Monday, January 30, 2012

Neurological and Functional Recovery: The Difference

Having a stroke is one of those medical conditions with a devastating effect on a person as well as for the family. I will not go into detail on this for this article but just to provide a general view a stroke is a medical/neurological condition wherein the brain gets injured due to sudden block of blood flow or due to rupture of a blood supply to it. The effect in terms of what happens to a person is generally affectation of the strength usually on the half side of the body. This is called hemiparesis(partial) or hemiplegia (complete) which is the paralysis of half of the body. i.e affectation of the left upper and left lower limb  or vice versa.

Now just to give a rundown, the cost for medical treatment is definitely something of a blow to any family. It not only disrupts the savings of the family but it may also affect the income especially if the one affected is the breadwinner. Not only that, the family members who will skip work or go on leave also looses their productivity/earnings. Do I need to say more?

Now after the patient becomes stable and is discharged, the question now arises if how much did the patient recover? I will define first neurological recovery. I will simplify this, a patient prior to a stroke has a normal strength on both upper and lower limbs. A Normal grade is 5 over 5(5/5). When the patient has a stroke the left side as an example lost its strength and became poor (2/5). Not only that but also his sensation to touch on the left side decreased by 80 percent. The patient also had difficulty in speaking. All of the above findings show a neurological deficit. If after 4 days of treatment the patient regained his strength from poor (2/5) to fair (3/5), his sensation to light touch improved from 80% less to 50% now while his speech became normal. Those improvements are what we call neurological recovery. See table below.

As for functional recovery, it is the ability of the patient to do activities with or without neurological deficits. Using the example above the patient has initially been fully functional, working, typing, eating, dressing independently etc. He had a stroke wherein he has 2/5 strength, 80% sensory deficit and affected speech. So he became confined to bed, unable to go to the bathroom, feed himself etc. He became fully dependent. Now lets change the situation after 4 days. He still has the same deficit but he is now able to sit by himself, he is able to sit for 30 mins with minimal support, and now able to eat with partial assistance. He has recovered functionally even if his neurological deficit is still the same after 4 days. See table below.

Why am I pointing out these differences? It is because it is often thought that being unable to move a limb means one cannot adapt and become functional. There are patients who had superb neurological recovery as they can move the upper and lower limbs after a stroke and yet are in wheelchair and fully dependent in their activities. While those who have 2/5 lower limbs strength are now able to ambulate with a cane and do self care activities with minimal assistance.

CONCLUSION: The point I am driving is that the functional recovery on an individual is not based solely on the neurological recovery. By undergoing physical rehabilitation and with the proper motivation a patient can recover functionally even with a poor neurological recovery.

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