ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 21 of 57
JMBS 2020, 5(1): 149–155
Clinical Medicine

Early Incremental Mobilization in the Practice of Neurorehabilitation of Ischemic Stroke

Muratova T., Khramtsov D., Stoyanov O., Andryushchenko E., Kotov S.

The purpose of the study was to evaluate the experience of early incremental mobilization of the practice of neurorehabilitation in ischemic stroke. Material and methods. The study was conducted during 2016–2019 in the stroke unit of the Center for Reconstructive and Rehabilitation Medicine (University Clinic) of Odessa National Medical University. The study involved 228 patients with ischemic stroke who underwent various types of incremental mobilization starting from the 2nd day after the stroke. For passive verticalisation, the standard Enraf Nonius (Netherlands) turntable was used, and for the active–passive hardware verticalisation Easy Stand (Germany) was used. Active–passive manual verticalisation also utilized Rifton pacers, standard Zimmer frame walkers and rollers. Treatment efficacy was evaluated on changes in the NIHSS, BI (Bartell index), RMI (Rivermead Mobility Index), the Mobility Subscale of the Stroke Rehabilitation Assessment of Movement at the time of admission and discharge, and further evaluated the dynamics of indicators on RMI, STREAM and CGI–I during three months. Results and discussion. The average NIHSS score at the time of admission was 12.1±0.7 points. Signs of moderate cognitive deficits were found in 69 (30.3%) patients, the average MMSE score was 23.8±1.1 points. When assessing baseline parameters on the BI, RMI, and STREAM scales, a significant reduction in rehabilitation potential was identified at the time of treatment initiation. Thus, in most patients the Bartel index did not exceed 65 points (mean 54.3±1.2 points), and RMI and STREAM were 2.8 ±0.2 points and 66.7±2.7 points, respectively. The average length of stay in the hospital was 12.8±1.2 days. The most common ischemia focus was localized in the middle cerebral artery (68.0%), lesions in the posterior cerebral artery and vertebro–basilar pool (21.1%), and anterior cerebral artery (20.9%) were less frequently reported. In 62 (27.2%) patients, lacunar infarctions were observed. All 228 (100.0%) patients underwent passive verticalisation, including 65 (28.5%) rotary table hardware. In 58 (25.4%) patients, active–passive hardware verticalization was used on the stand, and 177 (77.6%) had manual active–passive verticalization. Active verticalisation was used in 146 (64.0%) patients. Incremental mobilization is a relatively safe procedure where the risks are well managed. It also improves the functional outcomes of rehabilitation. The greatest risk of complications is inherent in the passive hardware verticalization method. Conclusion. According to the RMI and STREAM scales, the patients with stroke were stable and showed a tendency to increase functional reserves by 9.1±0.2 points and 87±3 points, respectively. BI increased to 81±5 points. CGI–I averaged to 2.9±0.2 points three months later, regardless of the used incremental mobilization method. To prevent complications and side effects of verticalization, it is advisable to carefully evaluate the clinical status of patients on admission and to conduct clinical monitoring of hemodynamic parameters.

Keywords: neurorehabilitation, acute cerebral circulation disorders, incremental mobilization, clinical monitoring

Full text: PDF (Ukr) 618K

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