• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.143-150
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• 2009

Objective : The purpose of this study was to investigate the reliable factors influencing the surgical outcome of the patients with traumatic acute subdural hematoma (ASDH) and to improve the functional outcome of these patients. Methods : A total of 256 consecutive patients who underwent surgical intervention for traumatic ASDH between March 1998 and March 2008 were reviewed. We evaluated the influence of perioperative variables on functional recovery and mortality using multivariate logistic regression analysis. Results : Functional recovery was achieved in 42.2% of patients and the overall mortality was 39.8%. Age (OR=4.91, p=0.002), mechanism of injury (OR=3.66, p=0.003), pupillary abnormality (OR=3.73, p=0.003), GCS score on admission (OR=5.64, p=0.000), and intraoperative acute brain swelling (ABS) (OR=3.71, p=0.009) were independent predictors for functional recovery. And preoperative pupillary abnormality (OR=2.60, p=0.023), GCS score (OR=4.66, p=0.000), and intraoperative ABS (OR=4.16, p=0.001) were independent predictors for mortality. Midline shift, thickness and volume of hematoma, type of surgery, and time to surgery showed no independent association with functional recovery, although these variables were correlated with functional recovery in univariate analyses. Conclusion : Functional recovery was more likely to be achieved in patients who were under 40 years of age, victims of motor vehicle collision and having preoperative reactive pupils, higher GCS score and the absence of ABS during surgery. These results would be helpful for neurosurgeon to improve outcomes from traumatic acute subdural hematomas.

• 동서간호학연구지
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• 제2권1호
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• pp.22-36
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• 1997

Functional recovery of cerebrovascular accident (CVA) patients were studied by examining functional independence measure (FIM) to evaluate the functional state of the patients at admission to and at discharge from the hospital and its relationship with the family support. Study subjects consisted of 129 CVA patients, who were admitted and received rehabilitation treatment at K Medical Center of Oriental Medicine from August 3 to December 18, 1997. The results were as follows: 1) Total FIM score was $72.37{\pm}25.16$ at admission and $101.67{\pm}22.13$ at discharge. The difference of average score was 29.30, which was statistically significant by paired t-test. 2) The largest difference between FIM scores at admission and at clischarge was observed in items of walking and wheel-chair riding, and the smallest clifference in items of social interaction. 3) The recovery was faster with motor function than with cognitive function, because the difference of FIM scores at admission and at discharge was much larger with motor function. 4) Recovery was better in groups under age 49 than in groups above age 70. Functional recorvery was prominent especially in groups with normal sensory state and speech functions, and groups without urinary incontinence. Recovery was less significantly in patients with paraplegic patients hospitalized longer than 2 months, patients with family all the time, and patients with CVA over 11 days. 5) We could not find any relationship between functional recovery and family support. FIM scores were lower in groups of old age(r=-0.325), long stayed in hospital (r=-0.426), and long period of time after the onset of disease(r= -0.339) with a reciprocal correlation between FIM scores and these parameters. 6) Stepwise multiple regression analysis was done to evaluate factors to affect the recovery from CVA. FIM score at admission could explain 51.2 % of the functional recovery. Important factors were periods of hospitalization, state of sensory function, age, and education (listed in decreasing order of importance). In total, they could explain 64.89% of the functional recovery. These results indicate that functional recovery of CVA patients, who were admitted to oriental medicine hospital for rehabilitation treatment, could be estimated by measuring FIM scores. Recovery was significantly better at discharge from the hospital than at admission and motor function recovery rate was much faster than that of cognitive function. 2. Recommendation Based on these results, we recommend following further studies. 1) Comparative study of recovery of motor function and of sensory function would be necessary by measuring FIM scores once a week to evaluate the recovery of CVA patients. 2) It would be interesting to see whether there is any difference of functional recovery between patients treated with either western medicine or oriental medicine. 3) Psychological factors affecting the recovery of CVA patients need to be studied.

• 한국전문물리치료학회지
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• 제17권3호
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• pp.59-67
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• 2010

Mortality rates from stroke have been declining. Because of this, more people are living with residual disability. Rehabilitation plays an important role in functional recovery of stroke survivors. In stroke rehabilitation, early prediction of the obtainable level of functional recovery is desirable to deliver efficient care, set realistic goals, and provide appropriate discharge planning. The purpose of this study was to identify predictors of functional outcome after stroke using inpatient rehabilitation as measured by Functional Independence Measure (FIM) total scores. Correlation and stepwise multiple regression analyses were performed on data collected retrospectively from two-hundred thirty-five patients. More than moderate correlation was found between FIM total scores at the time of hospital admission and FIM total scores at the time of discharge from the hospital. Significant predictors of FIM at the time of discharge were FIM total scores at the time of hospital admission, age, and onset-admission interval. The equation was as follows: expected discharge FIM total score = $76.12+.62{\times}$(admission FIM total score)-$.38{\times}(age)-.15{\times}$(onset-admission interval). These findings suggest that FIM total scores at the time of hospital admission, age, and onset-admission interval are important determinants of functional outcome.

