Barthel Index Improvement Research Articles

Efficacy and safety of 3-month dual antiplatelet therapy in patients after mechanical thrombectomy for acute ischemic stroke: a retrospective study.

Mechanical thrombectomy (MT) is one of the effective treatment methods for acute ischemic stroke (AIS), which requires a period of dual antiplatelet therapy (DAPT) after endovascular treatment. This study aimed to compare the efficacy and safety of 3-month DAPT and 1-month DAPT in AIS patients receiving MT through a retrospective study. AIS patients who received MT from May 2018 to March 2023 were grouped into a 1-month group (1-M group) and a 3-month group (3-M group) according to the duration of DAPT after MT. The primary outcome was the mRS score at 90 days. Secondary outcomes included a good prognosis (mRS score of 0-2) at 90 days post-surgery, 6-month mortality, recurrence of cerebral infarction, Barthel's index, Montreal Cognitive Assessment (MoCA) score, and incidence of symptomatic intracranial hemorrhage (sICH) during hospitalization. A total of 147 patients with AIS were included in the final analysis, with 78 patients in the 1-M group and 69 patients in the 3-M group. The baseline and neurological characteristics were comparable between both groups. At 3-month follow-up, a total of 61 patients had an mRS of 0-2 at 90 days, with an average mRS of 3.3 ± 0.9 for all patients. There was no statistically significant difference in the mRS between the two groups of patients at 90 days (P > 0.05). There was no statistically significant difference in the mortality rate and incidence of sICH between the two groups of patients during the 6-month follow-up period (P > 0.05), but the recurrence rate of AIS in the 3-M group was lower than that in the 1-M group (P < 0.05). The improvement of Barthel index and MoCA in patients in the 3-M group was higher than those in the 1-M group at 6 months but not statistically different (P > 0.05). For AIS patients undergoing mechanical thrombectomy, compared to 1-month DAPT, 3-month DAPT can reduce the recurrence rate of IS during a 6-month follow-up period, without increasing the mortality and risk of cerebral hemorrhage.

Osmotic Demyelination Syndrome after Correction of Hyponatremia

Osmotic demyelination syndrome is a rare neurological disease resulting in cerebral apoptosis and loss of myelin due to osmotic stress. Based on anatomical localization and pathological attributes, ODS can be categorized as Central Pontine Myelinolysis (CPM) and Extrapontine Myelinolysis (EPM). It has a biphasic course, with first phase reflecting electrolyte imbalance and the second with pontine dysfunction, impaired vigilance and movement disorders. In an autopsy-based study, a prevalence rate of 0.25–0.5% was seen in the general population and 10% in patients undergoing liver transplantation. Being a rare disease with variable, but preventable outcome, the present case was managed with Ayurvedic oral medication and Panchakarma therapy with an aim to improve the quality of life. In Ayurvedic perspective, Vata kshaya lakshanas occur during the phase of hyponatremia and further correction of this leads to disruption of osmolality (Kapha pitta accumulation) resulting in Avarana of Vata. This may be the reason for demyelination and localisation of Vata in Sira and Snayu leading to Sira snayu shoshana on both halves of the body resulting in Sarvangaroga (full body afflicted with Vata). Thus Avaranahara, Srotosodhana and Vatanulomana principles were adopted. An improvement in Barthel index and modified rankin scale were observed after a course of treatment for 30 days.

Propensity-Matched Study of Early Cardiac Rehabilitation in Patients With Acute Decompensated Heart Failure.

