Rehabilitation after stroke : Effects of length of stay and treatments to faciliate motor recovery after stroke

Field: Medicine (Health Sciences)

Stroke is the primary cause of long-term disability. Although the effects \nof stroke unit rehabilitation have been well documented, the specific \nreasons for this advantage are difficult to single out. The aim of the \npresent study was to investigate if factors such as length of stay, TENS \nstimulation or site of lesion can influence rehabilitation outcome. \n \n \n \nTo investigate the effect of length of hospital stay, stroke patients \nadmitted before (n=38) and after restructuring of a stroke unit (n=54) \nwere assessed 12 months after stroke. The median length of stay decreased \nsignificantly after restructuring but there were no significant \ndifferences in motor function, ADL or other characteristics between \ngroups. Patients with a shorter length of stay were less depressed and \ntended to be more satisfied with family life and social contacts. \n \n \n \nPatients who had a paretic arm as a consequence of their first stroke \noccurring 6-12 months previously were included in a study with \nlow-frequency transcutaneous nerve stimulation (Low- TENS), and randomly \nassigned to either a treatment group (n=26) or a control group (n=18) All \npatients received physiotherapy at a day-care center, usually twice a \nweek. The treatment group received, in addition, Low-TENS to stimulate \nthe paretic arm for 60 min, five days a week for three months. In a \nfollow-up study, a subgroup of patients were re-tested 3 years after \ncompletion of the treatment. \n \n \n \nArm motor function increased significantly after Low-TENS stimulation, \ncompared to controls. Patients with less severely affected arms showed \ngreatest improvement. The lowTENS treatment did not decrease either pain \nor spasticity. Barthel-scores in activities of daily living (ADL) did not \nchange over the evaluation intervals. At follow up, the ADL score \nremained at a similar level in the Low- TENS group, whereas motor \nfunction of the paretic arm had deteriorated in both treatment and \ncontrol groups. Increased spasticity was seen in both groups. \n \n \n \nThe hypothesis that the topography of brain lesion following stroke \npredicts improved motor function after Low-TENS treatment was tested. \nMagnetic resonance imaging (MRI) was performed in 14 patients who had \npreviously received Low-TENS. Absence of lesions in a described part of \nthe periventricular white matter area increased the possibility for \nimproved motor capacity following Low- TENS treatment. \n \n \n \nThirty minutes daily Hi-TENS treatment for three months over a specific \nacupuncture point was used to reduce spasticity in the paretic leg after \nstroke. A significant reduction of spasticity was seen after completion \nof Hi-TENS treatment and could be seen in knee extensor muscles as well \nas in plantar flexor muscles. This reduction remained 2 weeks after the \nend of the treatment. \n \n \n \nIn conclusion, a shorter length of stay does not affect rehabilitation \noutcome for the group of patients living at home one year after stroke. \nMotor recovery for certain patient groups can be supported by treatment \nwith either Low- or Hi-TENS. The TENS-unit is easy to handle by the \npatients themselves or close family members. Determining the site of \nlesion could be a method to predict the positive effect of such \ntreatment.