The rehabilitation of patients with cerebrovascular accidents
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A rehabilitation programme for patients with cerebrovascular accidents is outlined. The effectiveness of this programme was assessed in 220 patients transferred from Tygerberg Hospital to Goodwood Aftercare Hospital during the past 4 years. They were accepted after the acute phase and when the strokes were completed. The results of rehabilitation were judged by evaluating activities of daily living, namely eating, washing and dressing, and factors such as mobility and use of an affected hand, sphincter control, and ability to communicate. Other factors used to evaluate the rehabilitation programme were complications during treatment and eventual placing of the patients. Of 130 patients (72.6%) who were bedridden on admission, 62 (34.6%) could walk unaided and 46 (25.7%) could walk with aid after discharge. Thus, 108 patients (60.3%) could walk, either with or without aid. Thirty-six patients (20.1%), in whom stroke rendered their upper limbs useless, regained the use of their hands. On admission 90 patients (50.2%) were incontinent of urine, and 82 (45.8%) were faecally incontinent. On discharge the figures were 45 (25.1%) and 29 (16.2%) respectively. Dysphasia was present in 56 patients of whom 24 (37.5%) improved on therapy. Thirty-eight patients were admitted with dysarthria, of whom 26 (68%) either recovered or improved. On admission 35 of the survivors (19.6%) could eat independently, and on discharge 121 patients (67.6%) could eat unaided. Only 17 patients (9.5%) were independent as far as washing and dressing were concerned, but on discharge 77 (43%) could wash and 75 (41.9%) could dress without aid. During the rehabilitation phase 41 of the 220 patients admitted (18.6%) died. Deep venous thrombosis occurred in 28 patients (12.7%) and clinically diagnosed pulmonary embolism in 4 (1.8%). Urinary tract infections presented a problem in patients with indwelling catheters. Reactive depression was a major problem. Subluxation of the hemiplegic shoulder occurred in 32 patients (17.6%). No new decubitus ulcers developed. On discharge 29 of the 114 patients who returned to their previous homes needed some form of help. Thirty-one were placed in old-age homes with nursing care and 9 in private nursing homes. A total of 25 were admitted to institutions for chronically ill or terminal-care patients.
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