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Factors associated with independent ambulation at 3 months after putaminal hemorrhage: an observational study
Noriko Ikeda1, Masaru Sakurai2, Emika Yamada2
1Department of Rehabilitation, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan.
Insights
Predicting walking ability after putaminal hemorrhage is possible using clinical indicators. Severity of hemiplegia, cognitive function, and ventricular rupture are key predictors for ambulation prognosis.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Medicine
Background:
- Putaminal hemorrhage is a severe type of stroke.
- Predicting functional outcomes like ambulation is crucial for patient management.
- Early identification of prognostic factors aids in rehabilitation planning.
Purpose of the Study:
- To identify clinical indicators that predict ambulation at 3 months post-putaminal hemorrhage.
- To evaluate the predictive value and optimal cut-off points for identified factors.
Main Methods:
- Retrospective analysis of 84 inpatients with putaminal hemorrhage.
- Evaluation of clinical data including consciousness, hemiplegia severity, cognitive function, and activities of daily living.
- Logistic regression and receiver operating characteristic (ROC) curve analysis.
Main Results:
- Ventricular rupture, hemiplegia severity (12-grade scale), and Functional Independence Measure (FIM) cognitive score independently predicted ambulation.
- Hemiplegia severity was the strongest predictor (sensitivity 80.4%, specificity 100% at grade 6).
- Grade 6 indicates the ability for coordinated hip joint movement.
Conclusions:
- Clinical indicators including hemiplegia severity, FIM cognitive score, and ventricular rupture are significant predictors of 3-month ambulation post-putaminal hemorrhage.
- Hip joint mobility is a critical factor for ambulation prognosis.
- These findings can inform clinical decision-making and rehabilitation strategies.
Abstract:
[Purpose] This study was aimed at evaluating the clinical indicators for predicting ambulation at 3 months after putaminal hemorrhage. [Participants and Methods] The participants were 84 inpatients with putaminal hemorrhage. The patients' background characteristics and computed tomography findings at the time of the onset of putaminal hemorrhage were obtained from their medical records. Impaired consciousness, severity of hemiplegia, higher brain dysfunction, sensory impairment, activities of daily living, and ambulatory ability were evaluated. Logistic regression analysis was performed to identify factors associated with ambulation at 3 months, and receiver operating characteristic curve analysis was conducted to determine the predictive value of the identified factors and the optimal cut-off values. [Results] Ventricular rupture, severity of hemiplegia (determined using the 12-grade hemiplegia function test), and Functional Independence Measure cognitive score were found to be independent predictors of prognosis. Severity of hemiplegia was the strongest predictor of ambulation, with a sensitivity of 80.4% and specificity of 100% when the cut-off was set at grade 6 (the ability for coordinated movement of the extensor and flexor muscles of the hip joint). [Conclusion] The severity of hemiplegia, Functional Independence Measure cognitive score, and ventricular rupture were independently associated with ambulation in patients with putaminal hemorrhage. The ability of the hip joint movement is one of the most important factors in ambulation prognosis.
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