The impact of early implementation of cardiac rehabilitation (CR) in heart failure (HF) patients remains to be elucidated. This study sought to determine whether CR during HF hospitalization could improve prognostic outcomes in patients with acute decompensated HF. We analyzed patients with HF enrolled in the JROADHF (Japanese Registry of Acute Decompensated Heart Failure) registry, a retrospective, multicenter, nationwide registry of patients hospitalized for acute decompensated HF. Eligible patients were divided into 2 groups according to CR during hospitalization. The primary outcome was a composite of cardiovascular death or rehospitalization due to cardiovascular event after discharge. The secondary outcomes were cardiovascular death and cardiovascular event rehospitalization. Out of 10 473 eligible patients, 3210 patients underwent CR. Propensity score matching yielded 2804 pairs. Mean age was 77±12 years and 3127 (55.8%) were male. During a mean follow-up of 2.8 years, the CR group had lower incidence rates of the composite outcome (291 versus 327 events per 1000 patient-years; rate ratio, 0.890 [95% CI, 0.830-0.954]; P=0.001) and rehospitalization due to cardiovascular event (262 versus 295 events per 1000 patient-years; rate ratio, 0.888 [95% CI, 0.825-0.956]; P=0.002) than the no CR group. In-hospital CR was associated with an improvement in Barthel index for activities of daily living (P=0.002). Patients with very low Barthel index at admission were benefited by CR in comparison with patients with independent Barthel index (very low; hazard ratio, 0.834 [95% CI, 0.742-0.938]: independent; hazard ratio, 0.985 [95% CI, 0.891-1.088]; P for interaction=0.035). CR implementation during hospitalization was associated with better long-term outcomes in patients with acute decompensated HF. These data support the need for a randomized, controlled, adequately powered trial to definitively test the role of early physical rehabilitation in hospitalized patients with HF.

Profiling of patients in aspecialized geriatric outpatient clinic

In Germany geriatric outpatient care is predominantly done by family doctors and general practitioners (GP). There are regionally different concepts for additional specialized geriatric outpatient care but they have not yet been validated and established. Still, it remains unclear whether ageriatric patient has to be diagnosed rather in aspecialized outpatient or inpatient setting. The aim of the present study is the profiling of geriatric outpatients to find key distinctions from geriatric patients that have to be admitted to hospital. Retrospective data analysis of patients sent to aspecialized geriatric outpatient clinic by their GP, compared with data of geriatric inpatients sent to hospital by their GP during the same time period. Study parameters comprised elements of the comprehensive geriatric assessment as well as results of routinely applied laboratory tests. Patients sent to the specialized geriatric outpatient clinic showed better results of functional assessments. Regression analysis: improvement of Barthel Index, GFR and total protein increased the chance of outpatient treatment. Early identification of geriatric patients who can be treated in aspecialized outpatient setting would ease the burden for GPs by interdisciplinary cooperation and prevent cost-intensive readmissions to hospital.

Iron deficiency, fatigue and muscle strength and function in older hospitalized patients

Background/ObjectivesIron deficiency is common in older patients. We investigated whether iron deficiency is an independent risk factor for functional impairment, low muscle function, fatigue, and rehabilitation progress in older hospitalized patients.Subjects/MethodsTwo hundred twenty-four patients (age range 65–95 years; 67% females) who were consecutively admitted to a geriatric acute care ward participated in this prospective longitudinal observational study. Ferritin, iron, transferrin in serum, and blood hemoglobin were measured and current iron supplementation was recorded. Fatigue and comorbidity were measured using the fatigue severity scale and Charlson Comorbidity Index, respectively. Barthel Index, handgrip strength, and isometric knee extension strength were conducted at the time of hospital admission and before discharge.ResultsNinety-one (41%) patients had iron deficiency in which the majority had functional iron deficiency (78/91, 86%). Absolute iron deficiency with and without anemia was diagnosed in 12 (13%) and one patients, respectively. Barthel Index and handgrip and knee extension strength significantly improved during hospitalization in iron deficiency and non-iron deficiency groups. Knee extension strength showed better improvement in iron-deficient patients receiving iron supplementation and iron supplementation during hospital stay was the main predictor for improvement in knee extension strength. Comorbidity, iron deficiency, and changes in handgrip strength were the major independent risk factors for poor improvement in Barthel Index during hospitalization. There were significant associations between patients’ fatigue and iron deficiency, comorbidity, and female gender.ConclusionIron deficiency is an independent risk factor for fatigue and poor functional recovery among older hospitalized patients. Iron supplementation seems to be capable of improving functional performance.

Effectiveness of Early Rehabilitation for Vertebral Compression Fractures: A Retrospective Cohort Study.

