RESUMEN
BACKGROUND AND PURPOSE: Complex regional pain syndrome type I (CPRS I), is a complex of symptoms characterized by diffuse pain usually with associated swelling, vasomotor instability, and severe functional impairment of the affected extremity in stroke patients. Pain is a prominent feature and is often refractory to variety of treatment. METHODS: To investigate the clinical, functional, and psychosocial effects of upper extremity aerobic exercise (UEAE) and compare the effect of aerobic exercise with that of conventional physiotherapy in patients with CPRS type I following stroke as a randomized controlled assesor blinded 4â week-study. A total of 52 inpatients with stroke [mean age: 65.95 ± 8.7 (min. = 53, max. = 80) years, and the mean age of the control group was 67.50 ± 11.2âyears], all within 6â months post-stroke and diagnosed with CPRS I. The UEAE program consisted of an arm crank ergometer (10 âW/min), in addition to a conventional physiotherapy (whirlpool, TENS, retrograd massage). Primary outcome measures were CPRS clinical determinants (pain, hyperalgesia, allodynia, and autonomic abnormalities) secondary outcome measures were functional independence measure (FIM), Nottingham Health Profile (NHP), and Beck Depression Scale scores that were performed at 0â month (baseline) and 4â weeks (post-treatment). RESULTS: In UEAE group, patients reported significant pain relief (89.9%) and significant decline in CRPS signs and symptoms. The mean change in pain at shoulder, pain at the hand as well as and NHP and BDS scores between groups were statistically significant (P < 0.05). CONCLUSIONS: UEAE made an excellent improvement in the symptoms and signs of CRPS I. Combined treatment of conventional physiotherapy and aerobic exercises may be an excellent synthesis for this syndrome in these patients.
Asunto(s)
Síndromes de Dolor Regional Complejo/terapia , Terapia por Ejercicio/métodos , Accidente Cerebrovascular/complicaciones , Extremidad Superior/fisiopatología , Anciano , Anciano de 80 o más Años , Síndromes de Dolor Regional Complejo/etiología , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Método Simple Ciego , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine predictors of falls in stroke patients in the first 6 months after a baseline evaluation before their discharge from inpatient rehabilitation. DESIGN: Prospective cohort study. SETTING: Rehabilitation hospital, then home. PARTICIPANTS: Consecutive stroke patients (N=66) were followed at home after discharge from the rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fall occurrence within 6 months after a baseline evaluation. All patients were assessed for baseline data during their inpatient rehabilitation (1.5±1.2 wk before discharge). Data regarding cerebrovascular accident (CVA) date, number of attacks, and brain imaging results were obtained; motor function and balance impairment were examined by the Fugl-Meyer Assessment Scale. The FIM and Functional Ambulation Category were also used. Presence of urinary incontinence, drug use, fall history, postural hypotension, neglect, cognitive status, poor vision, and hearing were evaluated. Six months after the baseline evaluation, any fall occurrence was ascertained via telephone calls to the caregivers of each patient. Multivariate logistic regression analysis was used to identify risk factors. RESULTS: The mean age ± SD was 64±10 years. The median time elapsed since CVA at the time of admission was 4 months. Twenty-four (36%) patients fell within the 6-month period. The fall rate was significantly higher in patients with left (47%) versus right (21%) hemispheric stroke. Left hemispheric lesion (vs right) showed a 4 times greater risk of fall within 6 months (odds ratio=4.093; 95% confidence interval, 1.082-15.482). There were no other significant differences between fallers and nonfallers with respect to the other evaluated factors. CONCLUSIONS: Our results suggest that the fall risk within 6 months after a baseline evaluation is greater in patients with left hemispheric lesions versus those with right hemispheric lesions.