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Rehabilitation outcome based on Brunnstrom recovery stages following comprehensive rehabilitation was examined for a sample of 98 inpatients with cerebrovascular accident and resulting hemiplegia or hemiparesis. Using admission and discharge dates retrieved from a computer-based patient information system, frequency distributions, cross-tabulations, and Spearman's correlations were computed. Regardless of severity of paralysis, length of stay, and time of admission from onset, patients tended to improve at all levels of recovery stages. The stage of recovery at admission seemed to set the probable upper limit on how far patients were likely to progress. The strong positive correlations between recovery at admission and discharge on all measures for arm, hand, and leg recovery, with or without proprioception, seem to indicate that recovery in hemiplegia is a global phenomenon.
Key Words: cerebrovascular accident * voluntary control * recovery
Patients with cerebrovascular accident (CVA) and resulting hemiplegia, when referred for comprehensive rehabilitation, tend to have longer onset-to-admission intervals, thereby portending less favorable outcomes (Feigenson, Gitlow, & Greenberg, 1980; Gordon, Drench, Jarvis, Johnson, & Wright, 1978). During comprehensive rehabilitation, therapists not only assist patients with functional independence and compensatory skills but also spend a significant proportion of their time restoring effective sensory-motor control of the paralyzed side (Brunnstrom, 1970; Shah & Corones, 1980; Stannington, 1980).
A number of studies used have various parameters and indices to measure rehabilitation outcome based on hémiplégie patients' ability to perform daily living skills such as eating, grooming, and dressing and the functional improvement thus made through compensatory skills Feigenson, 1980; Granger, Dewis, Peters, Sherwood, & Barren, 1979; Mahoney & Barthel, 1965). This article, however, addresses rehabilitation outcome somewhat differently, focusing on Brunnstrom (1970) recovery patterns following efforts to restore sensory-motor status in the paralyzed extremities.
Loss of voluntary movement from damage to the central nervous system structures and hypertonicity from the release of intact structures are two of the most common factors influencing the return of voluntary control in hemiplegia. Therefore, a brief description of the problem of volition following hemiplegia is appropriate.
Following hemiplegia, loss of movement is selective and some movements are more affected than others. Movements that are least automatic, that have unlimited range and versatility, and that are precise and discrete suffer a greater loss than other types of movement....