Most patients become physically inactive after vertebral compression fracture and thus need help for early mobilization. This study sought to investigate the effect of early rehabilitation on activities of daily living in patients following acute vertebral compression fracture. We conducted this retrospective cohort study with a hospital-based database created by the Japan Medical Data Center and comprising data from a Diagnosis Procedure Combination survey from more than 100 acute care hospitals across Japan. Data of consecutive inpatients hospitalized because of thoracic and/or lumbar compression fractures from 2014 to 2018 were extracted. We compared characteristics and outcomes between patients who underwent early rehabilitation (early rehabilitation group) and those who did not undergo rehabilitation (no rehabilitation group). The primary outcome measure was Barthel Index improvement. After applying exclusion criteria, a total of 8493 eligible patients with acute vertebral compression fracture were included in this study. The unadjusted data showed significantly greater Barthel Index improvement (72.5% vs 60.3, P < .001) and a higher rate of discharge to home (82.9% vs 77.4, P < .001) among patients in the early rehabilitation group compared with the no rehabilitation group. After adjustment by propensity score analysis, significant between-group differences were found. Early rehabilitation could possibly be a feasible alternative for maintenance of the Barthel Index in patients with acute vertebral compression fracture.

Medium-long-term mortality and change in functional status in elderly patients with pacemaker.

Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. We designed a prospective study to analyze the cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. An observational study including pacemaker implants in individual older than 70 years old in a single-center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long-term mortality, and functional status after implantation was undertaken. About 60% of patients were older than 80 years old. The third-degree atrioventricular blockage (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel Index and functional status in this subgroup of patients, 3 years after pacing. Long-term mortality in individuals older than 80 years old with pacemaker implantation was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Medium-long term mortality and change in functional status in elderly patients with pacemaker.

Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. We designed a prospective study to analyze cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Observational study including pacemaker implants in individual older than 70 years old in a single center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long term mortality and functional status after implantation were undertaken. 60% of patients were older than 80 years old. Third-degree atrio-ventricular block (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001 respectively). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel index and functional status in this subgroup of patients, 3 years after pacing. Long-term mortality in individuals older than 80 years old with pacemaker implantation, was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Application of survival analysis techniques to determine the optimal number of acupuncture therapy sessions for stroke patients

Acupuncture has shown clinical benefits in stroke patients but there is currently no clear recommendation on the number of acupuncture sessions that should be offered. The aim of this study was to determine the optimal number of acupuncture therapy sessions, following which significant clinical improvement could be anticipated. We performed a retrospective observational study in stroke patients who had received acupuncture therapy as an adjunct treatment at Trang Hospital-a non-academic provincial hospital in Southern Thailand-between 1 July 2016 and 30 June 2017. Significant clinical improvement in activities of daily living (ADLs) was defined as an increase in the Barthel Index of ⩾10 points from baseline. Survival analysis techniques were applied to determine the optimal number of acupuncture therapy sessions. Of 89 patients, 78% had a significant clinical improvement. Kaplan-Meier analysis estimated that 50% of the patients exhibited significant improvements by the eighth acupuncture therapy session. By the 16th session, the proportion of patients increased to 81%. Subgroup analyses revealed that the clinical improvement did not depend on baseline Barthel index, whereas early treatment (within 3 months of stroke onset) was associated with a faster response than late treatment. The median numbers of sessions required to achieve a significant improvement in the early and late treatment groups were 8 and 11, respectively. Stroke patients who were going to improve saw a significant improvement in Barthel index by the 16th acupuncture session and the marginal improvement declined substantially afterward. Our approach required minimal data available from the medical records of a non-academic facility, yet practical implication could be achieved. The study was retrospectively registered on 18 August 2017 with the Thai Clinical Trials Registry (ref. TCTR20170822002).

