Heather Thornton

Can young severely disabled stroke patients regain the ability to walk independently more than three months post stroke

Objective: To investigate the acquisition of ability to walk independently in young severely disabled stroke patients unable to walk three months after onset. Setting: A regional rehabilitation unit providing post-acute neurorehabilitation mainly for patients aged 16–65 years. Subjects and methods: A retrospective analysis of records was undertaken for 152 stroke patients admitted consecutively over a three-year period. All had a combination of physical, cognitive and language impairments; male/female 98/54; median age 54 (IQR 47–60) years. Main outcome measures: Time taken from stroke onset to regain the ability to walk safely and independently at least 5 metres around the hospital bay. Results: Seventy-five (49%) regained the ability to walk independently between 3 and 11 months post onset. Patients with cognitive impairments and neglect took longer to walk. Time from stroke onset to admission was longer in patients who did not walk (median 16.3 weeks), than in those who regained walking (median 12.7 weeks; p = 0.009). Independent positive associations were found between the time taken to walk and time from onset to referral for rehabilitation (= 0.55; p < 0.001), and time from acceptance to admission (= 0.30; p = 0.008). Conclusion: With intensive specialist input, significant numbers of severely disabled young stroke patients can regain independent walking many months after onset, though late walkers may follow a slower recovery course. These results argue for investment in appropriate rehabilitation for these patients. Waiting list delays may prolong rehabilitation and potentially compromise cost effectiveness.

Management of Neurogenic Heterotopic Ossification Three case histories to illustrate the role of physiotherapy

Summary Neurogenic heterotopic ossification is a process of abnormal bone formation of multi-factorial aetiology. It occurs at varying sites to produce deformity and restriction of joint movement, and has a major impact on physical ability. There is extensive literature on the medical management of heterotopic ossification, but the role of physiotherapy is poorly described. This article aims to illustrate the importance of proactive physiotherapy in the team management and treatment of this condition. The authors show that physiotherapy is not contra-indicated in the presence of neurogenic heterotopic ossification and illustrate how interventions for improving range of movement can be used. The authors suggest that integrated team management was essential to the successful outcomes in these complex cases.