뇌졸중 환자에서 재활치료 기간 중 신경학적 장해와 장애의 연관성

Abstract

Background: The relationship of impairment and disability in stroke is not well known. The purpose of this paper is to describe the association between impairment and disability during stroke rehabilitation and to describe the association between reduction of impairment and disability for examining the effect of rehabilitation therapy. Methods: National Institute of health Stroke Scale(NIHSS) for neurologic impairment, motor Functional Independence Measure(FIM) and cognitive FIM for disability were assessed 50 stroke patients who received rehabilitation therapy. Relationships were studied between NIHSS and the two FIM subscales on admission, discharge, and gain. Two groups of patients were identified; the 43 patients who experienced no substantial reduction of impairment expressed the non-impairment reduction(NIR) group, and the 7 patients who had a significant reduction of impairment level expressed the impairment reduction(IR) group. The relation of NIHSS and two FIM subscales, the relation of IR, NIR and FIM gain were analyzed by SPSS 10.0 program. Results: NIHSS correlated significantly with motor and cognitive FIM subscores on admission, discharge, and gain. Both the NIR group and the IR group experienced significant decreases in disability during rehabilitation therapy, except cognition FIM in the NIR group. Conclusions: Stroke subjects without improvement of the impairment demonstrate disability reduction during rehabilitation. Therefore although impairment and disability in stroke are correlated with each other, the reduced disability alone is not fully explained by the improvement of impairment that occurs during rehabilitation therapy. This results suggest that rehabilitation has an independent role in reducing disability.