Predictors Involved in Improving Motor Function in Patients with Putamen Bleeding with Severe Lower Limb Paralysis
Objective: The purpose of this study is to clarify the predictors involved in improving motor function in patients with putamen bleeding who have severe lower limb movement disorder.Method: The participants were 42 patients with putamen bleeding who had a total lower limb movement score of 3 points...
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| Published in | Physical Therapy Japan Vol. 49; no. 3; pp. 220 - 226 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society of Physical Therapy
20.06.2022
一般社団法人日本理学療法学会連合 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0289-3770 2189-602X |
| DOI | 10.15063/rigaku.12162 |
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| Abstract | Objective: The purpose of this study is to clarify the predictors involved in improving motor function in patients with putamen bleeding who have severe lower limb movement disorder.Method: The participants were 42 patients with putamen bleeding who had a total lower limb movement score of 3 points or less on the Stroke Impairment Assessment Set (SIAS) at the time of admission to the Kaifukuki rehabilitation ward (Kaifukuki ward). Survey items including age, gender, number of days from onset to Kaifukuki ward discharge, brain injury side, total lower limb movement of SIAS at the time of admission, tendon reflex, muscle tone, tactile sense, position sense, trunk verticality, abdominal muscle, visual space cognitive score, total motor and cognitive scores of functional independence measure, degree of damage to the corticospinal tract running area several days after the onset, amount of hematoma, and presence or absence of ventricular perforation were determined.Results: Multiple regression analysis was performed, with the degree of improvement in motor function as the dependent variable, and the item with significant correlation to the degree of improvement as the independent variable. The results of statistical analyses revealed that younger age, lower degree of damage to corticospinal tract running area, and higher SIAS trunk verticality score were significantly associated with the improvement of motor function.Conclusion: This study suggests that the sitting ability, in addition to the age and degree of damage to the corticospinal tract running area, are important in the assessment of physical therapy in order to predict the improvement of motor function in patients with severe motor disorders. |
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| AbstractList | Objective: The purpose of this study is to clarify the predictors involved in improving motor function in patients with putamen bleeding who have severe lower limb movement disorder.Method: The participants were 42 patients with putamen bleeding who had a total lower limb movement score of 3 points or less on the Stroke Impairment Assessment Set (SIAS) at the time of admission to the Kaifukuki rehabilitation ward (Kaifukuki ward). Survey items including age, gender, number of days from onset to Kaifukuki ward discharge, brain injury side, total lower limb movement of SIAS at the time of admission, tendon reflex, muscle tone, tactile sense, position sense, trunk verticality, abdominal muscle, visual space cognitive score, total motor and cognitive scores of functional independence measure, degree of damage to the corticospinal tract running area several days after the onset, amount of hematoma, and presence or absence of ventricular perforation were determined.Results: Multiple regression analysis was performed, with the degree of improvement in motor function as the dependent variable, and the item with significant correlation to the degree of improvement as the independent variable. The results of statistical analyses revealed that younger age, lower degree of damage to corticospinal tract running area, and higher SIAS trunk verticality score