Deans' stroke musings: Proposition of a classification of adult patients with hemiparesis in chronic phase

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, October 14, 2017

Proposition of a classification of adult patients with hemiparesis in chronic phase

Fucking useless. Classification but no mapping of stroke protocols to those classifications to get to full recovery of walking.
http://www.sciencedirect.com/science/article/pii/S1877065717303652

https://doi.org/10.1016/j.rehab.2017.07.242 Get rights and content

Objective

Patients who have developed hemiparesis after central nervous system lesion often experience reduced walking capacity. Related gait abnormalities at hip, knee, and ankle joints during swing induce decreased foot clearance and increased risk of falls, and thus need a meticulous management. This study aimed to (1) propose a classification focusing on these abnormalities for adult patients with hemiparesis, (2) evaluate its discriminatory capacity using clinical gait analysis (CGA).

Material/patients and methods

Twenty-six patients (10 women, 16 men) with hemiparesis (13 left, 13 right) in chronic phase (i.e. hemiparesis more than 6 months old) were included in this study. Clinical examination (i.e. passive range of motion, muscle weakness, and spasticity) and video records were conducted on each patient. The following classification was then applied: group I (GI) was mainly characterized by a decreased ankle dorsiflexion during swing, group II (GII) and group III (GIII) by a decreased knee flexion during swing, completed by a reduced range of hip motion and a hip flexors weakness in GIII. Subdivisions were also applied on each group to describe (a) absence or (b) presence of genu recurvatum during stance. The discriminatory capacity of the classification was then evaluated. For that, all patients were instrumented with cutaneous reflective markers and at least 5 gait cycles were recorded using optoelectronic cameras (OQUS, Qualisys, Sweden). A statistical analysis (ANOVA) was then performed between each group and subgroup on 24 kinematic parameters and walking speed.

Results

Only one patient could not be classified, 5 were classified in GI (1 GIa, 4 GIb), 15 in GII (7 GIIa, 8 GIIb), and 5 in GIII (1 GIIIa, 4 GIIIb). When subgroups (a) and (b) were combined, 16 of the 25 assessed parameters revealed a statistically significant difference (P-level < 0.05) between at least two groups. In particular, the maximum knee flexion in swing and the total amplitude of hip flexion-extension were significantly different between groups.

Discussion – conclusion

This classification can be performed in regular clinical practice (using clinical evaluation and video records). It should thus ease the development of clinical management algorithms and the efficiency assessment of related therapies.