Rehabilitation after stroke : Effects of length of stay and treatments to faciliate motor recovery after stroke

Sammanfattning: Stroke is the primary cause of long-term disability. Although the effects of stroke unit rehabilitation have been well documented, the specific reasons for this advantage are difficult to single out. The aim of the present study was to investigate if factors such as length of stay, TENS stimulation or site of lesion can influence rehabilitation outcome. To investigate the effect of length of hospital stay, stroke patients admitted before (n=38) and after restructuring of a stroke unit (n=54) were assessed 12 months after stroke. The median length of stay decreased significantly after restructuring but there were no significant differences in motor function, ADL or other characteristics between groups. Patients with a shorter length of stay were less depressed and tended to be more satisfied with family life and social contacts. Patients who had a paretic arm as a consequence of their first stroke occurring 6-12 months previously were included in a study with low-frequency transcutaneous nerve stimulation (Low- TENS), and randomly assigned to either a treatment group (n=26) or a control group (n=18) All patients received physiotherapy at a day-care center, usually twice a week. The treatment group received, in addition, Low-TENS to stimulate the paretic arm for 60 min, five days a week for three months. In a follow-up study, a subgroup of patients were re-tested 3 years after completion of the treatment. Arm motor function increased significantly after Low-TENS stimulation, compared to controls. Patients with less severely affected arms showed greatest improvement. The lowTENS treatment did not decrease either pain or spasticity. Barthel-scores in activities of daily living (ADL) did not change over the evaluation intervals. At follow up, the ADL score remained at a similar level in the Low- TENS group, whereas motor function of the paretic arm had deteriorated in both treatment and control groups. Increased spasticity was seen in both groups. The hypothesis that the topography of brain lesion following stroke predicts improved motor function after Low-TENS treatment was tested. Magnetic resonance imaging (MRI) was performed in 14 patients who had previously received Low-TENS. Absence of lesions in a described part of the periventricular white matter area increased the possibility for improved motor capacity following Low- TENS treatment. Thirty minutes daily Hi-TENS treatment for three months over a specific acupuncture point was used to reduce spasticity in the paretic leg after stroke. A significant reduction of spasticity was seen after completion of Hi-TENS treatment and could be seen in knee extensor muscles as well as in plantar flexor muscles. This reduction remained 2 weeks after the end of the treatment. In conclusion, a shorter length of stay does not affect rehabilitation outcome for the group of patients living at home one year after stroke. Motor recovery for certain patient groups can be supported by treatment with either Low- or Hi-TENS. The TENS-unit is easy to handle by the patients themselves or close family members. Determining the site of lesion could be a method to predict the positive effect of such treatment.