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Clinical Research on the Rehabilitation of Stroke Patients' Motor Ability

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Clinical Research on the Rehabilitation of Stroke Patients' Motor Ability 2002. Vol. 3. No. 1. 107-119 Korean Journal of Oriental Medicine Original Article Clinical Research on the rehabilitation of Stroke patients’ motor ability Chang-Nam Ko, Sang-Kwan Moon, Ki-Ho Cho, Young-Suk Kim, Hyung-Sub Bae, Kyung-Sub Lee Department of Cardiovascular and Neurological diseases(Storke center) Kyunghee University, Seoul, Korea Abstract Background and Purpose: This clinical study investigated the effect of oriental medical treatment (herbal medicine, acupuncture & moxibustion therapy, physiotherapy, etc.) for the motor recovery improvement in stroke patients. The MBI (Modified Barthel Index) and NIHSS (National Institute of Health Stroke Scale) were used to evaluate the motor recovery in these patients. Methods: We selected the 151 stroke patients (79 male and 72 female) who visited Kang Nam Korean Hospital, Kyunghee University from June 1. 2000 to June 30. 2001 and investigated their characteristics, risk factors, past history, lesion area and size, symptoms, admission period and the period from onset to admission. We analyzed the MBI & NIHSS records to prove the efficacy of oriental medical treatment. Results and conclusions: Age distribution shows in 60s, 70s, 50s, 40s and 80s. The average age was 65.6±10.0. Gender ratio was 1.09:1(M:F). Lesion areas were mostly in the MCA (Middle Cerebral Artery), multifocal, brainstem and PCA (Posterior Cerebral Artery). Antecedent diseases of stroke patients were hypertension (78.4%), heart diseases, and diabetes mellitus, prior attacks. Symptoms of these patients are motor disturbance, verbal disturbance, swallowing disturbance and stool and urine disturbance. The mean admission period was 35.3±36.2 days. The significant period from onset to admission was 23.6 ±42.8 days. Correlation with lipid profile of stroke was not significant. Analyzing the MBI & NIHSS, MBI records showed significant negative correlation in age, admission period and the period from onset to admission (p<0.01). The NIHSS record was significant positive correlation in admission period at admission (p<0.01) and positive correlation with admission period at discharge (p<0.05). DIF-MBI shows significant positive correlation with admission period (p<0.01). In score improvement of the MBI & NIHSS, the MBI showed such a significant improvement in cerebral infarction and hemorrhage (p<0.01). The NIHSS shows significant improvement in cerebral infarction (p<0.05). Korean Journal of Oriental Medicine 2002;3(1):107-119 Key Words: cerebral infarction, cerebral hemorrhage, the MBI and the NIHSS Introduction cognitive ability due to the problems in the circulatory system like the closing or rapture of a Stroke is a disease causing sudden nervous cerebral blood vessel. Along with cancers and disorders such as disturbance of consciousness, cardiac disorders, it is one of the three major motion and sensation as well as the decrease of causes of death by geriatric diseases. Even if the patient is lucky enough to survive, the serious · Correspondence to : Chang-Nam Ko, Kang Nam Kyung Hee aftereffects including various functional disorders oriental medicine hospital, 994-5 Dae-Chi 2dong, Kang Nam gu, Seoul, Korea. (Tel : 82-2-3457-9005, Fax : 82-2-3457-9069, will not let the patient recover to the level that he E-mail : [email protected]) or she used to cope with daily social life, · This study was supported by a grant from Kyung Hee University in the Program Year 2000 destroying not only the life of the patient but also 108 Korean Journal of Oriental Medicine their family and the society1). Besides, its high functionality level is very low. Thus, NIHSS return rate makes stoke one of the major concerns (National Institute of Health Stroke Scale) has not only by the health and medical authorities but been used as an assessment tool for those patients also by the entire country. who are in an acute phase of stroke5-8). In general, the functional rehabilitation of stoke Considering the fact that the number of oriental patients is based on the recovery of their motor medical clinics has rapidly increased so has the ability and this has become an important expectation and interest in the cure of stroke by theoretical propose since Twitchel treated stroke oriental medicine, it is time that systematic clinical patients and evaluated their status based on their research should be undertaken in order to prove rehabilitation stage in 1951. In 1970s, the motor the effectiveness of oriental medicine on stroke in ability assessment of stroke patients has become an objective way. This study aims to evaluate the more recognized along with the development of effectiveness of oriental medical treatments Brunnstrom’s research and various nervous or including the use of oriental medicines, physiological clinic methods2). Although it is acupuncture, moxibustion and physiotherapies to important to precisely evaluate the current status cure stroke patients by using the MBI (Modified of disorders and estimate the