Motor recovery after stroke. A comparison between recovery during rehabilitation stay at hospital and at home after discharge in two patients .

Liv-Signe Davidsen, Bevervn 9, 0596 Oslo

Division for Physiotherapy Science, University of Bergen

Abstract

Recovery after stroke has been investigated in different contexts. However, systematic studies of change in physical function at home after discharge from hospital compared with change in a rehabilitation ward have not been done. The purpose of this study was to investigate various aspects of change through these different phases and to elucidate conditions that appeared to influence recovery.

Recovery was investigated in two patients after stroke in a Single Subject Design. The patients were followed through two rehabilitation stays and one or two home-phases, in respectively 12 and 18 weeks after the stroke. Recovery was assessed in different ways, to examine the connection between different aspects of functional level and quality of movement. Motor function was recorded twice a week with a standardized test, Motor Assessment Scale (MAS). Change in quality of movement assessed by a physiotherapist and the patient's own experience of the recovery were registered by interviews.

According to the MAS the patients were recovering during the whole study. The most steady progress occurred during the rehabilitation phases. Changes were demonstrated in the way the patients used their affected side as well as how they managed everyday motor activities. There was a certain correspondence between the findings of the various ways of recording the recovery for one of the patients. The other patient experienced improvement through all the phases, mainly corresponding to the results from MAS, although his quality of movement deteriorated according to observation by the physiotherapist. Environmental factors and focus of treatment seemed to influence recovery of motor skills, as well as the quality of movement. The patients considered pain and to what extent they managed practical skills in their evalutation of recovery. They did not seem to be concerned about the way they moved.

The results from this study are not generalizable, due to the character of the design. The findings do, however, contribute to call attention to conditions that can influence recovery of movements in patients with stroke and to form the basis of further investigation of similar factors.

Keywords: Single Subject Design, Motor Assessment Scale, stroke rehabilitation, motor recovery

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