frenchay Arm Test), Self-Care Rating Scale (Barthel index) and social and living activities (Rehabilitation Activities Profile Scale), psychological status (procedures of Memory for Pictures and Ten Words, Schulte-Platonov Tables, Luscher Color Test, Hospital Anxiety and Depression Scale (HADS), Recovery Locus of Control Scale) questionnaire, functional (stabilography, transcranial magnetic stimulation) and laboratory (lipid profile test) results. The integrated assessment of health problems was defined as the sum of ranks of the signs studied; the effectiveness of stage rehabilitation in patients was defined as the coefficient of the dynamics of the sum of ranks of informative indicator. RESULTS: There was a preponderance of moderate motor impairments; the high incidence of cognitive impairment and paretic hand dysfunctions; a change in the temporal parameters of the nerve impulse through the corticospinal tract; obvious balance dysfunctions; and the relationship between equilibrium and the visual analyzer. The integral indicator of the level of health correlated with clinical and functional findings. After the rehabilitation, severe arm/hand paresis was not detected; paretic arm/hand function improved; the number of patients with moderate paresis declined; impaired vital and social activities reduced significantly; the proportion of patients with low dependence on others was as much as 86%; balance and psychological functions improved; the mean blood pressure reached the target values. An integrated effectiveness evaluation showed that 33, 58, and 9% of patients were discharged with a significant improvement, improvement, and a slight improvement, respectively. CONCLUSION: The integrated approach to evaluating health problems and the effectiveness of rehabilitation makes it possible to comprehensively estimate (taking into account neurological, psychological, functional disorders, risk factors for recurrent stroke) the harm to a patient's health and activity, which is associated with prior stroke and its reversal due to rehabilitation.