possibility of Barthel Index) and the NIHSS (National Institute rehabilitation, it is also necessary to set a realistic of Health Stroke Scale), which are most com- goal of treatment ensuring positive effectiveness monly used as a functionality assessment tool. due to the fact that disorders distressing stroke patients differ from one patient to another and their Objects & Methodology of the complications also present individual aspects. Research Therefore, even though the goal of the assessment of the development status of a stroke patient may 1. Objects differ per their progress, the level of consciousness (1) Research Objects and neurological disorder, responses to the a) Objects: The objects of this research are treatment, recover of motor ability and func- patients who have been hospitalized to the tionality are generally evaluated to treat the applicable medical center during the period patient3). Among these aspects, the assessment of between June 1, 2000 and June 30, 2001 and functionality is necessary to set treatment goals diagnosed as stroke by MRI (Magnetic Resonance and also to track the clinical progress of the Imaging) or CT (Computer Tomography). Among patient4) and Barthel Index has been commonly 251 patients who are in their initial development used for this type of assessment. The MBI of stroke (from the beginning to 6 months of (Modified Barthel Index), which is an updated development), only 151 patients have been version of Barthel Index, can be regarded as a selected as the research objects after excluding standard measure to evaluate a stroke patient’s those patients who meet the exception criteria. functionality in daily life in a convenient and b) Exception Criteria: If the physicochemical objective manner. It is recommended to evaluate diagnosis of a patient shows that he or she suffers patients with particular limits in functionality but from a severe lesion in the heart, liver or kidney not suitable to evaluate patients whose overall disorder or significant side effects, he or she is Chang-Nam Ko et. al. 109 excluded from the research objects. 3. Statistical Process Spsswin 8.0 has been introduced for statistical 2. Assessment Method & Treatments process of this research while Pearson Correlation (1) Assessment Method Analysis has been used to analyze the correlation a) Modified Barthel Index (MBI): The NIHSS of the MBI and NIHSS. Paired sample t-tests have (National Institute of Health Stroke Scale) is used been used to analyze the progress in motor ability for patients who are in an acute phase of stroke and the result below P<0.05 has been proved to be while the MBI (Assessment of Daily life motions) significant. is used for those who passed the acute phase and are in a stable phase. Research Results b) Assessment Period: The changes in the patients’motor ability by complicated and 1. Age Distribution integrated oriental medical treatments have been In terms of age distribution, 57 patients were in observed during the period from their admission to their 60s(37.7%), 38 patients were in their the time of leaving the hospital. 70s(25.2%), 32 patients were in their 50s(21.2%), (2) Treatments 11 patients were in their 40s and 80s(7.3%) while a) Patients have been provided with oriental 2 patients were under age 40(1.3%). The average medicines, acupuncture, moxibustion and age of male patients was 64.3±10.5 while that of physiotherapies. They have drunk a medical female patients was 66.9±9.4. The average age of decoction 3 times a day according to their medical the entire patients was 65.6±10.0. conditions. In relation to the acupuncture therapy, According to the gender analysis, among male Taegeu acupuncture has been applied for the patients, 59 had cerebral infarction while 20 had sound part of the patient’s body while the direct cerebral hemorrhage (total 79 male patients, treatment (such as Jungpungchilcheohyul, 52.3% of the entire patients). Among female Baekhoi(GV20), Poongji(G20), Injung(GV26), patients, 58 had cerebral infarction while 13 had Seungjang(CV24), Gokji(LI 11), Hapgok(LI4), cerebral hemorrhage (total 72 female patients, Yoigwan(TE5), Poongshi(G31), Joksamri(S36), 47.7% of the entire patients). Total 118 patients Hyunjong(G39), Taechoong(Liv3), Jokimeup (male 59 and female 58) had cerebral infarction, (G41) etc.) on the diseased area associated with showing 78.1% while 33 patients (male 20 and moxibustion (Gwanwon(CV4), Junggeuk(CV3) female 13) had cerebral hemorrhage, reaching etc.) to improve the patient’s disease. 50 minutes 21.9%. The ratio between male and female of physiotherapy has been provided for the patients was 1.09:1; indicating the number of male patients at the motor treatment room of the patients is slightly higher than that of female medical center once a day. patients. (Refer to Table 1) b) During the admission period, patients have been prescribed with western medicines 2. Distribution of Lesions per Area and Size (antihypertension agent, antidiabetic agent, According to the lesion distribution analysis per antithrombus resolution, anticoagulant, etc.) via area, 59 cerebral infarction patients had their cooperation with western medical doctors.
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