The Effects Of Exercise Training To Frailty Patient During Post-acute Care Hospitalization

In Taiwan, frailty patient can receive post-acute rehabilitative care in hospital after they leave acute care hospital. The post-acute care program is proposed by the Ministry of Health and Welfare in Taiwan for functional recovery of the frailty patient. The post-acute care program including strengthening, flexibility, cardiopulmonary, and balance exercise. PURPOSE: To evaluate the functional recovery of the frailty patient in in Taiwan with a two-weeks of regular exercise training. METHODS: Twelve frailty elderly (Age: 83.25±5.5 years of age) just leave acute medical care were included in this study. The patient must have one of the underlying diseases include dementia, chronic kidney disease, parkinsonism, and Chronic Obstructive Pulmonary Disease. The therapeutic interventions were regular exercise training including strengthening, flexibility, cardiopulmonary, and balance exercise for two weeks. Before and after intervention, Functional outcome were evaluated. Data collection from multiple variables was conducted using questionnaire and examination including Barthel index, IADL, Clinical Frailty scale, Confusion Assessment Method, and Mini Nutritional Assessment-Short Form. RESULTS: The result shows significant improvement in Barthel index, Clinical Frailty scale, and Mini Nutritional Assessment-Short Form (p < .05). Among other tests, there is no significant difference. CONCLUSION: Two-week exercise training program can improve functional outcome of frailty patient during post-acute care.

Carotid duplex parameters to predict long term outcomes of ischemic stroke patients receiving intra-arterial thrombectomy treatment.

Early treatment of acute ischemic stroke with intravenous thrombolysis therapy (ITT) followed by intra-arterial thrombectomy (IAT) is a promising new treatment option for improving functional outcomes. Identifying patients who will benefit from this treatment combination is important.A total of 92 acute ischemic stroke patients who received ITT and IAT with a minimum of 1-year follow-up were included in the study. All parameters of clinical and imaging examinations at baseline were examined which parameters were significantly correlated with the 1-year functional outcomes (modified Rankin scale [mRS], National Institute of Health Stroke Scale [NIHSS], and Barthel Index) after stroke. Receiver-operating characteristic (ROC) curves analysis was performed to estimate the diagnostic performance of each significantly related parameter. Youden index was used to determine the optimal threshold value. Multivariate logistic regression model analyses were applied to verify the results of predicting the favorable functional outcomes.Immediate postoperation outcome with modified thrombolysis in cerebral infarction grading showed that total of 62 patients qualified for satisfactory result (2b or 3). In predicting NIHSS improvement, ROC curve analysis showed that a cutoff point of vertebral artery pulsatility index (VA PI)-ipsilateral ≤2.3 yields the best diagnostic performance (area under the ROC curve [AUC] = 0.728); in predicting mRS improvement, VA PI-ipsilateral ≤1.92 and internal carotid artery resistance index (ICA RI)-ipsilateral ≤0.71 yield good diagnostic performance (AUC = 0.697 and 0.672, respectively); and ICA RI-contralateral ≤0.70 or plaque index-ipsilateral ≤2 had better diagnostic accuracy (AUC = 0.764 and 0.689, respectively) than other indices to predict Barthel index improvement. The multivariate analysis also showed that these 5 indices were those more powerful and highly significant favorable functional outcomes predictors.Parameters of pulsatility and resistance index from carotid duplex could be easily accessed and noninvasive. The outcome of ischemic stroke patients receiving ITT followed by IAT can be forecasted by these 2 crucial predictors that hint the patients' functional outcomes as well as guiding first line in-charge clinician in terms of decision making.

Predictors of hospital-based multidisciplinary rehabilitation effects in persons with multiple sclerosis: a large-scale, single-centre study.

BackgroundPersons with multiple sclerosis may benefit from hospital-based multidisciplinary rehabilitation.ObjectivesTo investigate the effects of hospital-based multidisciplinary rehabilitation and to identify their potential predictors in a large sample of persons with multiple sclerosis.MethodsFrom the charts of 655 persons with multiple sclerosis consecutively admitted to our unit, disease profiles, modified Barthel index, Expanded Disability Status Scale (EDSS), pain numerical rating score and type of interventions were retrospectively collected. We defined an improvement at discharge as follows: modified Barthel index increase of at least 5 points, EDSS decrease of 1.0 if baseline score was 5.5 or less and of 0.5 if baseline score was greater than 5.5; any numerical rating score decrease.ResultsAfter a median admission period of 36 days, at discharge 65%, 22% and 89% of persons with multiple sclerosis improved for modified Barthel index, EDSS and numerical rating score, respectively. The modified Barthel index improvement was associated with shorter disease duration, lower EDSS at baseline and with access to psychological counselling. EDSS improvement was associated with shorter disease duration, relapsing–remitting course, female gender and longer duration of the admission period.ConclusionsInpatient multidisciplinary rehabilitation was associated with improved autonomy in activities of daily living in a relevant proportion of persons with multiple sclerosis. The effect seems to be more evident in individuals with shorter multiple sclerosis duration and relapsing–remitting disease course.