were significantly associated with the improvement of motor function.Conclusion: This study suggests that the sitting ability, in addition to the age and degree of damage to the corticospinal tract running area, are important in the assessment of physical therapy in order to predict the improvement of motor function in patients with severe motor disorders. Objective: The purpose of this study is to clarify the predictors involved in improving motor function in patients with putamen bleeding who have severe lower limb movement disorder.Method: The participants were 42 patients with putamen bleeding who had a total lower limb movement score of 3 points or less on the Stroke Impairment Assessment Set (SIAS) at the time of admission to the Kaifukuki rehabilitation ward (Kaifukuki ward). Survey items including age, gender, number of days from onset to Kaifukuki ward discharge, brain injury side, total lower limb movement of SIAS at the time of admission, tendon reflex, muscle tone, tactile sense, position sense, trunk verticality, abdominal muscle, visual space cognitive score, total motor and cognitive scores of functional independence measure, degree of damage to the corticospinal tract running area several days after the onset, amount of hematoma, and presence or absence of ventricular perforation were determined.Results: Multiple regression analysis was performed, with the degree of improvement in motor function as the dependent variable, and the item with significant correlation to the degree of improvement as the independent variable. The results of statistical analyses revealed that younger age, lower degree of damage to corticospinal tract running area, and higher SIAS trunk verticality score were significantly associated with the improvement of motor function.Conclusion: This study suggests that the sitting ability, in addition to the age and degree of damage to the corticospinal tract running area, are important in the assessment of physical therapy in order to predict the improvement of motor function in patients with severe motor disorders. 【目的】目的は重度の下肢運動障害をきたした被殻出血患者の運動機能の改善に関わる予測因子を明らかにすることである。【方法】対象は回復期リハビリテーション病棟（回復期病棟）入棟時に脳卒中機能評価法（Stroke Impairment Assessment Set：以下，SIAS）の下肢運動合計点数が3点以下の被殻出血患者42例とした。調査項目は年齢，性別，発症から回復期病棟入退棟までの日数，脳損傷側，回復期病棟入棟時のSIASの下肢運動合計・腱反射・筋緊張・触覚・位置覚・腹筋力・体幹垂直性・視空間認知点数，機能的自立度評価法（Functional Independence Measure）の運動・認知合計点数，発症数日後の皮質脊髄路走行領域の損傷度，血腫量，脳室穿破の有無とした。【結果】改善度を従属変数，改善度と有意な相関を認めた項目を独立変数とした重回帰分析を行った結果，年齢が若く，皮質脊髄路走行領域の損傷度が低く，SIAS体幹垂直性点数が高いほど改善度が大きかった。【結論】予測には年齢，皮質脊髄路走行領域の損傷度，重症例特有の予測因子と考える座位能力を用いることが重要である。 |
| Author | YABE, Hiroki SAWAJIMA, Yuki ADACHI, Hirotaka TANAKA, Yoshihiro |
| Author_FL | 田中 善大 澤島 佑規 ADACHI Hirotaka YABE Hiroki |
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| Author_xml | – sequence: 1 fullname: SAWAJIMA, Yuki organization: Department of Rehabilitation, Kaikoukai Rehabilitation Hospital – sequence: 1 fullname: ADACHI, Hirotaka organization: Department of Rehabilitation, Kaikoukai Rehabilitation Hospital – sequence: 1 fullname: YABE, Hiroki organization: Department of Rehabilitation, Nagoya Kyoritsu Hospital – sequence: 1 fullname: TANAKA, Yoshihiro organization: Department of Rehabilitation, Kaikoukai Rehabilitation Hospital |
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| References | 3） Nasciutti-Prudente C, Oliveira FG, et al.: Relationships between muscular torque and gait speed in chronic hemiparetic subjects. Disabil Rehabil. 2009; 31: 103–108. 10） Shimodozono M, Noma T, et al.: Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: a randomized controlled pilot study. Brain Inj. 2014; 28: 203–210. 5） Meijer R, van Limbeek J, et al.: Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke. Int J Rehabil Res. 2006; 29: 1–8. 26） 澤島佑規，矢部広樹，他：被殻出血患者における各脳領域の損傷度による歩行自立度の予後予測．理学療法学．2018; 4: 216–226. 28） Kothari RU, Brott T, et al.: The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996; 27: 1304–1305. 