ABSTRACT
BACKGROUND: In animal models and healthy volunteers, the use of GABA A receptor agonists (GABA-AGs) seem deleterious for functional recovery. The agents are widely used for subacute stroke, but their effect on functional recovery remains unclear. OBJECTIVES: We aimed to evaluate the association between GABA-AG use and functional recovery after stroke. METHODS: We retrospectively recruited 434 survivors of subacute stroke admitted for inpatient rehabilitation between 2000 and 2013 in our institution (107 with and 327 without GABA-AG use). We used multivariate regression to assess the association of GABA-AG use and successful functional recovery, defined as reaching, between admission and discharge, the minimal clinically important difference (MCID) of 22 points on the global Functional Independence Measure (FIM). Secondary analyses were the associations of GABA-AG with cognitive and motor FIM MCID and constant GABA-AG exposure (24h/24 GABA-AG) with global, cognitive and motor FIM MCID. A new estimation of the MCID was performed with the standard error of measurement. RESULTS: Reaching the global FIM MCID was associated with GABA-AG use (adjusted odds ratio [aOR] 0.54 [95% CI 0.31-0.91], P=0.02) as well as 24h/24 GABA-AG use (aOR 0.25 [0.08-0.83]; P=0.02). Furthermore, GABA-AG and 24h/24 GABA-AG use was inversely but not always significantly associated with reaching the cognitive FIM MCID (aOR 0.56, P=0.07; aOR 0.26, P=0.06, respectively) and motor FIM MCID (aOR 0.51, P=0.07; aOR 0.13, P=0.01, respectively). The estimated MCID was 19 for global FIM, 4 for cognitive FIM, and 16 for motor FIM. CONCLUSIONS: GABA-AG use is associated with not reaching successful functional recovery during stroke rehabilitation. Randomised trials are needed to formally establish the potential deleterious effect of GABA-AG use on functional recovery.
Subject(s)
GABA-A Receptor Agonists/pharmacology , Recovery of Function/drug effects , Stroke Rehabilitation/methods , Stroke/drug therapy , Survivors/psychology , Adult , Aged , Aged, 80 and over , Cognition/drug effects , Disability Evaluation , Female , GABA-A Receptor Agonists/adverse effects , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Regression Analysis , Retrospective Studies , Stroke/psychology , Treatment OutcomeABSTRACT
The neurorehabilitation of brain injury patients usually begins at the hospital, during the acute care, where the aim is essentially at limiting the complications and at beginning the reeducation. The patients benefit then mostly from an inpatient and/or outpatient neurorehabilitation. During all these phases, the rehabilitation declines according to its 3 dimensions, namely: reeducation, rehabilitation and reintegration. In all this process, it is important to remain watchful to the invisible handicaps, such as cognitive impairments, post-traumatic brain injury complaints, behavioural or mood changes. These represent a potential obstacle to the social and professional reintegration.
Subject(s)
Brain Injuries/rehabilitation , Stroke Rehabilitation , Humans , Rehabilitation/methodsABSTRACT
Functional outcome after stroke with severe disability (Barthel Index<60 points) was analyzed retrospectively in one hundred patients, including seventy-three with nonhemorrhagic stroke and twenty-seven with hemorrhagic stroke admitted to our neurorehabilitation center between 1986 and 2000. Neurological deficits and functional disabilities were assessed with the Barthel Index at admission to rehabilitation and after the rehabilitation program in survivors. The rehabilitation therapy was based on the Bobath concept. Patients were not discharged until neurological and functional stability had been reached. There was no difference for age, length of stay, Barthel Index scores at admission and discharged between the groups. Gain in the Barthel Index scores between admission and discharge (p=0.005) resulted from more efficiency in the group with hemorrhagic stroke. These patients appeared to exhibit better functional gain at discharge from rehabilitation than nonhemorrhagic patients. This observation points out that long-term outcome is also better for patients who experience hemorrhagic stroke.
Subject(s)
Stroke Rehabilitation , Aged , Aphasia/diagnosis , Aphasia/etiology , Aphasia/rehabilitation , Female , Functional Laterality/physiology , Hospitalization , Humans , Length of Stay , Male , Prospective Studies , Psychomotor Disorders/diagnosis , Psychomotor Disorders/etiology , Psychomotor Disorders/rehabilitation , Retrospective Studies , Severity of Illness Index , Stroke/complications , Stroke/diagnosis , Treatment OutcomeABSTRACT
35 patients with subcortical ischemic or hemorrhagic stroke included in the Lausanne Stroke Registry underwent cerebral blood flow measurement using I-123-IMP and 99mTc-HMPAO single photon emission tomography (SPECT). Our findings suggest that neuropsychological disturbances are not systematically correlated to cortical hypoperfusion secondary to the deep lesion (diaschisis). The role of cortical diaschisis was especially prominent in patients with aphasia and left subcortical lesion.
