Human mind reaching for new ideas never retreats to the previous dimensions.
- Oliver Wendell Holmes

INTRODUCTION

Brain plasticity plays role in the whole human life. It is stimulated by many factors, particularly by stimuli resulting from every day activity, and thus early begun rehabilitation of post stroke patients reduces in a greater dimension the degree of disability. [1]

Clinical examination provides a lot of information concerning severity of the stroke, its dynamism and effects. It may also have some significance in the further prognosis of survival and the results of rehabilitation. [2] Mazur et al. [3] have devised a classification based on the symptoms occurring for 24 hours after the stroke (S), with the division to three clinical groups (CG), on the basis of general motor activity of the body (GMA).

I CG GMA  -  patients with focused neurological deficiency, able to sustain standing   position.

II CG GMA- patients with focused neurological deficiency, not able to sustain standing  position.

III CG GMA - patients with consciousness disorder and symptoms as in CG GMA I and II,  if the severity of the disorder allows determination of its occurrence.

The aim of the project was to analyse the results of rehabilitation in the period of 12 months of observation of patients’ CG after stroke concerning their sex, side of the paresis and the influence of general motor activity in connection with the age of the patients.

MATERIAL AND METHODS

The results of the rehabilitation were analysed in the group of 90 patients (45 women and 45 men) in the age of 37 to 84 with right side paresis (40 patients) and left side paresis (50 patients) with particular focus on their general motor activity (53 patients from II CG GMA and 37 patients from III CG GMA).

The patients underwent possibly complete and consistent rehabilitation program covering: individual kinesitherapy and physiotherapy, occupational therapy, hydrotherapy and logotherapy, if needed.

The clinical groups were divided into three subgroups concerning the age of the patients: to 59 years (A, A1), 60 to 69 years (B, B1) and over 70 (C, C1) years of age.

Neurological, functional and general condition of rehabilitated patients was assessed according to Mathew et al [4], Barthel [5] and Rankin [2] scale. The assessment was repeated four times - at the admission to the hospital, at he beginning of rehabilitation (about 6 weeks after the stroke), after completing rehabilitation (about 11 weeks after the stroke) and finally, after 12 months after the stroke.

The results were analysed using Wilcoxon (WI), Cochran-Cox (CC) and t-Student tests (SN).

RESULTS

Significant statistical differences (p<0.05) according to Mathew et al, and Barthel scale were noted in both groups of patients (with right and left paresis) only at the admission to the hospital (fig. 1, 2). In Rankin scale no statistically important differences were observed (fig. 3).

No statistically significant differences (p>0.05) in any of the applied scales were noted between both groups of patients (women and men) at the admission to the hospital (fig. 4, 5, 6). Also, no statistically significant differences were observed before the beginning of rehabilitation, after the rehabilitation and 12 months after the stroke.

During the observation, statistically significant differences in the condition of patients were noticed between motor activity and age groups. The differences occurred only during the first three stages of treatment and were measured according to both neurological and functional scales (fig. 7 and 8). In Rankin scale some differences appeared after rehabilitation (fig. 9). Still, the follow-up examination after 12 months, showed no statistically significant differences between groups of patients (fig. 8).

GENERAL REMARKS

Even the slightest improvement in functional and psychological condition influences the quality of life of patients and their family. The problem and needs of a patient and their relatives tend to change during the rehabilitation.

In many publications patients with left side paresis are considered more difficult to treat and achieving worse results during the rehabilitation. [6,7,8] The authors of those publications explain the phenomenon with perceptive-motor disorder related to right hemisphere injuries.

However, it is not a widely accepted observation. The above results prove that the side of paresis does not play significant role in the later assessment of rehabilitation.

The differences between women and men are most noticeable in verbal intelligence, various linguistic tests and manual tasks. The reason for these differences is seen in the different level of lateralization of the described functions directly related with sex. This fact may be reflected in the effectiveness of the rehabilitation of motor and neurological functions. [9]

Most of authors do not consider sex as a determinant in the prognosis in rehabilitation of patients after the stroke. [1,10,11,12,13] But the assessment of patients’ condition against three different scales does not confirm the significance of sex for later rehabilitation results.