• PNF and Movement
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• 제19권3호
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• pp.351-359
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• 2021

Purpose: This purpose of this study was to investigate the effects of initial cognitive status on the recovery of functional status in patients with subacute stroke. Methods: The participants were 111 patients with subacute stroke, divided into two groups: mini-mental state examination (MMSE) <20 (n=49) group and MMSE ≥20 (n=62) group. Clinical evaluation scores were collected before and after rehabilitation. The repeated measurements ANOVA was used to confirm the changes in functional status before and after intervention in the two groups. Changes in functional status within the group were examined through a paired test. A Pearson correlation coefficient analysis was performed to identify the correlation between MMSE change amount and functional status score. Results: In each of the two groups, according to the initial cognitive status, the clinical evaluation score increased statistically significantly, but there was no difference between the two groups in the degree of significant increase. When examining the correlation between the MMSE change amount, according to the initial cognitive state and the functional state score change amount, it was found, only in the group with MMSE <20, that the larger the change in the MMSE score, the greater the functional state change of Berg balance scale, Rivermead Mobility Index, and motor assessment scale. This did not apply to the group with MMSE ≥20. Conclusion: Initial cognitive status should be considered when setting the patient's goal, and considering cognitive improvement when constructing a rehabilitation program is thought to have a positive effect on rehabilitation services.

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.164-174
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• 2013

Objective : The aim of this study was to determine 30-day mortality and 6-month functional recovery rates in spontaneous intracerebral hemorrhage (S-ICH) patients undergoing hemodialysis treatment for end-stage renal disease (ESRD), and to compare the outcomes of these patients and S-ICH patients without ESRD. Methods : The medical records of 1943 S-ICH patients from January 2000 to December 2011 were retrospectively analyzed with focus on demographic, radiological, and laboratory characteristics. Results : A total of 1558 supratentorial S-ICH patients were included in the present study and 102 (6.5%) were ESRD patients. The 30-day mortality of the S-ICH patients with ESRD was 53.9%, and 29.4% achieved good functional recovery at 6 months post-S-ICH. Multivariate analysis showed that age, Glasgow Coma Scale (GCS) score, pupillary abnormality, ventricular extension of hemorrhage, hemorrhagic volume, hematoma enlargement, anemia, and treatment modality were independently associated with 30-day mortality in S-ICH patients with ESRD (p<0.05), and that GCS score, volume of hemorrhage, conservative treatment, and shorter hemodialysis duration was independently associated with good functional recovery at 6 months post-S-ICH in patients with ESRD (p<0.05). Conclusion : This retrospective study showed worse outcome after S-ICH in patients with ESRD than those without ESRD; 30-day mortality was four times higher and the functional recovery rate was significantly lower in S-ICH patients with ESRD than in S-ICH patients without ESRD.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.491-499
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• 2018

Background: Advances in surgical techniques, implant technology, radiotherapy, and chemotherapy have increased the recovery chances of patients with bone sarcomas. Accordingly, patients' expectations on life quality have also increased, highlighting the importance of objective evaluation of the functional results of reconstruction. Methods: Thirteen patients with distal femoral endoprosthesis, who had been followed for an average of 2.9 years were evaluated. Postural stability, daily energy expenditure, muscle power, and range of motion were the four parameters analyzed in this study. The Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS) were used to assess postoperative function and examine correlations with other parameters. Results: Patients had sedentary activities in 84% of their daily lives. They exhibited a slower speed in the walk across test and a higher sway velocity in the sit-to-stand test (p = 0.005). MSTS scores were significantly correlated with the daily energy expenditure and walking speed. Conclusions: Objective functional results acquired from various clinics will provide significant data to compare reconstruction techniques, rehabilitation protocols, and surgical techniques. In this way, it will be possible to satisfy the expectations of patients that increase in relation to enhanced recovery.

• Clinics in Shoulder and Elbow
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• 제24권3호
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• pp.166-171
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• 2021

Background: This study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after arthroscopic rotator cuff repair (ACRC). Methods: Among patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Functional outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) score and Constant score. Healing of the repaired tendon and retear were observed at the 6-month follow-up via magnetic resonance imaging (MRI) or computed tomography (CT) arthrography. Results: At the 3-month follow-up, the steroid injection group showed lower visual analog scale scores than the control group (p<0.05) and showed faster recovery of forward flexion and internal rotation (p<0.05). From the 6-month follow-up, the two groups did not show differences in pain and ROM, and the ASES score and Constant score also did not significantly differ at the 24-month follow-up. The two groups did not differ in retear rate as determined by MRI or CT arthrography at the 6-month follow-up. Conclusions: This study demonstrated that ultrasound-guided subacromial steroid injection at 4 or 6 weeks after ARCR leads to quick pain reduction and ROM recovery until 3 months after surgery. Therefore, subacromial steroid injection is speculated to be an effective and relatively safe method to assist rehabilitation.

