Abstract
BackgroundSo far, the role of clinical neurophysiology in the prediction of outcome from neurological and neurosurgical early rehabilitation is unclear.MethodsClinical and neurophysiological data of a large sample of 803 early rehabilitation cases of the BDH-Clinic Hessisch Oldendorf in Northern Germany have been carefully reviewed. Most patients (43.5 %) were transferred to rehabilitation after stroke, mean age was 66.6 (15.5) years. Median somatosensory (SEP), auditory (AEP) and visual evoked potentials (VEP) along with EEG recordings took place within the first two weeks after admission. Length of stay (LOS) in early rehabilitation was 38.3 (37.2) days.ResultsAbsence of SEP on one or both sides was associated with poor outcome, χ2 = 12.98 (p = 0.005); only 12.5 % had a good outcome (defined as Barthel index, BI ≥50) when SEP were missing on both sides. In AEP, significantly longer bilateral latencies III were observed in the poor outcome group (p < 0.05). Flash VEP showed that patients in the poor outcome group had a significantly longer latency III on both sides (p < 0.05). The longer latency III, the smaller BI changes (BI discharge minus admission) were observed (latency III right r = −0.145, p < 0.01; left r = −0.206, p < 0.001). While about half of the patients with alpha EEG activity belonged to the good outcome group (80/159, 50.3 %), only 39/125 (31.2 %) with theta and 5/41 (12.2 %) with delta rhythm had a favourable outcome, χ2 = 24.2, p < 0.001.ConclusionsResults from this study suggest that loss of median SEP, prolongation of wave III in AEP and flash-VEP as well as theta or delta rhythms in EEG are associated with poor outcome from neurological early rehabilitation. Further studies on this topic are strongly encouraged.
Highlights
The role of clinical neurophysiology in the prediction of outcome from neurological and neurosurgical early rehabilitation is unclear
Loss of cortical somatosensory evoked potentials (SEP) on one or both sides was associated with poor outcome (Table 7), χ2 = 12.98 (p = 0.005)
While 153/353 (43.3 %) had a good outcome when SEP were present, only 26.3 % (21/80) belonged to the good outcome group when SEP were absent on one side and 12.5 % (2/16) when SEP were absent on both sides
Summary
The role of clinical neurophysiology in the prediction of outcome from neurological and neurosurgical early rehabilitation is unclear. Patients entering neurological and neurosurgical early rehabilitation are severely impaired. Rehabilitation patients are dependent on nursing and may be colonized with multi-drug resistant germs [4, 5]. Their outcome is poor, but it is quite difficult to predict outcome accurately [3]. The role of clinical neurophysiology, in particular electroencephalography (EEG) and evoked potentials (EP) in predicting outcome of these patients is still unclear. The question is whether clinical neurophysiological techniques may help to distinguish between patients who benefit from neurological early rehabilitation and such who don’t. In contrast to imaging techniques, neurophysiological measurements are easy to perform, cheap, safe and available in most rehabilitation facilities
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