Impact of unilateral spatial neglect with or without other cognitive impairments on independent gait recovery in stroke survivors.

OBJECTIVE: To investigate the impact of unilateral spatial neglect with or without other cognitive impairments on recovery of independent gait in stroke survivors. DESIGN: A prospective cohort study. SUBJECTS: Ninety-four stroke survivors in an inpatient rehabilitation ward. METHODS: The presence of unilateral spatial neglect was assessed by the visuospatial perception score of the Stroke Impairment Assessment Set, and other cognitive impairments were assessed by Mini-Mental State Examination. Participants were categorized into 3 groups: group 1, unilateral spatial neglect with other cognitive impairments; group 2, unilateral spatial neglect without other cognitive impairments; and group 3, non-unilateral spatial neglect. The outcome was the walking score of the Functional Independence Measure (FIM) at discharge (score ≥ 6 or ≤ 5). RESULTS: Multivariate logistic regression analysis (reference, group 3) showed that the presence of unilateral spatial neglect with other cognitive impairments (group 1) had a significant association with dependence of gait (p = 0.003), and the odds ratio (95% confidence interval) was 5.55 (1.19-23.04). In contrast, there was no significant relationship between the presence of unilateral spatial neglect without other cognitive impairments (group 2) and dependence of gait (p = 0.207). CONCLUSION: The presence of unilateral spatial neglect without other cognitive impairments is not a significant factor for regaining independent gait. In contrast, unilateral spatial neglect becomes a strong negative factor when combined with other cognitive impairments.

Usefulness of the prediction method based on a logarithmic model for functional recovery in stroke patients: in case of using the motor-Functional Independence Measure score.

Predicting functional recovery is important for the rehabilitation of stroke patients. This study aimed to examine the predictive validity of motor items of Functional Independence Measure (motor-FIM) using the prediction method based on a logarithmic model. This prospective observational cohort study included 111 patients with subacute stroke (mean age: 67.0±13.8 years). The motor-FIM score was assessed at admission, 1 month after admission, and at discharge. We calculated the predictive value of motor-FIM scores at discharge using a logarithmic model, which used only motor-FIM scores at admission and 1 month after admission. The relationship between the actual motor-FIM score at discharge and the predictive value was assessed with the intraclass correlation coefficient. The motor-FIM score at admission, 1 month after admission, and at discharge, and the predictive value were 41.9±15.0, 52.3±18.4, 66.0±18.8, and 65.1±21.2, respectively. The predictive value was highly correlated with the actual motor-FIM score at discharge (intraclass correlation coefficient=0.89). Our results suggest that we can use the prediction method based on a logarithmic model for predicting the motor-FIM score at discharge. This may be useful for designing rehabilitation programs for patients with subacute stroke.

Combination of Low Body Mass Index and Low Serum Albumin Level Leads to Poor Functional Recovery in Stroke Patients.

BACKGROUND: Nutritional status is associated with the functional recovery of stroke patients. This study aimed to examine the influence of the combination of body mass index (BMI) and serum albumin level on functional recovery in subacute stroke patients. METHODS: This retrospective cohort study included 259 subacute stroke patients (mean age 68.9 ± 12.3 years). Patients were categorized into 4 groups according to their BMI and serum albumin level: group 1, low BMI (<18.5 kg/m2) and low serum albumin level (<3.5 g/dL); group 2, low BMI and high serum albumin level (≥3.5 g/dL); group 3, normal weight (≥18.5 kg/m2) and low serum albumin level; and group 4, normal weight and high serum albumin level. The outcome variable was the motor subscale of the Functional Independence Measure (M-FIM) effectiveness. We defined the first quartile of M-FIM effectiveness as poor functional recovery. Multivariate logistic regression analysis was performed to examine the influence of the combination of BMI and serum albumin level on poor functional recovery. RESULTS: Multivariate logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that group 1 was mostly associated with a significant risk of poor functional recovery (odds ratio, 4.13; 95% confidence interval, 1.53-11.15). CONCLUSIONS: Our results suggested that the combination of low BMI and low serum albumin level was more significantly associated with poor functional recovery in subacute stroke patients than either factor alone. The combination of BMI and serum albumin level should be taken into account when predicting functional recovery in subacute stroke patients.

[Osteoporosis in the disabled].

Osteoporosis is a well-known complication of paralytic diseases. We investigated 11 patients with chronic spinal cord injury who have been paralyzed for 20 years or more. History of fracture was searched in these 11 patients. Mineral density in the lower limbs was measured, and the bone metabolism was examined. Of the total of 8 fractures, 87.5% occurred in the relatively low muscle tonus group. Patients showed decreased bone mineral density of the femoral neck, and this was negatively correlated with period of paralysis. One female patient showed an abnormal rise in bone absorption markers. In this case, bisphosphonates can be effective to increase the bone mineral density. To prevent fracture in patients with paralysis, particular care should be taken in wheelchair operation and handling of the lower limbs.