Effectiveness of post-stroke rehabilitation in early recovery period

Background. Post-stroke rehabilitation is of great medical and social importance for stroke patients. Rehabilitation measures are aimed at restoring lost functions of the central nervous system, as well as early diagnosis and prevention of possible dysfunctions of organs and body systems after a stroke. Effective rehabilitation helps to reduce the degree of disability, maintain working capacity, and improve the quality of life for patients and their relatives.

Objective: To evaluate the effectiveness of rehabilitation treatment in patients during the early recovery period after ischemic stroke using standardized functional scales depending on the pathogenetic classification of strokes and lesion localization.

Material and methods. The study involved 57 patients aged 41 to 82 years with a diagnosis of ischemic stroke confirmed by neuroimaging data. The integral indices characterizing the clinical condition of patients before (on Day 1) and after (on Day 10) rehabilitation measures were dynamically assessed using functional scales and indices: Rehabilitation Routing Scale, Rivermead mobility index, Barthel Index for Activities of Daily Living, and modified Rankin Scale. In the middle of the study, on Days 6–7, the Functional Independence Measure was applied once. The Trial of ORG in Acute Stroke Treatment (TOAST) classification was used to distinguish stroke subtypes.

Results. Although the absolute values of changes in indices due to the limited duration of rehabilitation measures were relatively small, their positive dynamics was clearly observed. On Day 10 of rehabilitation treatment, reliable (p≤0.05) improvement was noted for all functional indices. More pronounced positive changes were noted in patients with atherothrombotic and cardioembolic stroke subtypes according to TOAST. Statistically significant positive dynamics of all studied indices was recorded in patients with brain lesions localized in vertebral and basilar arteries; less pronounced changes in indices were noted in carotid system. The dynamics of indices with lesion localization in the right and left middle cerebral arteries were equivalent. Thus, stage II rehabilitation measures showed comparable effectiveness in groups of patients distributed by both the pathogenetic subtype of stroke and localization of the brain lesion.

Conclusion. The method of assessing the rehabilitation potential of patients using functional scales is pathogenetically substantiated and can be used to predict rehabilitation, as well as to select and adjust an individual program of measures at the next (III) stage of medical rehabilitation.

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