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, November 21, 2020

Influence of the amount of rehabilitation and the disease phase on recovering independence in patients with cerebral stroke

 What fucking stupidity, predicting failure to recover. Rather that pointing out the protocols needed for 100% recovery. I want to hear your conversation with your patients when you tell then then they will still be dependent even after their rehab. Please explain how that won't be a complete failure on the doctor's part.

Influence of the amount of rehabilitation and the disease phase on recovering independence in patients with cerebral stroke

  • Y.V. Flomin MC «Universal Clinic “Oberig”», Kyiv, Ukraine https://orcid.org/0000-0002-7123-3659
  • V.G. Gurianov Bogomolets National Medical University, Kyiv, Ukraine
  • M.V. Guliaieva MC «Universal Clinic “Oberig”», Kyiv, Ukraine
  • L.I. Sokolova Bogomolets National Medical University, Kyiv, Ukraine
Keywords: stroke; outcome; stroke phase; rehabilitation; prognosis; prognostic model.

Abstract

Objective ‒ to determine independent predictors and develop a prognostic model for asses-sing the likelihood of lack of a good outcome (dependence) in cerebral stroke patients with severe disabilities who were admitted to a comprehensive stroke unit in a subacute or chronic phase.
Materials and methods. A retrospective observational study enrolled patients with a verified cerebral stroke, who were admitted to the Stroke Center (SC) over 2010‒2018 in the early subacute (from Day 8 to Day 90 from onset), the late subacute (from Day 91 to Day 180 from onset) or chronic (after 180 days from onset) phase of the disease and had severe disabilities upon admission (i.e. a modified Rankin scale (mRS) 4 or 5). There were included 290 patients (38.7 % of women) aged from 20.4 to 91.2 years (median ‒ 64.9 years, interquartile range ‒ 56.6‒74.6). Care in the SC was provided in accordance with guidelines and included active interdiscipli-nary rehabilitation. The restoration of independence in daily living at discharge was considered a good outcome (mRS 0‒2). We assessed the relationship of the risk of failure to achieve a good outcome with five clinical variables: age, sex, stroke period, and baseline mRS score and the amount (dose) of rehabilitation (total time of physical therapy, ergotherapy or mechanotherapy).
Results. 81 (28.0 %) participant had intracerebral hemorrhage, whereas 209 (72.0 %) had cerebral infarction. The total National Institutes of Health stroke scale (NIHSS) score on admission ranged from 1 to 36 (median 14 points, interquartile range 10–20). While 188 (64.8 %) of the patients were hospitalized to the SC during the early subacute, 34 (11.8 %) and 68 (23.4 %) study participants were admitted only in the late subacute and chronic phase of stroke, respectively. In the analysis of generalized linear regression models, three features had a significant relationship with a decrease in the mRS score: sex, time from stroke onset to SC admission, and the total time of mechanotherapy. According to the multivariate analysis, four factors were significantly associated with a need for assistance in activities of daily living at SC discharge: the risk of dependence was significantly (p = 0.004) lower in men, was directly depended on the initial mRS score and the time elapsed from the estimated stroke onset to the SC admission, but was inversely related to the amount (dose) of certain rehabilitation interventions (the odds ratio of not achieving a good outcome was 0.93 (95 % CI 0.89‒0.97) for every additional 100 minutes of mechanotherapy). The logistic regression model based on the selected set of features turned out to be adequate (χ2 = 60.7 at 7 degrees of freedom, p <0.001). The area under the curve of operational characteristics AUC = 0.82 (95 % CI 0.77‒0.86) indicates good internal prognostic model agreement, and its sensitivity and specificity were good with 76.1 % (95 % CI 70.1‒81.4 %) and 75.0 % (95 % CI 61.6‒85.6 %), respectively.
Conclusions. In a cohort of patients with cerebral stroke, independent predictors of dependency after in-patient rehabilitation were identified and a predictive model was developed to assess the likelihood of a good treatment outcome. If its external validity is confirmed in other settings, the developed model may be useful for optimizing treatment strategies and providing patients and their families with prognostic evaluations.

 

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