The factors influencing the functional state recovery in cerebral stroke patients during the second rehabilitation stage]

The aim of the study was to determine the functions influencing the recovery of the motor and cognitive functions and general functional state in cerebral stroke patients during the second rehabilitation stage, and their prognostic value. The contingent and methods. The studied contingent consisted of 226 cerebral stroke patients: 109 men and 117 women who had undergone the second stage rehabilitation in Virsuziglis Rehabilitation Hospital, a branch institution of Hospital of Kaunas University of Medicine. The mean age of the patients was 67.8 +/- 10.4 years. The greatest proportion of the patients (88.5%) was with cerebral infarction. The mean duration of rehabilitation was 38.8 +/- 8.9 days. The functional state of the patients was assessed by functional Independence Measure; the cognitive function, by the short mental function study method; the severity of the stroke, in accordance with the National Institutes of Health Stroke Scale. The prognostic value of the factors was evaluated by the logistic regression method. A study analyzed the influence of patient's gender, age, social factors, clinical symptoms and signs, risk factors for stroke, comorbities, the character and localization of the stroke, and psychoemotional state on the recovery of capacities related to motor and cognitive functions, and restoration of general functional state. Results. During the second stage of rehabilitation, the score of the functional state of the patients assessed by the Functional Independence Measures significantly improved from 65.9 +/- 20.3 to 93.5 +/- 20.9 (P<0.0001). At the end of rehabilitation, good efficacy of rehabilitation was determined in 64.2% of the rehabilitees; moderate, in 19.4%; insufficient, in 16.4%. In prognosing insufficient recovery of general functional state during the second stage of rehabilitation, the following factors had a significant influence: extremity hemiplegia, disturbed cognitive functions, urination impairment, joint and heart diseases. In cases of insufficient recovery of capacities linked with motor function in the second stage of rehabilitation, exerted extremity hemiplegia, neglect of the affected side of the body, urination impairments, joint and heart disorders had a significant influence, whereas localization of the stroke lesion in the left hemisphere of the brain, impairment of cognitive functions (disturbance of speech and perception), urination disturbances - on the insufficient recovery of capacities related to cognitive functions. Conclusion. Insufficient efficacy of rehabilitation of the rehabilitees with cerebral stroke in the second stage of rehabilitation was influenced by impairment of motor and cognitive functions, urination disturbancies, and comorbidities. In forming individualized inpatient rehabilitation programs and prognosing the further health care of patients with cerebral stroke, it is important to pay attention to factors, influencing insufficient efficacy of rehabilitation.