• 대한한의학회지
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• 제23권2호
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• pp.180-189
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• 2002

Background and Purpose : The hemiplegic upper extremity is affected in many stroke patients, and recovery is often poor. The purpose of this study was to assess the efficacy of electroacupuncture (EA) in enhancing the upper extremity motor and functional recovery of ischemic stroke patients. Subjects and Methods : Forty ischemic stroke patients (the upper extremity Fugl-Meyer motor scale (FM) score lower than 46, lesion location within middle cerebral artery territory) within 2 weeks of stroke onset were randomly allocated to either an EA group that received EA treatment or a control group that received only routine ward care. The EA was applied at Quchi-Shousanli (LI11-LI10), Waiguan-Hegu (TE5-LI4) points on the hemiparetic side six times per week for 4 weeks. The frequency of stimulation was 25-50Hz and the intensity was set at a level sufficient to induce muscle contraction. EA treatment was given for 30 minutes and all patients of both groups received standard rehabilitation program. Outcomes were assessed, in a blind manner, before treatment began and at 4 weeks after treatment, with the FM, the Motor Power score (MP) for shoulder/elbow, and the subsection of the Modified Barthel Index (MBI) for drinking/feeding/dressing upper body/grooming. Results : These 2 groups had comparable clinical characteristics, lesion location, lesion size, and pretreatment impairment scores. By the end of treatment, the EA group showed significantly more improvement than the control group in the subsection of the FM for shoulder/elbow/coordination (6.4 vs. 3.7; P=0.047) and the MP for shoulder/elbow (5.3 vs. 3.3; P=0.008). The subsection scores of the MBI for drinking/feeding/dressing upper body/grooming were not significantly different between two groups. No adverse effects due to treatment were found Conclusion : These results suggest that EA enhances the upper extremity motor recovery of acute stroke patients. However, this study failed to demonstrate any significant functional benefit related with upper extremity. Future study should be carried out in a larger sample size and use the functional outcome measure that is more specific and sensitive to the upper extremity.

• 대한한방내과학회지
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• 제19권1호
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• pp.97-113
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• 1998

BACKGROUND The purpose of this study was to investigate disability of the patients after stroke, clinical applicability and usefulness of the FIM in evaluating the functional abilities and to assess the characteristics of the patients after stroke. And this study examined difference by predictive factors on the treatment outcome. METHOD The study was composed of 31 stroke patients who were within 1 week after stroke and had been treated in hospital more than 4 weeks. Improving rate was measured by using the Functional Independence Measure(FIM), and the correlation was analyzed between Motor FIM and Cognitive FIM. We analyzed significant meaning statistically in the mean value of FIM. RESULT 1. There was no significant meaning statistically in the mean value of FIM that was between both at admission and after 2 weeks. But there was proportional correlation between both at admission and after 4 weeks, and significant meaning statistically. 2. There was proportional correlation between both FIM and Motor FIM, and significant meaning statistically. But there was no significant meaning statistically between both FIM and Cognitive FIM. 3. There was no significant meaning statistically between both FIM and sex, age, side of weakness, stroke subtype, hypertension, hypercholesterolemia, diabetes mellitus, heart disease, starting point of rehabilitation therapy and past history of cerebral vascular accident. While dysarthria affected functional recovery in stroke patients, and significant meaning statistically. CONCLUSION 1. FIM appeared to be a valid and reliable method to measure the functional abilities of the patients after stroke. 2. Only one thing between Motor FIM and score didn't influence FIM score. 3. Dysarthria affected functional recovery in stroke patients, and it is the statistically significant factor.

• 한방재활의학과학회지
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• 제30권2호
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• pp.105-123
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• 2020

Objectives This study was conducted to verify the effectiveness of east-west integrative rehabilitation therapy on activity of daily living and cognitive functional recovery in stroke patients by comparing with integrative rehabilitation therapy group and conventional rehabilitation therapy group in a single institution. Methods The medical records of 106 stroke patients hospitalized in Department of Rehabilitation Medicine, Dongguk University Bundang Oriental Hospital from January 1, 2017 to February 28, 2019 were reviewed. After screening and dividing it into conventional rehabilitation (CR) group and integrative rehabilitation (IR) group, Korean version of Modified Barthel Index (K-MBI), functional independence measure (FIM), clinical dementia rating-sum of boxes (CDR-SB) were statistically analyzed. Results IR group showed significant improvement in K-MBI, FIM, and CDR-SB after treatment (p<0.001) and there was a statistically significant difference in K-MBI and CDR-SB score changes than CR group (p<0.05). And chronic patient of IR group showed significant improvement in K-MBI, FIM, and CDR-SB after treatment (p<0.01) and there was a statistically significant difference in CDR-SB score changes than CR group (p<0.05). In particular, the earlier the treatment initiation time, the more the improvement in function and when the treatment started within 2 years from the onset and patients took acupuncture and pulsed electromagnetic therapy, all scales significantly improved (p<0.001). Conclusions IR showed more improvement on activities of daily life and cognitive functional recovery than CR in this study.