38） Gialanella B, Mattioli F: Anosognosia and extrapersonal neglect as predictors of functional recovery following right hemisphere stroke. Neuropsychol Rehabil. 1992; 2: 169–178. 12） Yoo JW, Hong BY, et al.: Effects of age on long-term functional recovery in patients with stroke. Medicina (B Aires). 2020; 56: 451. 1） Cho KH, Lee JY, et al.: Factors related to gait function in post-stroke patients. J Phys Ther Sci. 2014; 26: 1941–1944. 23） Ghetti G: Putaminal Hemorrhages. Front Neurol Neurosci. 2012; 30: 141–144. 29） Brown AW, Marlowe KJ, et al.: Age effect on motor recovery in a post-acute animal stroke model. Neurobiol Aging. 2003; 24: 607–614. 31） Yeo SS, Chang MC, et al.: Corticoreticular pathway in the human brain:Diffusion tensor tractography study. Neurosci Lett. 2012; 508: 9–12. 14） Gracies JM: Pathophysiology of spastic paresis. I: Paresis and soft tissue change. Muscle Nerve. 2005; 31: 535–551. 18） Zhu LL, Lindenberg R, et al.: Lesion load of the corticospinal tract predicts motor impairment in chronic stroke. Stroke. 2010; 41: 910–915. 35） Fujita T, Sato A, et al.: Contribution of abdominal muscle strength to various activities of daily living of stroke patients with mild paralysis. J Phys Ther Sci. 2015; 27: 815–818. 30） Yamada M, Nishiguchi S, et al.: Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc. 2013; 14: 911–915. 34） Karatas M, Cetin N, et al.: Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004; 83: 81–87. 42） Cooke EV, Mares K, et al.: The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis. BMC Med. 2010; 8: 60. 9） Prabhakaran S, Zarahn E, et al.: Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair. 2008; 22: 64–71. 17） Chung CS, Caplan LR, et al.: Striatocapsular haemorrhage. Brain. 2000; 123: 1850–1862. 8） Binkofski F, Seitz RJ, et al.: Recovery of motor functions following hemiparetic stroke: a clinical and magnetic resonance-morphometric study. Cerebrovasc Dis. 2001; 11: 273–281. 37） Saj A, Honore J, et al.: Reducing rightward bias of subjective straight ahead in neglect patients by changes in body orientation. J Neurol Neurosurg Psychiatry. 2008; 79: 991–996. 21） Swayne OB, Rothwell JC, et al.: Stages of motor output reorganization after hemispheric stroke suggested by longitudinal studies of cortical physiology. Cereb Cortex. 2008; 18: 1909–1922. 15） Pizzi A, Carrai R, et al.: Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. J Rehabil Med. 2009; 41: 654–660. 20） Imura T, Nagasawa Y, et al.: Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients. J Phys Ther Sci. 2015; 27: 1383–1386. 24） 日本脳卒中学会脳卒中ガイドライン委員会：脳卒中ガイドライン2021．協和企画，東京，2021, pp. 43–45. 13） Duncan PW, Goldstein LB, et al.: Measurement of motor recovery after stroke Outcome Assessment and Sample Size Requirements. Stroke. 1992; 23: 1084–1089. 27） 澤島佑規，矢部広樹，他：被殻出血患者における皮質脊髄路走行領域の損傷度と下肢の運動機能との関係．愛知県理学療法学会誌．2018; 2: 72–77. 22） Baird AE, Dambrosia J, et al.: A three-item scale for the early prediction of stroke recovery. Lancet. 2001; 357: 2095–2099. 19） Koyama T, Marumoto K, et al.: Outcome assessment of hemiparesis due to intracerebral hemorrhage using diffusion tensor fractional anisotropy. J Stroke Cerebrovasc Dis. 2015; 24: 881–889. 6） Alexander MP: Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care. Stroke. 1994; 25: 128–134. 36） Mayo NE, Korner-Bitensky NA, et al.: Recovery time of independent function post-stroke. Am J Phys Med Rehabil. 1991; 70: 5–12. 2） Fujita T, Ohashi Y, et al.: Functions necessary for gait independence in patients with stroke: A study using decision tree. J Stroke Cerebrovasc Dis. 2020; 29: 104998. 7） Kwakkel G, Wagenaar RC, et al.: Predicting disability in stroke—a critical review of the literature. Age Ageing. 1996; 25: 479–489. 33） Weiller C, Ramsay SC, et al.: Individual patterns of functional reorganization in the human cerebral cortex after capsular infarction. Ann Neurol. 1993; 33: 181–189. 41） Jang SH, Yeo SS: Recovery of an injured corticoreticular pathway via transcallosal fibers in a patient with intracerebral hemorrhage. BMC Neurol. 