Factors necessary for independent walking in patients with thalamic hemorrhage

Shigenori Hiraoka,Shinichiro Tanaka,Reisuke Funahashi,Hideto Okazaki,Sayaka Okamoto,Shinichiro Maeshima,Naoki Asano,Kei Yagihashi,Hirokazu Hori,Ikuko Fuse,Shigeru Sonoda

doi:10.1186/s12883-017-0991-2

Shigenori Hiraoka, Shinichiro Tanaka + Show 9 more

Open Access

https://doi.org/10.1186/s12883-017-0991-2

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Abstract

BackgroundThalamic hemorrhages cause motor paralysis, sensory impairment, and cognitive dysfunctions, all of which may significantly affect walking independence. We examined the factors related to independent walking in patients with thalamic hemorrhage who were admitted to a rehabilitation hospital.MethodsWe evaluated 128 patients with thalamic hemorrhage (75 men and 53 women; age range, 40–93 years) who were admitted to our rehabilitation hospital. The mean duration from symptom onset to rehabilitation hospital admission was 27.2 ± 10.3 days, and the mean rehabilitation hospital stay was 71.0 ± 31.4 days. Patients’ neurological and cognitive functions were examined with the National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination (MMSE), respectively. The relationship between patients’ scores on these scales and their walking ability at discharge from the rehabilitation hospital was analyzed. Additionally, a decision-tree analysis was used to create a model for predicting independent walking upon referral to the rehabilitation hospital.ResultsAmong the patients, 65 could walk independently and 63 could not. The two patient groups were significantly different in terms of age, duration from symptom onset to rehabilitation hospital admission, hematoma type, hematoma volume, neurological symptoms, and cognitive function. The decision-tree analysis revealed that the patient’s age, NIHSS score, MMSE score, hematoma volume, and presence of ventricular bleeding were factors that could predict independent walking.ConclusionsIn patients with thalamic hemorrhage, the neurological symptoms, cognitive function, and neuroimaging factors at onset are useful for predicting independent walking.

Highlights

Thalamic hemorrhages cause motor paralysis, sensory impairment, and cognitive dysfunctions, all of which may significantly affect walking independence
Evaluations We evaluated the following items in our patients with thalamic hemorrhage: age, duration from symptom onset to rehabilitation hospital admission, classification for hematoma location on computed tomography (CT) images [4], side of the stroke focus, hematoma volume, ventricular bleeding, and neurological and cognitive function
The two patient groups were significantly different in terms of age, duration from symptom onset to rehabilitation hospital admission, presence/absence of ventricular bleeding, hematoma volume, National Institutes of Health Stroke Scale (NIHSS) scores, Mini-Mental State Examination (MMSE) scores, and presence/absence of unilateral neglect (Table 2)

Summary

Introduction

Thalamic hemorrhages cause motor paralysis, sensory impairment, and cognitive dysfunctions, all of which may significantly affect walking independence. We examined the factors related to independent walking in patients with thalamic hemorrhage who were admitted to a rehabilitation hospital. Given its interconnectedness with other regions, thalamic hemorrhages can cause cognitive dysfunctions such as aphasia, unilateral neglect, and memory impairments, as well as motor paralysis and sensory disturbances. Few reports discuss the factors related to walking in patients with thalamic hemorrhage [3]. Understanding these factors is important for predicting patient outcome and for efficiently and effectively advancing their rehabilitation program

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