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1. Rehabilitation of the upper extremity and basic activities of daily living in the first month after ischemic stroke: an international cohort comparison study

Author

Cesar Minelli, Francisco A.A. Gondim, Amilton Antunes Barreira, and Alexander W. Dromerick

Subjects
Rehabilitation, Arm, Activities of Daily Living, Outcome Assessment, Internationality Randomized Controlled trials, Medicine, Internal medicine, RC31-1245, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Background: Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischaemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings. Design and Methods: This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria. The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared. Results: Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (P 0.05). Conclusions: Substantially different treatment approaches after ischaemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results.

Published
2009
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2. Assessment of autonomic nervous system dysfunction in multiple sclerosis and the association with clinical disability

Author

Cesar Minelli, Alexander W. Dromerick, Amilton Antunes Barreira, and Francisco de Assis Aquino Gondim

Subjects
medicine.medical_specialty, Activities of daily living, Multiple Sclerosis, Barthel index, medicine.medical_treatment, Developing country, sympathetic skin reaction, Neurosciences. Biological psychiatry. Neuropsychiatry, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Medicine, 030212 general & internal medicine, 10. No inequality, Prospective cohort study, Internal medicine, Cohort comparison, Rehabilitation, business.industry, autonomic nervous system, RC31-1245, 3. Good health, disability, Ischemic stroke, Physical therapy, Neurology (clinical), EDSS, business, Developed country, 030217 neurology & neurosurgery, RC321-571
Abstract

Background: Recent studies have reported autonomic dysfunction (AD) in multiple sclerosis (MS), bladder and/or bowel dysfunction, orthostatic hypotension, and cardiac adaptation disorders have been observed in a wide range (15-80%). The primary aim of this study is to investigate the frequency and association of AD in MS patients, assessed by sympathetic skin reaction (SSR) and a symptoms questionnaire. The secondary aims of this study are to study the association of AD and disease disability assessed by expanded disability status scale (EDSS), as well as disease duration. Design and Methods: 100 clinically definite MS patients were evaluated for ANS dysfunction by use of an autonomic symptoms questionnaire and SSR testing. The relationship between these methods, AD and disease-related parameters, such as the expanded disability status scale (EDSS) and disease duration were all evaluated. Results: 65% of the patients presented with AD and 29% of these patients had abnormal SSR results. MS patients with high EDSS values (EDSS >4) and longer disease duration were more likely to have ANS dysfunction (p less than 0.0001). Conclusions. ANS dysfunction is not uncommon in CDMS patients and thus noninvasive investigations of AD are warranted to optimize AD evaluation and disease management.

Published
2009

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