2014; 14: 1–4. 16） Song YM: Somatotopic organization of motor fibers in the corona radiata in monoparetic patients with small subcortical infarct. Stroke. 2007; 38: 2353–2355. 11） Everaert DG, Thompson AK, et al.: Su Ling Chong: Does functional electrical stimulation for foot drop strengthen corticospinal connections? Neurorehabil Neural Repair. 2010; 24: 168–177. 25） 道免和久：脳卒中片麻痺患者の機能評価法Stroke Impairment Assessment Set（SIAS）の信頼性および妥当性の検討（1）：麻痺側運動機能，筋緊張，腱反射，健側機能．リハビリテーション医学．1995; 32: 113–122. 40） Do KH, Yeo SS, et al.: Injury of the corticoreticular pathway in patients with proximal weakness following cerebral infarct: Diffusion tensor tractography study. Neurosci Lett. 2013; 546: 21–25. 4） Nolfe G, D’Aniello AM, et al.: The aftermath of rehabilitation for patients with severe stroke. Acta Neurol Scand. 2003; 107: 281–284. 32） Nudo RJ: Recovery after brain injury: mechanisms and principles. Front Hum Neurosci. 2013; 7: 887. 39） Matsuyama K, Mori F, et al.: Locomotor role of the corticoreticular–reticulospinal–spinal interneuronal system. Prog Brain Res. 2004; 143: 239–249. |
| References_xml | – reference: 5） Meijer R, van Limbeek J, et al.: Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke. Int J Rehabil Res. 2006; 29: 1–8. – reference: 20） Imura T, Nagasawa Y, et al.: Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients. J Phys Ther Sci. 2015; 27: 1383–1386. – reference: 27） 澤島佑規，矢部広樹，他：被殻出血患者における皮質脊髄路走行領域の損傷度と下肢の運動機能との関係．愛知県理学療法学会誌．2018; 2: 72–77. – reference: 9） Prabhakaran S, Zarahn E, et al.: Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair. 2008; 22: 64–71. – reference: 16） Song YM: Somatotopic organization of motor fibers in the corona radiata in monoparetic patients with small subcortical infarct. Stroke. 2007; 38: 2353–2355. – reference: 39） Matsuyama K, Mori F, et al.: Locomotor role of the corticoreticular–reticulospinal–spinal interneuronal system. Prog Brain Res. 2004; 143: 239–249. – reference: 14） Gracies JM: Pathophysiology of spastic paresis. I: Paresis and soft tissue change. Muscle Nerve. 2005; 31: 535–551. – reference: 1） Cho KH, Lee JY, et al.: Factors related to gait function in post-stroke patients. J Phys Ther Sci. 2014; 26: 1941–1944. – reference: 29） Brown AW, Marlowe KJ, et al.: Age effect on motor recovery in a post-acute animal stroke model. Neurobiol Aging. 2003; 24: 607–614. – reference: 26） 澤島佑規，矢部広樹，他：被殻出血患者における各脳領域の損傷度による歩行自立度の予後予測．理学療法学．2018; 4: 216–226. – reference: 12） Yoo JW, Hong BY, et al.: Effects of age on long-term functional recovery in patients with stroke. Medicina (B Aires). 2020; 56: 451. – reference: 21） Swayne OB, Rothwell JC, et al.: Stages of motor output reorganization after hemispheric stroke suggested by longitudinal studies of cortical physiology. Cereb Cortex. 2008; 18: 1909–1922. – reference: 30） Yamada M, Nishiguchi S, et al.: Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc. 2013; 14: 911–915. – reference: 28） Kothari RU, Brott T, et al.: The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996; 27: 1304–1305. – reference: 33） Weiller C, Ramsay SC, et al.: Individual patterns of functional reorganization in the human cerebral cortex after capsular infarction. Ann Neurol. 1993; 33: 181–189. – reference: 41） Jang SH, Yeo SS: Recovery of an injured corticoreticular pathway via transcallosal fibers in a patient with intracerebral hemorrhage. BMC Neurol. 2014; 14: 1–4. – reference: 13） Duncan PW, Goldstein LB, et al.: Measurement of motor recovery after stroke Outcome Assessment and Sample Size Requirements. Stroke. 