motor impairment disability related to age

8/9/2019 Motor Impairment Disability Related to Age

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Original Article

Ischemic Stroke: Motor Impairment

And Disability With Relation To AgeAnd Lesion LocationF Soyuer, A Soyuer

Keywords

lesion location, rehabilitation, strokeCitation

F Soyuer, A Soyuer.Ischemic Stroke: Motor Impairment And Disability With Relation To AgeAnd esion ocation. The Internet Journal of Neurology. 2004 Volue ! Nuber 2.Abstract

"b#ecti$es% To &escribe the association bet'een otor i(airent an& &isability an& toestablish the relation to age, an& heis(here of stroke in ischeic stroke.

)etho&s% A total of *00 (atients 'ith ischeic stroke 'ere assesse& at +rciyes ni$ersityNeurology -e(artent. The i$erea& )otor Assessent /)A 'as use& to easureotor i(airent an& the Functional In&e(en&ence )easure /FI) 'as use& to easure&isability. The assessents 'ere a&e (oststroke in 1*0 &ays an& ! onths.

esults% )A correlate& significantly 'ith FI) for both 1*0 &ays an& ! onths. )otori(airent an& &isability 'ere not relate& 'ith age an& istatistically bet'een both

heis(heres there 'as no significant &ifference in either otor i(airent or &isability.

3onclusions% Strokerelate& otor i(airent an& &isability are significantly correlate& 'itheach other. -es(ite soe inconsistencies in eisting literature, our stu&y sho'e& that age an&lesion location ha& no effect in otor i(airent an& &isability assessents.Introduction

Although stroke often results in soe &egree of longter i(airent an& &isability, ost(atients e(erience soe natural reco$ery of neurologic functioning an& i(ro$eent inability to (erfor acti$ities of &aily li$ing /*,2,!,4,5. I(airent, anifeste& by &eficits in

(riary neurologic functions, results in &isability, 'hich is anifeste& by the re&uce& ability

to (erfor functional acti$ities such as &ressing, 'alking an& eliination /6. 7o'e$er, thenature of the relation bet'een otor i(airent an& &isability aong in&i$i&uals 'houn&ergo stroke rehabilitation reains unclear. )uch of the lack of e(irical e$i&ence for therelation bet'een stroke otor i(airent an& &isability can be attribute& to the &ifficulty in8uantifying neurologic functioning an& se$erity of &isability. Soe authors ha$e sho'n thatincrease& age (re&icts (oor outcoe after stroke /1, 9 , 'hereas other researchers aintainthat age is an in&e(en&ent (re&ictor of functional outcoe /:.In a&&ition to age, the si&e of lesion also a((ears strongly relate& to functional outcoes.;atients 'ith se$ere functional i(airent on a&ission follo'ing right heis(here lesionsa((ear to &eonstrate less i(ro$eent than those 'ith left heis(here lesions /1, *0.Although these fin&ings are not uni8ue /* soe researchers ha$e not foun& a &ifference inoutcoe relate& to lesion location /9 an& recent literature re$ie's suggest that heis(here ofstroke &oes not (re&ict outcoe /*0, **.
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Sub#ect &eogra(hics an& associate& stroke characteristics are liste& in table *. )otori(airent an& ratings for the entire sa(le are (ro$i&e& in table 2. 3orrelations bet'eenotor i(airent an& &isability easures are sho'n in table ! an& 4. These analysesre$eale& significant correlations bet'een )A an& FI) easureents for both tie

(erio&s. 7o'e$er, the correlation bet'een the cFI) an& assessent easures 'ere re$eale&

(oor relation. The le$el of association 'as also lo'er in relation to ar o$eent. Ingeneral, relations bet'een i(airent an& otor &isability at both 1*0 &ays an& at ! onths'ere stronger than 'ere the relationshi(s bet'een i(airent an& cogniti$e &isability. Ingeneral, the correlations at ! onths 'ere siilar to at 1*0 &ays.Figure 1

Table *% ;atient -eogra(hics an& stroke 3haracteristics

Figure 2

Table 2% )otor I(airent an& -isability atings *00 Stroke ;atients


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Figure 3

Table !% 3orrelation Analyses of )A )easures an& FI) )easures of Stroke ;atients at 1*0 &ays

