Clinical Study of the Initial Day of Stroke Rehabilitation Exercise

• Published in: Rihabiritēshon igaku Vol. 34; no. 8; pp. 564 - 572
• Main Authors: ITOH, Hideki, SHIOI, Miki, OSHIDA, Naoko, NAKAMURA, Kayo, TOYOTA, Akihiro, ITOH, Motoya
• Format: Journal Article
• Language: English
• Published: The Japanese Association of Rehabilitation Medicine 1997
• Subjects: disorders of higher cortical function; progressive infarction; rehabilitation in acute state; the expansion of intracerebral hemorrhage in acute state; the initial day of stroke rehabilitation exercise
• ISSN: 0034-351X; 1880-778X
• DOI: 10.2490/jjrm1963.34.564

This study investigated the characteristics of the expantion of hypertensive intracerebral hematoma in acute state and progressive infarction to determine when early stroke rehabilitation can be safely initiated. The subjects were 545 patients admitted on the day of stroke onset. Of these patients, 309 had cerebral infarction and the remaining 236 had intracerebral hemorrhage. The findings were as follows: 1) The measurement of expansion of hematoma on CT images during the highly acute stage of hypertensive intracerebral hemorrhage detected in 9 patients. The site of hemorrhage was the putamen in 5 patients and the thalamus in 4 patients. Neurological deterioration occurred within 12 hours. Persistent hypertension above 150mmHg was recorded in 8 patients. 2) Eight patients showing the expansion of the hematoma in acute state started rehabilitation exercises within 2 weeks. Of 227 without hematoma expansion, 168 started rehabilitation exercises within one week and 40 started within 2 weeks. 3) Progressive infarction was observed in 71 patients (23.0%). All patients with progressive infarction showed initial deterioration of neurological deficits within 5 days after onset. Thirty-nine patients showed deterioration on day 2 and 13 patients showed deterioration on day 3. Deterioration of neurological deficits usually stopped one day after the beginning of progression. The maximal period from beginning to end of deterioration of neurological deficits was 7 days. Progressive infarction was not seen in patients with higher cortical dysfunction without sensory or motor disturbance, but was seen in only 8 (4%) of 187 patients with sensory or motor disturbance without higher cortical dysfunction. Progressive infarction was seen in 63 (57%) patients with sensory or motor disturbance and higher cortical dysfunction. It was also frequently seen in patients with atrial fibrillation (Af) on ECG (p<0.001). 4) Forty-seven patients with progressive infarction started rehabilitation exercises within one week and 5 started within 2 weeks. Of 238 patients without progressive infarction, 193 patients rehabilitation exercises started within one week. Therfore, blood pressure should be controlled for 24 hours in patients with hypertensive intracerebral hemorrhage. In the diagnosis of progressive infarction, it is useful to identify the higher cortical dysfunction and Af on admission.