中風動作預後回顧總結

目前謝老師、怡靜學姐與我一起在思考如何推動臨床的中風衛教團體，以及思考該提供的衛教內容。我想中風患者本身最感興趣的主題應該是中風的預後，因此在整想相關預後資料時，我想我該先記錄一下自己主要的idea...... 

Key points: 1. Motor recovery typically reaches a plateau within the first 3 months after stroke, and is limited by the extent of damage to descending white matter pathways. 2. The motor recovery plateau can be predicted for individual patients by combining clinical measures with an objective evaluation of descending motor pathway integrity. 3. Interventions that aim to promote neuroplasticity during spontaneous recovery may increase the rate, rather than extent, of motor recovery. 4. Patients improved to 70% of their maximum possible improvement on Fugl-Meyer scale by 3 months poststroke. But 70% rule did not hold for patients with initially more sever impairment and Fugl-Meyer scores less than 11/66. 5. Gains at the chronic stage may reflect a reversal of deterioration, rather than further recovery beyond the initial motor function plateau. It is also possible that patients continue to improve at the chronic stage if they failed to reach their full potential for motor recovery during the spontaneous recovery period, because of an inadequate rehabilitation dose.

如果我是中風患者，我最想問的會是:”我可以恢復到什麼程度?要花多久的時間?”

身為治療師的我們，針對這個問題，又可以回覆到什麼樣的程度?

首先，針對這個問題，我們先做幾個面向的分析。

1.預測”我”的未來能力，有哪幾個因素是重要的預測因子?

2.”我”是否有恢復潛能?如何判斷是否有恢復潛能?最大恢復潛能有多少?

 →是否plateau?，自身的損傷程度?

3.”我”在問這句話的時候，是屬於哪一個中風時期?以及本身能力程度如何?

4.”我”想預期多久之後，自己的哪種能力 ? (動作?ADL?IADL?行走?)

5.如何促進”我”的最大恢復潛能?

最美好的結果是綜合各家文獻，可以完整填答此表格。

時間點		個案能力
起始時間	預測時間	輕度	中度	重度
剛發病	出院	完全恢復%	完全恢復% 可恢復最大程度
	3M
	6M
	12M
出院	3M
	6M
	12M
3M	6M
	12M
6M	12M

To be continued......