Figure 4

Table 4 % 3orrelation Analyses of )A )easures an& FI) )easures of Stroke ;atients at !)onths


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egression analyses bet'een age an& FI) an& )A easureents at 1*0 &ays an& !onths 'ere not significant /(@.05. The regression analyses bet'een age an& FI), )Aeasureents 'ere also insignificant in the &ifference bet'een 1*0 &ays an& ! onthsfollo'ing the stroke. In&e(en&ent t test re$eale& no significant &ifferences bet'een the leftheis(here an& right heis(here grou(s on the )A an& FI) /(@.05. 7o'e$er, onlycogniti$e FI) re$eale& a significant &ifference bet'een both heis(heres /(.05. The leftheis(here easureents in cogniti$e FI) 'ere higher than the in right heis(here /Table5.

Figure 5Table 5 % In&e(en&ent t tests on )A an& FI) by 7eis(here


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Discussion

Although any re(orts ha$e &escribe& changes in &isability le$els &uring stroke

rehabilitation /*,2,!,4, 20, 2*, there has been relati$ely little eaination of the se$erity ofstrokein&uce& otor i(airent at rehabilitation a&ission an& &ischarge. 3linicalobser$ation an& a fe' e(rical stu&ies ha$e suggeste& the otor i(airent an& &isability instroke sur$i$ors are relate& to in subtle an& co(le 'ays /!, 22, 2!. The (ur(ose of thisin$estigation 'as to &escribe these relationshi(s by using &ifferent fro literature on otori(airent an& &isability easures only in ischeic stroke grou(, (articularly because of&ifferent $ie's in literature 'hich ha$e researche& the effect of age an& lesion location oni(airent an& &isability in this liite& grou(.Se$eral (rior stu&ies ha$e eaine& the relationshi(s bet'een or&inal easureents ofi(airent an& &isability. >oo&-au(hinee an& colleagues /24 foun& that t'o easures ofneurologic status /inclu&ing the Fugl)eyer scale significantly correlate& 'ith the Barthelin&e. T'o stu&ies /5, 25 use& a easure of i(airent, the National Institutes of 7ealthStroke Scale /NI7SS, to &eonstrate a correlation bet'een i(airent an& &isability afterstroke. Cenerally these stu&ies 'ere liite& by a sall sa(le si?e, an& the ischeic an&heorrhagic grou(, 'hich can also a((ear &ifferent fro (rogression of reco$ery in stroke,'ere taken together /5, 24, 25, 21.There are se$eral a&$antages to using the )A to easure i(airent. )A easuresfunctional otor assessent. >hile otor i(airent of (atient 'ith stroke 'as e$aluate& toassess o$er all ake )A uch ore (referencDable an assessent etho&. )A isconsi&ere& a highly reliable an& $ali& easure of strokerelate& i(airent, an& is easy toa&inister /*!, *4. This is an assessent etho& 'hich is ob#ecti$e an& can ake stability

easure in itself, an& can also sho' the le$el of )A i(airent, to &eterine the effect ofthe rehabilitation (rogra 'hich is to be chosen an& to easure the reco$ery 8uantity.


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Furtherore, FI) is siilar to )A, has been use& etensi$ely in rehabilitation. It too,(ossesses e$i&ence of high reliability an& $ali&ity, although the FI) instruent easures&isability rather than i(airent /*5, *:.In this stu&y, a large cohort of consecuti$ely a&itte& stroke (atients 'ho un&er'ent aco(rehensi$e rehabilitation (rogra 'ere consistently e$aluate& using the )A an& the

