Clinical characteristics affecting motor recovery and ambulation in stroke patients.
Alparslan Yetisgin
PMID 28265142WHAT IT FOUND
Women with stroke hemiplegia had lower hand and upper-limb motor stages and more complex regional pain syndrome.
Shoulder pain was linked to complex regional pain syndrome. Rehabilitated patients were further from stroke, so better walking scores cannot be credited to rehabilitation alone.
Key findings
01Female patients had lower Brunnstrom hand and upper-extremity motor stages than male patients on the six-stage Brunnstrom system.
02Complex regional pain syndrome was observed in 18.9% of patients, was more common in females, and was associated with shoulder pain.
03Patients recorded as rehabilitated had higher lower-extremity Brunnstrom stage and Functional Ambulation Scale score, but they were more months after stroke.
STILL TO COME
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What it does not show
The study was retrospective and included only 53 patients from a single outpatient clinic, so the findings may not apply to other stroke populations. Patients who could not walk independently before stroke were excluded, so it says nothing about patients who were already unable to walk before stroke. Patients with cognitive or hearing limitations that prevented examination were excluded. Other systemic diseases that could affect prognosis were not determined. Whether shoulder pain or complex regional pain syndrome was treated was not assessed. The rehabilitated group was more months after stroke, so the better lower-limb and ambulation scores cannot be separated from time since stroke. The rehabilitation program included neurophysiological exercises, range-of-motion exercises, posture, balance, gait training, and ergotherapy, so the contribution of any single component cannot be separated. The paper states all patients received rehabilitation but also compares rehabilitated and non-rehabilitated patients. This makes the rehabilitation grouping unclear.
Declared interests
The authors declared no conflict of interest. No funding source is reported in the supplied text.
The easy way to misread this
Do not conclude that rehabilitation caused better walking or lower-limb motor recovery. The rehabilitated group was 6.7 ± 3.2 months after stroke rather than 3.4 ± 2.8 months, and the program included neurophysiological exercises, range-of-motion exercises, posture, balance, gait training, and ergotherapy together, so no single component can be separated.