1992; 23: 1084–1089. – reference: 19） Koyama T, Marumoto K, et al.: Outcome assessment of hemiparesis due to intracerebral hemorrhage using diffusion tensor fractional anisotropy. J Stroke Cerebrovasc Dis. 2015; 24: 881–889. – reference: 2） Fujita T, Ohashi Y, et al.: Functions necessary for gait independence in patients with stroke: A study using decision tree. J Stroke Cerebrovasc Dis. 2020; 29: 104998. – reference: 31） Yeo SS, Chang MC, et al.: Corticoreticular pathway in the human brain:Diffusion tensor tractography study. Neurosci Lett. 2012; 508: 9–12. – reference: 8） Binkofski F, Seitz RJ, et al.: Recovery of motor functions following hemiparetic stroke: a clinical and magnetic resonance-morphometric study. Cerebrovasc Dis. 2001; 11: 273–281. – reference: 22） Baird AE, Dambrosia J, et al.: A three-item scale for the early prediction of stroke recovery. Lancet. 2001; 357: 2095–2099. – reference: 32） Nudo RJ: Recovery after brain injury: mechanisms and principles. Front Hum Neurosci. 2013; 7: 887. – reference: 7） Kwakkel G, Wagenaar RC, et al.: Predicting disability in stroke—a critical review of the literature. Age Ageing. 1996; 25: 479–489. – reference: 10） Shimodozono M, Noma T, et al.: Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: a randomized controlled pilot study. Brain Inj. 2014; 28: 203–210. – reference: 11） Everaert DG, Thompson AK, et al.: Su Ling Chong: Does functional electrical stimulation for foot drop strengthen corticospinal connections? Neurorehabil Neural Repair. 2010; 24: 168–177. – reference: 17） Chung CS, Caplan LR, et al.: Striatocapsular haemorrhage. Brain. 2000; 123: 1850–1862. – reference: 4） Nolfe G, D’Aniello AM, et al.: The aftermath of rehabilitation for patients with severe stroke. Acta Neurol Scand. 2003; 107: 281–284. – reference: 40） Do KH, Yeo SS, et al.: Injury of the corticoreticular pathway in patients with proximal weakness following cerebral infarct: Diffusion tensor tractography study. Neurosci Lett. 2013; 546: 21–25. – reference: 34） Karatas M, Cetin N, et al.: Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004; 83: 81–87. – reference: 25） 道免和久：脳卒中片麻痺患者の機能評価法Stroke Impairment Assessment Set（SIAS）の信頼性および妥当性の検討（1）：麻痺側運動機能，筋緊張，腱反射，健側機能．リハビリテーション医学．1995; 32: 113–122. – reference: 42） Cooke EV, Mares K, et al.: The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis. BMC Med. 2010; 8: 60. – reference: 37） Saj A, Honore J, et al.: Reducing rightward bias of subjective straight ahead in neglect patients by changes in body orientation. J Neurol Neurosurg Psychiatry. 2008; 79: 991–996. – reference: 24） 日本脳卒中学会脳卒中ガイドライン委員会：脳卒中ガイドライン2021．協和企画，東京，2021, pp. 43–45. – reference: 15） Pizzi A, Carrai R, et al.: Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. J Rehabil Med. 2009; 41: 654–660. – reference: 6） Alexander MP: Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care. Stroke. 1994; 25: 128–134. – reference: 36） Mayo NE, Korner-Bitensky NA, et al.: Recovery time of independent function post-stroke. Am J Phys Med Rehabil. 1991; 70: 5–12. – reference: 38） Gialanella B, Mattioli F: Anosognosia and extrapersonal neglect as predictors of functional recovery following right hemisphere stroke. Neuropsychol Rehabil. 1992; 2: 169–178. – reference: 35） Fujita T, Sato A, et al.: Contribution of abdominal muscle strength to various activities of daily living of stroke patients with mild paralysis. J Phys Ther Sci. 2015; 27: 815–818. – reference: 3） Nasciutti-Prudente C, Oliveira FG, et al.: Relationships between muscular torque and gait speed in chronic hemiparetic subjects. Disabil Rehabil. 2009; 31: 103–108. – reference: 18） Zhu LL, Lindenberg R, et al.: Lesion load of the corticospinal tract predicts motor impairment in chronic stroke. Stroke. 2010; 41: 910–915. – reference: 23） Ghetti G: Putaminal Hemorrhages. Front Neurol Neurosci. 2012; 30: 141–144. |
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| SubjectTerms | Predictors of improvement Putamen bleeding patients Severe lower limb movement disorder 改善の予測因子 被殻出血患者 重度の下肢運動機能障害 |
| Title | Predictors Involved in Improving Motor Function in Patients with Putamen Bleeding with Severe Lower Limb Paralysis |
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| ispartofPNX | Physical Therapy Japan, 2022/06/20, Vol.49(3), pp.220-226 |
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