Recovery of Hemiplegia after a Cranioplasty in Chronic Stage
Background: Early cranioplasty is warranted to facilitate rehabilitation (RH) in patients after decompressive craniectomy. However, in clinical practice in RH wards, we sometimes experience the patients with large craniectomy. Underlying diseases of these patients include massive cerebral infarction or severe traumatic brain injury (TBI) with uncontrollable intracranial hypertension in acute stage, or removal of a bone flap due to postoperative subgaleal/epidural empyema after a craniotomy. A prosthetic flap repair, i.e. cranioplasty, should be delayed.
Objective: We evaluated quantitatively the recovery from impairment and disability in the hemiplegic stroke survivors who received cranioplasty in chronic stage.
Subjects and Methods: Seven first-ever stroke or TBI survivors with hemiplegia (mean age, 56 +/- 3 years) who required delayed (3 to 9 months after the onset) cranioplasty during continuous RH therapy. Recovery grade (1-12) of hemiplegia and Barthel index were assessed monthly before (the 1st RH) and after the cranioplasty (the 2nd RH).
Results: The recovery grade of upper (U/E) and lower extremity (L/E) movements significantly increased both in the 1st and 2nd RH. Changes in the U/E and L/E grades were significantly larger in the 2nd RH (1.0 +/- 0.3 in the 1st vs. 2.4 +/- 0.7 in the 2nd RH for U/E, p=0.007; 1.4 +/- 0.4 in the 1st vs. 3.4 +/- 0.7 in the 2nd RH for L/E, p=0.002). Increase in the Barthel index was larger in the 2nd RH (23 +/- 8 in the 1st vs. 33 +/- 5 in the 2nd RH); all patients regained the ability to walk.
Conclusion and Discussion: Significant recovery of functional grade and recovery from disability occurred after the cranioplasty in the chronic stage (≥3 months) of stroke. The functional recovery might not only be due to an incidental syndrome of the trephined, but also due to improvements of some intrinsic mechanical factors, such as cerebral blood flow, cerebral energy metabolism or cerebrospinal fluid hydrodynamics.