Of course, early rehabilitation is going to get you recovered better, you're in the spontaneous recovery phase.
Cognitive and Psychomotor Performance of Patients After Ischemic Stroke Undergoing Early and Late Rehabilitation
by
, , , and
Aleksander Korchut
1,
Danuta Sternal
2,
Sylwia Krzemińska
3,
Ewa Marcisz-Dyla
4 and
Ewelina Bąk
2,* 1
DSW University of Lower Silesia, 53-609 Wroclaw, Poland
2
Faculty of Health Sciences, University of Bielsko-Biala, 43-300 Bielsko-Biala, Poland
3
Faculty Health of Sciences, Higher Medical School in Kłodzko, 57-300 Klodzko, Poland
4
Faculty of Management, Psychology, Katowice Business University, 40-659 Katowice, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(6), 2122; https://doi.org/10.3390/jcm14062122
Submission received: 18 February 2025
/
Revised: 13 March 2025
/
Accepted: 18 March 2025
/
Published: 20 March 2025
(This article belongs to the Special Issue Clinical Perspectives in Stroke Rehabilitation)
Abstract
Objectives: The aim of this study
was to determine the performance of cognitive and psychomotor functions
in patients after ischemic stroke, taking into account the
effectiveness of early and late rehabilitation.
Methods: The
study included 86 patients with ischemic stroke hospitalized in the
Neurological Rehabilitation Unit. The patients were divided into two
groups according to the timing of rehabilitation, considering early
rehabilitation which started within 30 days of hospital discharge (56
patients), and late rehabilitation which started after 30 days of
hospital discharge (30 patients). Cognitive and psychomotor functions
were measured in all the study patients using the Integrated System for
the Measurement of Psychophysiological Variables called Polypsychograph,
including tests assessing memory, attention, eye–hand coordination, and
reaction speed. The measurements were repeated after 21 days of
post-stroke rehabilitation.
Results: Early rehabilitation led to
significant improvements in most of the parameters studied, including
memory, attention, speed of thinking, and precision of movement. Late
rehabilitation was followed by an improvement in the results of the
indicators studied to a lesser extent than the early rehabilitation.
Improvements in temporal and qualitative parameters were observed in
both groups of patients undergoing early and late rehabilitation.
Conclusions:
In patients after ischemic stroke, early rehabilitation improved
cognitive and psychomotor performance to a greater extent than late
rehabilitation.
1. Introduction
Stroke
is one of the main causes of physical and cognitive impairment and
onset of emotional difficulties in people. Among people over 65 years of
age, stroke is a direct cause of cognitive impairment in two-thirds of
patients [1].
This is associated with irreversible damage to brain tissue due to
vascular dysfunction. Stem-cell-based therapy is being considered to
stimulate neuroregeneration and minimize post-stroke deficits. A
comprehensive description of the pathomechanisms involved in stroke and
the possibilities of post-stroke brain regeneration with the use of
exogenous stem cells is presented in the review paper by Ejma et al. [2].
Neuropsychological difficulties resulting from stroke significantly
reduce patients’ quality of life and affect the recovery process and the
effectiveness of rehabilitation.
In Poland,
post-stroke rehabilitation focuses mainly on improving motor function,
while behavioral disorders, which can equally significantly affect
patients’ limitations, are often neglected. This state of affairs poses a
challenge to the rehabilitation system, which should take into account
both physical and mental disabilities [3].
The
type and severity of neuropsychological deficits depend on factors such
as the location of the brain injury, the number of strokes suffered,
and the age of the patient. These disorders are rarely limited to a
single area of functioning, further complicating diagnosis. The issue of
cognitive deficits is complex and diagnostic options remain limited.
Attention
deficit disorder is one of many conditions that can follow a stroke.
Attention plays a key role in the selection and reduction of information
and in cognitive processes. Structures such as the brainstem, thalamus,
prefrontal cortex, and association cortex of the parietal lobe are
responsible for the attention processes [4]. Attention disorders can be divided into specific and nonspecific types [5].
Executive
functions, responsible for planning and controlling actions, are
essential for social and cognitive activities. Their damage causes
adaptive difficulties, increases dependence on the environment and the
risk of social isolation and emotional disturbances [6].
Deficits in this area pose significant challenges for both patients and
therapists, limiting the effectiveness of rehabilitation.
Cognitive
rehabilitation and therapy are rapidly developing fields. The diagnosis
of cognitive deficits and their treatment require a multidimensional
approach.
In Poland, post-stroke rehabilitation
usually starts in neurological or stroke wards, often already on the
day of admission to hospital. The next step consists of rehabilitation
wards, outpatient clinics, or rehabilitation at the patient’s home.
Rehabilitation offers the chance to return to an active life and improve
the quality of functioning. Early comprehensive management including
not only physical rehabilitation, but also psychological support is
crucial [7].
According
to the European Stroke Initiative (EUSI) guidelines, rehabilitation
should be considered in every stroke patient and started as early as
possible, preferably in a stroke unit. Effective rehabilitation requires
the collaboration of an interdisciplinary team including physicians,
physiotherapists, neurologists, occupational therapists,
neuropsychologists or psychologists, and nurses [8,9].
The
rehabilitation planning process should take into account both motor
deficits and other limitations that significantly reduce patients’
quality of life [8].
The duration and intensity of activities should be individually
tailored to the patient’s needs, and documentation of rehabilitation
progress should be available to the whole treatment team [10].
The European Stroke Organisation (ESO) guidelines, which update the
EUSI recommendations, indicate the need for early rehabilitation
delivered in stroke units. Integrated interdisciplinary team efforts
positively influence treatment outcomes, regardless of age, gender, or
symptom severity.
However, most diagnostic
methods used to assess psychophysical function are not adapted to the
specific needs of stroke patients. Popular methods such as the
Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment
(MoCA), and the Clock Drawing Test (CDT), although considered useful for
screening dementia disorders, have limited utility in more complex
clinical studies that take into account the specificities of individual
cases [11,12,13].
Similar
limitations apply to tools used to assess personality, temperament,
intelligence, depression, or mood disorders. Most of these methods are
based on quantitative scores, neglecting the qualitative aspects of
functioning of patients with central nervous system (CNS) damage. In
addition, many tests require independent writing or marking of answers,
which can be a significant limitation for people with dominant hand
paresis.
The aim of this study was to determine
the performance of cognitive and psychomotor functions in patients
after ischemic stroke, taking into account the effectiveness of early
and late rehabilitation.
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