Early Selective Serotonin Reuptake Inhibitors for Recovery after Stroke: A Meta-Analysis and Trial Sequential Analysis

Potential benefits and risks of early (≤30 days from stroke onset) selective serotonin reuptake inhibitors (SSRIs) treatment for neurologic functional recovery after stroke are not fully understood. We searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials that assessed SSRI medications during the initial ictus after stroke versus placebo. Primary outcome was decrease in National Institutes of Health Stroke Scale (NIHSS) score. Secondary outcomes included the improvement of Barthel index, functional independence (modified Rankin Scale score 0-2 at the end of follow-up), the incidence of depression, and adverse events including diarrhea, insomnia, hepatic enzyme disorders, seizure, and intracranial hemorrhage. We used fixed effects models or random effects models to estimate weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) according to heterogeneity. Eight trials were included, with 1549 patients. Compared with placebo, decrease in NIHSS was greater in SSRI-treated patients (WMD, 0.82; 95% CI, 0.31-1.33; P = .002). Trial sequential analysis showed that the cumulative z curve crossed the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. Early SSRI treatment also promoted Barthel index (WMD, 5.32; 95% CI, 1.65-8.99; P = .005) and functional independence (RR, 2.54; 95% CI, 1.82-3.55; P < .0001). There was no difference in the incidence of depression and adverse events between groups. No evidence of publication bias was detected. The early SSRIs treatment reduces the defective neurologic function in patients undergoing rehabilitation after stroke.

Changes in structure and perfusion of grey matter tissues during recovery from Ischaemic subcortical stroke: a longitudinal MRI study.

Stroke recovery with changes in volume and perfusion of grey matter (GM) tissues remains largely unknown. We hypothesized that GM atrophy co-existed with GM plasticity presenting with increased volume and perfusion in specific regions in the period of post-stroke recovery. Twelve well-recovered stroke patients with pure subcortical lesions in the middle cerebral artery-perfused zone were included. All of them underwent structural and perfusion magnetic resonance imaging (MRI) examinations at admission and a mean of 6months after stroke onset. Differences in GM volume (GMV) on structural images and cerebral blood flow (CBF) derived from perfusion images between two examinations were compared using voxel-based morphometry. The associations between changes in GMV and CBF with clinical scores were analysed. Decreased GMV was found in post-central gyrus, pre-central gyrus, precuneus, angular gyrus, insula, thalamus and cerebellum, and increased GMV was found in hippocampus, orbital gyrus and lingual gyrus (all corrected P<0.05) at the follow-up examination. Increased CBF was found in subcallosal cingulate gyrus, hippocampus and lingual gyrus (all corrected P<0.05) at the follow-up examination. Only decreased GMV in the anterior lobe of cerebellum was negatively associated with improvement of Barthel index (β=-0.683, P=0.014). Our study provides the imaging evidence of GM atrophy co-existing with GM plasticity involving in increased volume and perfusion in specific regions (including cognition, vision and emotion) in well-recovered stroke patients, which advances our understanding of neurobiology of stroke recovery.

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study.

BackgroundStroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units.MethodsWe performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient’s classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes).ResultsAmong 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54–8.63 and OR = 3.0, 95%CI = 1.52–5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81–10.75 and OR = 3.45, 95%CI = 1.31–9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65–17.03 and OR = 3.87, 95%CI = 1.69–8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23–0.75) and HCC (OR = 0.37, 95%CI = 0.19–0.73), for LOS lower Vs higher tertiles.ConclusionOur data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.

