Aug 12

中風之【治療黃金六個月】Stroke【Important Principles of Rehabilitation】

中風之後的復原

Stroke

中風是腦部神經因血管阻塞造成血液供應的阻斷或因血管爆裂出血而造成組織壓迫,在接受緊急治療之後,腦部會進行自行復原和重組,有進行適當的中風復建(物理治療,職能治療,語言治療等),將會加速腦部神經的修復及連接。

vitamin-b12-and-stroke-recovery

腦部神經復原快速期是在頭1~3個月,之後的復原速度將會緩慢下來。一般我們會將復原分類為自主性復原和功能性復原。

自主性復原

腦神經受傷之後,因腦部不同區域受損將會反映肢體部位或功能上的影響,一開始損傷層度的大小,將會影響之後預後的情況。自主的復原只會發生在中風頭3~6個月而已,之後就必須靠復建來改善。有研究顯示,中風2~3年的患者,復原最顯著的時期是中風頭6個月,這也是為何在剛開始中風的時期,復建的介入必須要盡快,儘早及積極的接受治療。

功能性復原

功能性的損傷將可以從日常生活的活動來評估,而這些功能性活動都可以透過復建來改善,而復原的快慢會因病人本身的願意程度,學習能力,家人的支持,治療師的治療品質或治療時間的長短及次數,而有所不同。功能性復原會受自主性復原的程度影響,但是卻不是全全依賴自主性復原的快慢。

這也是為何適當的治療方式密集的治療療程足夠的治療時間對中風的康復是有多麼大的影響啊!

 rehabilitation

Neurological Recovery

  • Neurological recovery is defined as recovery of neurological impairments and is often the result of brain recovery/reorganization; it has been increasingly recognized as being influenced by rehabilitation.

  • The majority of neurological recovery occurs within the first 1-3 months.

  • Afterwards recovery may occur much more slowly for up to one year or more.

Spontaneous Neurological Recovery

  • Neurological deficits resulting from a stroke are often referred to as impairments. These are determined primarily by the site and extent of the stroke.

  • As a general rule, the severity of the initial deficit is inversely proportional to the prognosis for recovery.

  • Most spontaneous recovery occurs during the first 3-6 months after the stroke.

  • The course of recovery is a predictable phenomenon; it is initially very rapid and then negatively accelerates as a function of time (Skilbeck et al. 1983). Skilbeck et al. (1983) studied 92 stroke survivors with a mean age of 67.5 years (range= 36-89) at final assessment, either 2 or 3 years after stroke. The majority of recovery was reported within the first 6 months, with continued but non-statistically significant recovery after 6 months.

  • This type of recovery has, until recently, been regarded as largely inaccessible to medical intervention or manipulation.

Functional Recovery

  • Functional deficits are often referred to as disabilities and are measured in terms of functions such as activities of daily living.

  • Functional recovery is defined as improvement in mobility and activities of daily living; it has long been known that it is influenced by rehabilitation.

  • This recovery depends on the patient’s motivation, ability to learn and family supports as well as the quality and intensity of therapy.

  • Functional recovery is influenced by neurological recovery but is not dependent on it.

That why proper treatment method, intensive rehabilitation is so important to Stroke patient.