FI) at both 1*0 &ays an& ! onths after stroke. This affor&e& the o((ortunity to &eterinethe relationshi( bet'een i(airent an& &isability. There 'ere statistically significantassociations bet'een i(airent an& &isability in both subscale an& total scores at both the1*0 &ays an& ! onths after stroke. +s(ecially, our stu&y also sho'e& that gross an& lego$eent contribute ore to high acti$ities of &aily li$ing /A-E scores than u((er libfunction.The fin&ing that there 'as ore i(ro$eent in otor function /!! than in cogniti$efunction /*9 is consistent 'ith the coon clinical obser$ation that otor reco$ery ten&sto occur earlier an& to a greater etent than &oes cogniti$e reco$ery /22, 21.It 'as foun& that there is istatistically a (oor relation bet'een cogniti$e FI) an& i(airentin this stu&y. >oo& -au(hinee an& colleagues also foun& a relation bet'een the otor

(erforance an& cogniti$e subscale of le$el of rehabilitation scale /24.The follo'ing are the $ie's of soe researchers about ho' the effects of age factor onfunctional ca(asity an& (rognose in (atients 'ith a stroke. Alean&er /1 foun& initial se$erityof stroke an& age to be the ost (o'erful (re&ictors of functional reco$ery. Siilarly,Gotila


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correlate& 'ith each other. The etent of i(ro$eent in i(airent an& &isability 'asfoun& to be in&e(en&ent of age.In *00 (atients 'ith ischeic stroke se(erate& into t'o grou(s, left an& rigth heis(herelessions, no statistically significant &ifferences 'ere foun& bet'een the grou(s in assessentsa&e at 1*0 &ays an& ! onths, ece(t in cogniti$e function istatistically.

Correspondence toFerhan Soyuer +rciyes ni$ersitesi 7alil Bayraktar SaDlDk 7i?etleri )", GayseriHTurkey+ail% soyuerfKerciyes.e&u.tr Tel% 0542 2!54062References

*. Eehann JF, &e Eateur BJ, Fo'ler S, >arren 3C, Arnhol& , Schert?er C. Strokerehabilitation% outcoe an& (re&iction. Arch ;hys )e& ehabil *:15= 56%!9!!9:.2. Skilbeck 3+, >a&e -T, Eangton7e'er . eco$ery after stroke. J Neurol Neurosurg;sychiatry *:9!= 46%59.!. Ferrucci E, Ban&inelli S, Curalnic J), Ea(oni ), Bertini 3. eco$ery of functionalstatus after stroke% a (ost rehabilitation follo'u( stu&y. Stroke *::!= 24% 200205.4. 7ailton BB, Cranger 3V. -isability outcoes follo'ing in(atient rehabilitation forstroke. ;hys Ther *::4= 14% 4:450!.5. oth +J, 7eineann A>, Eo$ell EE. I(airent an& -isability% Their relation &uringstroke rehabilitation. Arch ;hys )e& ehabil *::9= 1:% !2:!!5.6. >orl& 7ealth "rgani?ation />7". 3lassification of i(airents, &isabilities an&han&ica(s /I3-I-7. Cene$a% >7"= *:90.1. Alean&er );. Stroke rehabilitation outcoe% a (otential use of (re&icti$e $ariables toestablish le$els of care. Stroke *::4= 25% *29*!4.9. Gotila ). Four year (rognosis of (atients un&er the age of 65 sur$i$ing their first ischeic

brain infarction. Ann 3lin es *:96= *9% 161:.:. Sauelsson ), So&erfel&t B, "lsson CB. Functional outcoe in (atients 'ith lacunar

infarction. Stroke *::6= 21% 942946.*0. 3ifu -L, Eorish T. Stroke rehabilitation. 5. Stroke outcoe. Arch ;hys )e& ehabil*::4= 14 Su((l% 5660.**. Car&ars&ottir S, Ga(lan S. Vali&ty of the Arnottir "TA-E neurobeha$ioral e$aluation%;erforance in acti$ities of &aily li$ing an& neurobeha$ioral i(airents of (ersons 'ith leftan& rigth heis(here &aage. A J of "ccu( Ther(y 2002= 56% 4::509.*2. >7" S(ecial e(ort. Stroke *:9:% recoen&ations on stroke (re$ention, &iagnosis,an& thera(y. Stroke *:9:= 20%*401*4!*.*!. Eincoln NB, Eea&bitter -. Assessent of )otor Function in Stroke ;atients.;hysiothera(y *:1:= 65%495*.*4. A&as SA. The ri$erea& otor assessent. /In )arilyn A. 7arrison /+&