Early Post Stroke Rehabilitation Load Correlates With Greater Functional Improvement of Hemiparesis

Background: Evidences show that generally stroke patients receiving greater amount of physiotherapy obtain better motor function over time, although this has not been investigated in the early post stroke population. The aim of the present observational retrospective study was to investigate the relationship between the amount of physiotherapy provided to early post acute stroke patients and their motor improvement. Methods: Overall, 846 early stroke patients with hemiparesis, treated with physiotherapy, were retrospectively analyzed. Clinical data at admission as well as functional scales at the first evaluation and at discharge were analyzed. For each patient, a rehabilitation load (resulting from the total number of the 30’ daily consecutive physiotherapy sessions they received) was used as the dose of physiotherapy. Pre and post rehabilitation scales were analyzed and their change (Δ) was correlated with the rehabilitation load. Results: The mean rehabilitation load was ten sessions (range 2 to 56). The scores of Barthel index, Motor Assessment Score, Motricity index for both lower and upper limb, Functional Ambulation Classification, Berg Balance scale and Trunk control test significantly improved from pre to post rehabilitation, and a significant correlation was found between the rehabilitation load and the improvement in Barthel index (P < 0.05), Motor Assessment Score, Motricity Index for upper and lower limb (P < 0.001), Berg Balance scale (P < 0.05) and Trunk control test (P < 0.001). Conclusions: In this study, a significant correlation was found between early post stroke motor rehabilitation dose and greater improvement in functional scales, assessing patient’s independence, balance and paretic limb’s motricity.

Rehabilitation of Handicapped Children Suffering from Infantile Cerebral Palsy with Combined Embedding Acupuncture (YNSA + Body Acupuncture) and Complex Physiotherapy

Objectives: The standard treatment of infantile cerebral palsy contain following elements: medication, developmental behavior therapy, surgery, assistive technologies and some form of CAM. Acupuncture treatment is difficult to be carried out in children due to less tolerance of inserted needles. Therefore we were looking for atraumatic, not frequently disturbing methods for these patients. The aim of this prospective, assesor-blinded randomized control trial study was to investigate whether a special form of acupuncture, namely the embedding acupuncture, especially Yamamoto’s New Scalp Acupuncture (YNSA), combined with some effective body acupoints is of value for children suffering from cerebral palsy (CP) in addition to the different forms of motor and mental rehabilitation. Design: A prospective, assessor-blinded randomized control trial was carried out in the past 15 years with 585 children in an inpatient rehabilitation unit with day hospital service. After inclusion, patients were randomly stratified into a control group and an acupuncture group. The continous follow up was performed pediatric neurologists and physiotherapy, occupational and speech therapy in addition to skilled medical and nursing care. Outcome measures: changes in optimizing mobility, learning potential, mental development, changes of primary conditions, Qualtiy of Life (QoL) and the independent neurological investigation were used to follow-up the efficacy of the treatment. Results: In the permanent acupuncture group (combined YNSA and body acupuncture) all the sensory, motor and functional scores improved significantly during the examination period until 5 years after birth. A significant development during the 2-year follow-up was found due to developmental behavior pediatrician activity and special daily performed moving exercices, but the embedding acupuncture with YNSA and some important body points (they are motoric trigger points of muscles) treatment facilitated the mental and functional development. Improved moving and mental function, more flexible joints and ligaments were observed in comparison to the small patients’ condition prior to treatment. The number of seizures decreased, the reduction of antiepileptic drugs was possible, which resulted an elevated mental vigility. Statistical analyses showed significant improvement in Barthel index. Conclusion: The data suggest, that the embedding forms of acupuncture of YNSA and body acupoints are useful additional accessor methods in the rehabilitation of some forms of infantile CP. It enhances their quality of life, helping their integration into healthy child population.

