Factors associated with outcomes of inpatient stroke rehabilitation

Completely missing the gorilla in the room. No recovery stroke protocols from your doctor. At least identify the real problem instead of dancing around it by quoting irrelevant study after study.

Factors associated with outcomes of inpatient stroke rehabilitation

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

If someone has done this for stroke it is impossible to tell because our fucking failures of stroke associations have not created a database of all stroke related research.
http://journals.lww.com/jtrauma/Abstract/publishahead/Volumetric_analysis_of_day_of_injury_computed.99321.aspx

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Journal of Trauma and Acute Care Surgery:

Post Acceptance: October 31, 2016

doi: 10.1097/TA.0000000000001263

Original Article: PDF Only

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.

Majercik, Sarah MD, MBA; Bledsoe, Joseph MD; Ryser, David MD; Hopkins, Ramona O. PhD; Fair, Joseph E. M.S.; Frost, R. Brock PhD; MacDonald, Joel MD; Barrett, Ryan MS; Horn, Susan PhD; Pisani, David MD; Bigler, Erin D. PhD; Gardner, Scott PA-C; Stevens, Mark MD; Larson, Michael J. PhD

Published Ahead-of-Print

Abstract

Introduction: Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center.

Methods: Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0 .05="" considered="" p="" significant.="" was="">

Results: 96 patients were enrolled in the study. Mean age was 43+/-21 years, admission Glasgow Coma Score 8.4+/-4.8, Injury Severity Score 24.7+/-9.9, and head Abbreviated Injury Scale score 3.73+/-0.97. Acute hospital length of stay (LOS) was 12.3+/-8.9 days and rehabilitation LOS was 15.9+/-9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006).

Conclusion: In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients.

Level of Evidence/Study Type

Level V, case series, Prognostic/Epidemiological

(C) 2016 Lippincott Williams & Wilkins, Inc.

Emerging Treatments for Motor Rehabilitation After Stroke

Do you really think your doctor and hospital are going to take this and create stroke protocols without YOU demanding they do something about their appalling recovery statistics?
And they still do not talk about the best way to improve rehabilitation outcomes would be stopping the neuronal cascade of death.

http://nho.sagepub.com/content/early/2014/11/13/1941874414561023.abstract?

1. Edward S. Claflin, MD1⇑
2. Chandramouli Krishnan, PhD, PT1
3. Sandeep P. Khot, MD2

1. ¹Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
2. ²Department of Neurology, University of Washington, Seattle, WA, USA

1. Edward S. Claflin, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108, USA. Email: clafline@med.umich.edu

Abstract

Although numerous treatments are available to improve cerebral perfusion after acute stroke and prevent recurrent stroke, few rehabilitation treatments have been conclusively shown to improve neurologic recovery. The majority of stroke survivors with motor impairment do not recover to their functional baseline, and there remains a need for novel neurorehabilitation treatments to minimize long-term disability, maximize quality of life, and optimize psychosocial outcomes. In recent years, several novel therapies have emerged to restore motor function after stroke, and additional investigational treatments have also shown promise. Here, we familiarize the neurohospitalist with emerging treatments for poststroke motor rehabilitation. The rehabilitation treatments covered in this review will include selective serotonin reuptake inhibitor medications, 

constraint-induced movement therapy, 

noninvasive brain stimulation,  

mirror therapy, 

and motor imagery or mental practice.