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A Rehabilitation Program for Patients Recovering from Severe Stroke

Published online by Cambridge University Press:  02 December 2014

Robert W. Teasell ,
Norine C. Foley ,
Sanjit K. Bhogal ,
Raja Chakravertty  and
Anna Bluvol
Robert W. Teasell*
Affiliation:
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care London, London, Ontario, Canada Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada Lawson Health Research Institute, London, Ontario, Canada
Norine C. Foley
Affiliation:
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care London, London, Ontario, Canada
Sanjit K. Bhogal
Affiliation:
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care London, London, Ontario, Canada
Raja Chakravertty
Affiliation:
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care London, London, Ontario, Canada Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
Anna Bluvol
Affiliation:
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph's Health Care London, London, Ontario, Canada
*
Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St. Joseph’s Health Care London, 801 Commissioners Road East, London, Ontario, Canada N6C 5J1
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Abstract:

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Objective:

The purpose of this study was to describe the outcomes of patients with a severe stroke admitted to a specialized “slow stream” rehabilitation program and to develop a model to predict discharge destination.

Methods:

Chart review of 196 consecutive non-ambulatory (“lower-band”) stroke patients admitted between 1996-2001, to a specialized in-patient rehabilitation unit designed to accommodate the needs of patients with profound disabilities, and who were considered inappropriate for conventional inpatient rehabilitation programs. Special features of this program included the availability of an independent living unit, therapies tailored to individual tolerance and the opportunity to remain on the unit for an extended period until such time that the patients' rehabilitation potential had been maximized.

Results:

Patients were admitted to the unit after a median of 49 days following stroke onset. Their median admission and discharge functional independence measure (FIMTM) scores were 46 and 70, respectively. The improvement in ability to perform self-care tasks was statistically significant (Z= -11.18, p<0.0001). By discharge, 54 patients (28%) were able to ambulate independently (with or without an assistive device), while 142 patients (72%) remained wheelchair dependent. Eighty-five patients (43%) returned to their own home upon rehabilitation discharge, while the remainder were admitted to nursing homes or hospitals closer to the patients' home. Admission FIM score, age, no previous history of stroke and male sex were the variables found to most strongly predict discharge home.

Conclusions:

Patients with severe strokes who received individualized care on a highly specialized stroke rehabilitation unit achieved impressive functional outcomes despite a lag of seven weeks post stroke before rehabilitation was initiated. Many patients were no longer wheelchair dependent and almost half returned home. Active rehabilitation should not be limited to “middle-band” stroke patients.

Résumé:

RÉSUMÉ:Objectif:

Le but de cette étude était de décrire les résultats d’un programme de réadaptation spécialisé « allégé » chez des patients ayant subi un accident vasculaire cérébral (AVC) sévère et de développer un modèle pour prédire le type d‘hébergement requis lorsqu‘ils ont complété le programme.

Méthodes:

Il s’agit d’une revue du dossier de 196 patients consécutifs non ambulants ayant subi un AVC admis à une unité spécialisée de réadaptation entre 1996 et 2001. Cette unité est conçue pour répondre aux besoins de patients ayant des handicaps sévères pour lesquels les programmes de réadaptation conventionnels ne sont pas appropriés. Ce programme comporte une unité d‘hébergement autonome, des traitements adaptés au niveau de tolérance individuelle et la possibilité d’y demeurer tant que le potentiel de réadaptation du patient n’a pas été maximisé.

Résultats:

Les patients étaient admis à l’unité après un temps médian de 49 jours post AVC. Le score médian à la mesure de l’indépendance fonctionnelle (MIF) au moment de l’admission et du départ était de 46 et 70 respectivement. L’amélioration de la capacité à pourvoir à leurs soins personnels était statistiquement significative (Z = -11,18 ; p < 0,0001). Au moment du congé, 54 patients (28%) pouvaient marcher seul (avec ou sans appareil) et 142 patients (72%) étaient en fauteuil roulant. Quatre-vingt-cinq patients (43%) sont retournés à leur domicile à leur sortie de l’unité alors que les autres ont été admis en centre de soins de longue durée ou à un hôpital plus près de leur domicile. Le score MIF à l’admission, l’âge, l’absence d’antécédents d’AVC et le genre masculin étaient les variables qui prédisaient le mieux le retour à domicile au moment du congé de l’unité.

Conclusions:

Les patients ayant subi un AVC sévère qui reçoivent des soins individualisés dans une unité de réadaptation spécialisée dans l’AVC réussissent à atteindre un niveau fonctionnel impressionnant en dépit d’un délai de sept semaines entre l’AVC et la réadaptation. Plusieurs patients ne sont plus dépendants du fauteuil roulant et presque la moitié retourne à la maison. La réadaptation active ne devrait pas être limitée aux patients ayant des déficits modérés.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 512 - 517
Copyright
Copyright © The Canadian Journal of Neurological 2005

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