What is the course of behavioural symptoms and functional conditions in hospitalised older people with dementia? A multicentre cohort study in Italy

IntroductionDementia is one of the major causes of disability and dependency among older people worldwide, and hospitalization occurs frequently in demented patients. The present study examined the course of behavioural symptoms and functional conditions in hospitalised older people with dementia. Materials and methodsProspective cohort study of 179 demented patients (age > 64 years) admitted to four geriatric units, evaluated at admission, discharge and at 6 months after discharge. An analysis of predictors of functioning improvement was performed. ResultsPatients with no symptoms at NeuroPsychiatric Inventory baseline assessment did not show any changes at both discharge and follow-up, while patients with symptoms at baseline showed an improvement in every subscale from admission to discharge. Using Barthel Index as a measure of functioning, we found a significant improvement in both “admission-discharge” and “discharge-follow-up” timeframe for the most impaired patients. However, for the less impaired patients, no significant changes emerged from admission to discharge, while a significant worsening occurred from discharge to follow-up. The significant associated variables with improvement in Barthel Index from discharge to follow-up were age and Blaylock Risk Assessment Screening Score at admission. ConclusionInteresting trends in the course of hospitalized older patients with dementia have been found, and they were associated to different levels of functional impairment at admission. Further research is still needed to understand the predictors of improvement and worsening in such hospitalized patients.

Factors affecting the evacuation rate of intracerebral hemorrhage in basal ganglia treated by minimally invasive craniopuncture

ObjectiveMinimally invasive craniopuncture has been used to treat intracerebral hemorrhage (ICH) for over 20 years in China. However, one-off total evacuation of hematoma cannot be achieved through this procedure because it is not an open surgery. This study is designed to identify factors that can increase the hematoma evacuation rate (ER) of this procedure and to evaluate the influence of ER on long-term outcome. MethodsA total of 309 patients with basal ganglia ICH treated by minimally invasive craniopuncture were analyzed retrospectively. Univariate and multivariate linear regression analyses were used to identify factors correlated with a high ER. The correlation between ER and long-term outcome was also analyzed by logistic regression and the Spearman correlation. ResultsA low hematoma mean CT number (β=−0.773, p<0.001) and postoperative cerebrospinal fluid (CSF) outflow (β=0.193, p<0.001) were found to be independent factors associated with a high ER. In patients with 30–50ml of hematoma, a high ER was correlated with a high Barthel index improvement (r=0.611, p<0.001) and a high modified Rankin scale decline (r=0.517, p<0.001). In patients with 50–80ml of hematoma, a high ER was a protective factor of case fatality (B=−2.297, p=0.005). ConclusionsThe hematoma mean CT number can predict the efficiency of minimally invasive craniopuncture in patients with ICH. In patients with ventricular involvement, the tip of the puncture needle should be placed close to the tear in the ventricle rather than at the center of the hematoma to facilitate postoperative CSF outflow.

Traumatic vs non-traumatic spinal cord lesions: comparison of neurological and functional outcome after in-patient rehabilitation

Retrospective comparative study of 2 years duration. To compare neurological and functional outcome and length of stay of persons with traumatic vs non-traumatic spinal cord lesion (SCL) after in-patient rehabilitation. Neurological rehabilitation department of a tertiary research center in Bangalore, Karnataka, India. Seventy-six in-patients with spinal cord lesion: traumatic (38 patients, M/F=34:4) and non-traumatic (38 patients, M/F=16:22) were admitted for in-patient multidisciplinary neurorehabilitation. ASIA impairment scale, duration of stay (DOS), and admission and discharge--Barthel Index scores in both the groups were recorded, compared and analyzed. ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.020 and 0.017), respectively, showing lesser impairment in non-traumatic group. DOS for rehabilitation was higher for traumatic group as compared to non-traumatic group (65.97+/-47.66 vs 60.68+/-45.69 days), although statistically not significant (P>0.05). Barthel Index scores were 28.68+/-17.15 vs 27.63+/-14.96 at admission and 54.21+/-25.10 vs 51.44+/-19.86 at discharge in traumatic and non-traumatic groups, respectively. All patients (n=76) showed significant improvement in Barthel Index (P=0.000), but no statistically significant difference (P>0.05) was recorded between the two groups, both at admission and at discharge. Orthoses was required significantly more frequently (P=0.043) in traumatic SCL group. The study showed that despite more impairment in persons with traumatic spinal cord lesion, there was statistically no significant difference in the length of stay and the functional outcome between persons with traumatic and non-traumatic spinal cord lesion after in-patient rehabilitation.