Clinical and sociodemographic factors associated with gait recovery in individuals after thrombolysis for acute ischemic stroke
DOI:
https://doi.org/10.11606/issn.2317-0190.v29i2a190587Keywords:
Stroke, Early Ambulation, GaitAbstract
The thrombolytic treatment promotes cerebral reperfusion after ischemic stroke and it is considered the most effective treatment in the acute phase. The thrombolysis is associated with better clinical and functional outcomes. Hemiparesis and balance deficits are important sequelae after a stroke and both affect the individual's locomotion. Objective: The aim of this study was to investigate what factors are associated with gait recovery in the acute phase of stroke after thrombolysis. Method: This is a longitudinal study, including 32 individuals in the acute phase of stroke after thrombolytic treatment. The individuals were evaluated in the first hours after thrombolytic therapy, and then, after 7 days or at the time of discharge from the inpatient unit. Results: The main outcome was the presence or absence of independent gait until the seventh day of hospitalization or until discharge from the unit. The response variable was the number of days required to recover gait, being analyzed in 3 categories: "1 day", "2 days" and "3 or more days". Of the 32 individuals in the sample, only 4 did not walk within 7 days after the stroke and about 50% walked on the first day of hospitalization. There was a significant association between the Berg Balance Scale and the time to walk. Conclusions: This study suggests that most individuals undergoing thrombolysis for the treatment of ischemic stroke recover their capacity to walk within seven days of the event and this recovery is associated with balance in the first hours after stroke.
Downloads
References
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89. Doi: https://doi.org/10.1161/STR.0b013e318296aeca
Bensenor IM, Goulart AC, Szwarcwald CL, Vieira MLFP, Malta DC, Lotufo PA. Prevalence of stroke and associated disability in Brazil: National Health Survey - 2013. Arq Neuropsiquiatr. 2015;73(9):746-50. Doi: http://dx.doi.org/10.1590/0004-282X20150115
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-110. Doi: http://dx.doi.org/10.1161/STR.0000000000000158
Lees KR, Emberson J, Blackwell L, Bluhmki E, Davis SM, Donnan GA, et al. Effects of alteplase for acute stroke on the distribution of functional outcomes. Stroke. 2016;47(9):2373-9. Doi: http://dx.doi.org/10.1161/STROKEAHA.116.013644
Conterno LO, Barbosa RWN, Rego CM, Silva Filho CR. Gravidade do déficit neurológico e incidência de infecções hospitalares em pacientes idosos com acidente vascular cerebral agudo. Sci Med. 2016;26(4):25168. Doi: http://dx.doi.org/10.15448/1980-6108.2016.4.25168
Sousa ASP, Tavares JMRS. Interlimb coordination during step-to-step transition and gait performance. J Mot Behav. 2015;47(6):563–74. Doi: https://doi.org/10.1080/00222895.2015.1023391
Nakao M, Izumi S, Yokoshima Y, Matsuba Y, Maeno Y. Prediction of life-space mobility in patients with stroke 2 months after discharge from rehabilitation: a retrospective cohort study. Disabil Rehabil. 2020;42(14):2035-42. Doi: https://doi.org/10.1080/09638288.2018.1550533
Mahendran N, Kuys SS, Brauer SG. Recovery of ambulation activity across the first six months post-stroke. Gait Posture. 2016;49:271-6. Doi: http://dx.doi.org/10.1016/j.gaitpost.2016.06.038
Ferreira MS, Chamlian TR, Franca CN, Massaro AR. Non-motor factors associated with the attainment of community ambulation after stroke. Clin Med Res. 2015;13(2):58-64. Doi: https://doi.org/10.3121/cmr.2014.1232
Jones PS, Pomeroy VM, Wang J, Schlaug G, Tulasi Marrapu S, Geva S, et al. Does stroke location predict walk speed response to gait rehabilitation? Hum Brain Mapp. 2016;37(2):689-703. Doi: https://doi.org/10.1002/hbm.23059
Perennou DA, Hillier SL. Volumes of intact gray matter outside the stroke predict gait performance. Neurology. 2014;82(10):822-3. Doi: https://doi.org/10.1212/WNL.0000000000000194
Jain A, Houten D Van, Sheikh L. Retrospective study on national institutes of health stroke scale as a predictor of patient recovery after stroke. J Cardiovasc Nurs. 2016;31(1):69-72. Doi: https://doi.org/10.1097/JCN.0000000000000198
Huang Y, Wang W, Liou T, Liao C, Lin L, Huang S. Postural assessment scale for stroke patients scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward. J Rehabil Med. 2016;48(3):259–64. Doi: https://doi.org/10.2340/16501977-2046
Antunes J, Justo F, Justo A, Ramos G, Prudente C. Influência do controle postural e equilíbrio na marcha de pacientes com sequela de acidente vascular cerebral. Fisioter Saúde Func. 2016;5(1):30-41.
Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF, Mariano DC, et al. Validation of the national institutes of health stroke scale, modified rankin scale and barthel index in Brazil: the role of cultural adaptation and structured interviewing. Cerebrovasc Dis. 2009;27(2):119–22. Doi: https://doi.org/10.1159/000177918
Miyamoto ST, Lombardi Junior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Brazilian J Med Biol Res. 2004;37(9):1411–21. Doi: https://doi.org/10.1590/s0100-879x2004000900017
Yoneyama SM, Roiz RM, Oliveira TM, Oberg TD, Lima NMFV. Validação da versão brasileira da Escala de Avaliação Postural para Pacientes após Acidente Vascular Encefálico. Acta Fisiátr. 2008;15(2):96-100. Doi: https://doi.org/10.11606/issn.2317-0190.v15i2a102920
Blennerhassett JM, Levy CE, Mackintosh A, Yong A, McGinley JL. One-quarter of people leave inpatient stroke rehabilitation with physical capacity for community ambulation. J Stroke Cerebrovasc Dis. 2018;27(12):3404-10. Doi: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.08.004
Soize S, Fabre G, Gawlitza M, Serre I, Bakchine S, Manceau P-F, et al. Can early neurological improvement after mechanical thrombectomy be used as a surrogate for final stroke outcome? J Neurointerv Surg. 2019;11(5):450-4. Doi: http://dx.doi.org/10.1136/neurintsurg-2018-014332
Santos NSB, Anjos JLM. Associação entre a gravidade do AVC, equilíbrio e mobilidade funcional em pacientes trombolisados. Revista Neurociências. 2021; 29(1-19). https://doi.org/10.34024/rnc.2021.v29.11868
Louie D, Eng J. Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation. J Rehabil Med. 2018;50(1):37-44. Doi: https://doi.org/10.2340/16501977-2280
Ursin MH, Bergland A, Fure B, Tørstad A, Tveit A, Ihle-Hansen H. Balance and mobility as predictors of post-stroke cognitive impairment. Dement Geriatr Cogn Dis Extra. 2015;5(2):203-11. Doi: https://doi.org/10.1159/000381669
Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, et al. Balance and gait after first minor ischemic stroke in people 70 years of age or younger: a prospective observational cohort study. Phys Ther. 2020;100(5):798-806. Doi: https://doi.org/10.1093/ptj/pzaa010
Rodrigues MDS, Santana LF, Galvão IM. Fatores de risco modificáveis e não modificáveis do AVC isquêmico: uma abordagem descritiva. Rev Med. 2017;96(3):187. Doi: https://doi.org/10.11606/issn.1679-9836.v96i3p187-192
José BPS, Corrêa RA, Malta DC, Passos VMA, França EB, Teixeira RA, et al. Mortalidade e incapacidade por doenças relacionadas à exposição ao tabaco no Brasil, 1990 a 2015. Rev Bras Epidemiol. 2017;20(suppl 1):75–89. Doi: https://doi.org/10.1590/1980-5497201700050007
Thorpe ER, Garrett KB, Smith AM, Reneker JC, Phillips RS. Outcome measure scores predict discharge destination in patients with acute and subacute stroke: a systematic review and series of meta-analyses. J Neurol Phys Ther. 2018;42(1):2-11. Doi: http://dx.doi.org/10.1097/NPT.0000000000000211
Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, et al. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil. 2015;37(15):1316-23. Doi: https://doi.org/10.3109/09638288.2014.963706
Scrutinio D, Monitillo V, Guida P, Nardulli R, Multari V, Monitillo F, et al. Functional gain after inpatient stroke rehabilitation. Stroke. 2015;46(10):2976–80. Doi: https://doi.org/10.1161/STROKEAHA.115.010440
Kongsawasdi S, Klaphajone J, Wivatvongvana P, Watcharasaksilp K. Prognostic factors of functional outcome assessed by using the modified rankin scale in subacute ischemic stroke. J Clin Med Res. 2019;11(5):375-82. Doi: https://doi.org/10.14740/jocmr3799
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Acta Fisiátrica

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.