Functional recovery after rehabilitation for cerebellar stroke
Functional recovery after rehabilitation for cerebellar stroke
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DOI：
10.1161/01.str.32.2.530
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发表时间：
2001-02-01
期刊：
影响因子：
8.3
通讯作者：
Furie, KL
中科院分区：
文献类型：
--
作者：
Kelly, PJ;Stein, J;Furie, KL
背景和目的：关于缺血性和出血性脑卒中后功能恢复的资料相对较少。我们研究了小脑卒中后入住康复医院的患者，以量化康复治疗后的恢复情况，并确定预测功能结局的变量。方法：本研究是对连续2年内新发小脑梗死或出血病例的回顾性分析。记录卒中的临床特征，并用Charlson指数对合并症进行评分。通过电话访谈获得后续资料。在入院（AFIM）、出院（DFIM）和随访（FFIM）时对功能独立性测量（FIM）进行评分。结局指标为DFIM和FFIM。进行单因素和多因素分析。结果：本组病例58例，平均年龄69.2岁，49例梗死，9例出血。平均AFIM为65,5，平均DFIM为89.8，梗死亚组的平均AFIM显著高于出血亚组（70比43，P = 0.006）。梗死亚组平均DFIM也较高，但无统计学意义（93比74，P = 0.1）。随访45例（78%），平均随访时间19.5个月。中位FFIM为123,5，预后与AFIM和眩晕/呕吐/共济失调/头痛的首发症状显著正相关。结果与先前存在的合并症评分、初次就诊时意识水平的改变和小脑上动脉梗死呈负相关。在多变量分析中，AFIM和合并症评分是预后的独立预测因子。结论：小脑梗死后康复后，FIM平均评分有明显改善。功能预后最好通过预先存在的合并症和急性住院出院时的功能状态来预测。
Background ann Purpose-Relatively few data exist concerning functional recovery after ischemic and hemorrhagic cerebellar stroke. We studied patients admitted to a rehabilitation hospital after cerebellar stroke to quantify recovery after rehabilitation therapy and to identify variables that predicted functional outcome.Methods-This study was a retrospective review of consecutive cases admitted in a ii-year period with new cerebellar infarct or hemorrhage. Clinical features of stroke were recorded and comorbidities scored with the Charlson Index. Follow-up information was obtained by telephone interview. The Functional Independence Measure (FIM) was scored at admission (AFIM), discharge (DFIM), and follow-up (FFIM). Outcome measures were DFIM and FFIM. Univariate and multivariate analyses were performed.Results-Fifty-eight cases were identified (mean age 69.2 years; 49 infarcts, 9 hemorrhages). Mean AFIM was 65,5, and mean DFIM was 89.8, Mean AFIM was significantly higher in the infarct than in the hemorrhage subgroup (70 versus 43, P = 0,006). Mean DFIM was also higher in the infarct subgroup but did not reach statistical significance (93 versus 74, P = 0.1). Follow-up information was obtained for 45 cases (78%) (mean interval 19.5 months). Median FFIM was 123,5, Outcome was significantly positively correlated with AFIM and initial presenting syndrome of vertigo/vomiting/ ataxia/headache. Outcome correlated negatively with preexisting comorbidity score, altered level of consciousness at initial presentation, and superior cerebellar artery infarction. On multivariate analysis, AFIM and comorbidity score were independent predictors of outcome.Conclusions-Substantial improvement of mean FIM score frequently occurs after rehabilitation after cerebellar infarction. Functional outcome is best predicted by preexisting comorbidities and functional status at the time of discharge from acute hospitalization.