;hysiothera(y in stroke anageent. 3hurchill Ei$ingstone, *::5=*25*!!.*5. 7ailton BB, Cranger 3V, Sher'in FS, Mielen?y ), Tashan JS. A unifor national&ata syste for e&ical rehabilitation. In Fuhrer )J, +&. ehabilitation outcoes% analysisan& easureent. Baltiore /)-% Brooks ;ublishing 3o(any, *:91= *!1*41.*6. -oo&s TA, )artin -;, Stolo$ >3, -eyo A. A $ali&ation of the functional in&e(en&enceeasure an& its (erforance aong rehabilitation in(atients. Arch ;hys )e& ehabil *::!=14% 5!*5!6.*1. 7ailton BB, Eaughlin JA, Fie&ler 3, Cranger 3V. Interrater reliability of the 1le$elFunctional In&e(en&ence )easure /FI). Scan& J ehabil )e& *::4= 26% **5**:.*9. 7eineann A>, Einacre J), >right B-, 7ailton BB, Cranger 3V. )easureentcharacteristics of the functional in&e(en&ence easure. To( Stroke ehabil *::4= *% **5.

*:. Einacre J>, 7eineann A>, >right B-, Cranger 3, 7ailton BB. The structure an&stability of the functional in&e(en&ence easure. Arch ;hys )e& ehabil *::4= 15% *21*!2.


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20. Jorgensen 7S. The 3o(enhagen Stroke Stu&y e(erience. J Stroke 3erebro$asc -is *::6=6% 5*6.2*. Fie&ler 3, Cranger 3V, "ttenbacher GJ. The unifor &ata syste for e&icalrehabilitation% re(ort of first a&issions for *::4. A J ;hys )e& ehabil *::6= 15% *25*2:.

22. Gotila ), >altio ", Nie )E, Eaaksonen , Ee(inen ). The (rofile of reco$eryfro stroke an& factors influencing outcoe. Stroke *:94= *5% *0!:*044.2!. Bran&stater )+. An o$er$ie' of stroke rehabilitation. Stroke *::0= 2* Su((l II%II40II42.24. >oo&-au(hinee SE, >illias JI, Sha(iro S7. +aining outcoe easures in aclinical stu&y. Stroke *::0= 2*% 1!*1!:.25. ;ullicino ;, Syn&er >, Cranger 3V. The NI7 Stroke scale an& the FI) in strokerehabilitation /letter. Stroke *::2= 2!% :*:.26. 3hae J, Johnston ), Gi 7, Moro'it? . A&ission otor i(airent as a (re&ictor of

(hysical &isability after stroke rehabilitation. A J ;hys )e& ehabil *::5= 14%2*922!.21. An&re's G, Brocklehurst J3, ichar&s B, Eaycock ;J. The rate of reco$ery fro stroke

an& its easureent. Int ehabil )e& *:9*= !% *55*6*.29. 3hen , Eing . A *4 year follo'u( stu&y of !06 cases of stroke. Stroke *:95= *6% !2!!21.2:. Ferrucci E, Ban&inelli S, Curalnik J), Ea(oni ). eco$ery of functional status afterstroke. Stroke *::!= 24% 200205.!0. 3ifu -L, Eorish T. Stroke rehabilitation. 5. Stroke outcoe. Arch ;hys )e& ehabil*::4= 15 Su((l % 5660.!*. )ills >), -iCenio ). Functional -ifferences in (atients 'ith left or rightcerebro$ascular acci&ents. ;hysical Thera(y *:9!= 6!% 49*491.!2. Arna&ottir C. The brain an& beha$ior% Assessing cortical &ysfunction through acti$ities of&aily li$ing. St. Eouis, )"% )osby, *::0.!!. Arna&ottir C. I(act of neurobeha$ioral &eficits on acti$ities of &aily li$ing. In C. CillenOA.Burkhar&t /+&s, Stroke rehabilitation% A functionbase& a((roach. St. Eouis, )"%)osby. *::9, 29!!!!.

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motor impairment disability related to age

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