Mazur et al [3] believe that application of classification regarding the division into motor activity groups, which is strictly connected with clinical picture of cerebral ischemia during the first 24 hours after the stroke, has important prognostic value, and moreover allows predicting the effects of the rehabilitation. According to the above data and previous research [14], the assessment according to CG GMA cannot determine predicted dynamism of recovery of rehabilitated patients.

Early complications occurring after the stroke have particular influence on the quality of patients’ life. The complications are frequently caused by the lack of rehabilitation, often make further rehabilitation impossible, heighten the costs of treatment, and  moreover, they significantly limit patients independence [1,8]. According to Laider [1] the main factors facilitating achievement of optimal efficiency after the stroke are: patient’s condition before the stroke, later complications, severity of disorders, uncoordinated or contradicting rehabilitation techniques.

However, it appears that the degree of patient’s recovery mainly depends on generally defined plasticity of the brain and the patient himself.

CONCLUSIONS

1. The side of the paresis and sex of the patient does not play significant role in the assessment of the rehabilitation after stroke.

2. Assessment of the motor activity of the body is not a prognostic criterion in the assessment of patients’ condition after 12 months after stroke.

3. Age of patients rehabilitated after a stroke should not be a prognostic criterion in the assessment of the results of the treatment.

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REFERENCES

1.    Laider P.: Stroke rehabilitation. Chapman and Hall, London 1994.

2.    Brola W., Czernicki J.: Evaluation of treatment and rehabilitation progress methods at patients with stroke (in Polish). Przegl. Lek., 1996, 53, 1-3.

3.    Mazur R. et al: Physical activity in the acute cerebral flow failure (in Polish). Pol. Tyg. Lek., 1992, 47 (14-15), 302-304.

4.    Mathew N.T. et al.: Double blind evaluation of glycerol therapy in acute cerebral infarction. The Lancet, 1972, Dec., 1327.

5.    Mahoney F.J. Barthel  D.W.:  Evaluation the Barthel Index. Maryland State Med. J., 1965, 14, 61-65.

6.    Czerner M., Wieczorek E.: Udary mózgu – rokowanie w zależności od miejsca uszkodzenia. Post. Reh., 1997, 11 (3), 11-19.   

7.    Chojnacka-Szawłowska G., Szawłowski K.: Rola zaburzeń wyższych czynności  nerwowych w rehabilitacji chorych z niedowładami połowiczymi. W:  Zdolności kompensacyjne i możliwości ich wykorzystania w rehabilitacji osób z ogniskowymi uszkodzeniami ośrodkowego układu nerwowego. Materiały z sesji naukowej.  Poznań, 7-8 listopada 1983, PZWL.  1985.

8.    Chojnacka-Szawłowska G., Szawłowski K.: Rehabilitacja medyczna. Agencja Wydawniczo-Informacyjna , Warszawa, 1994.

9.    Szafraniec L., Czernicki J.:  Asymetria czynnościowa półkul mózgowych. Lek. Wojsk., 1994, 1 (1- 2), 67-72.

10.    Jaracz K.: Czynniki warunkujące poziom ograniczenia ról społecznych u chorych po udarze mózgu. Post. Reh., 1995, 9 (1), 69-78.

11.    Kwolek A.: Czynniki ryzyka udaru mózgu u chorych rehabilitowanych szpitalnie. Post. Reh., 1997, 11(3), 21-46.

12.    Stępniak U., Orłowski T.,  Augustajtys B.: Rehabilitacja chorych z niedowładami połowiczymi pochodzenia naczyniowego. Baln. Pol., 1996, 38 (1-2), 53-56.

13.    Woldańska-Okońska M., Czernicki J.: Ocena wyników rehabilitacji kobiet i mężczyzn  po udarze niedokrwiennym mózgu. Post. Rehab., 1999, 13 (2), 5-10.

14.    Woldańska-Okońska M., Czernicki J.: Przydatność oceny motoryki ogólnej ciała w różnych grupach wiekowych w prognozowaniu wyników rehabilitacji chorych po udarze mózgu. Post. Rehab., 1999, 13 (2), 11-17.

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Adres do korespondencji:

Marta Woldańska-Okońska
ul. Kochanowskiego 4
98-200 Sieradz
tel.: 601 377 610
fax: 0 43 827 50 58

Artykuł nadesłano: 16.11.2007
Zaakceptowano do druku: 10.01.2008