PASS ON

AMBULATION
o Perla Perez, SPT
Yen-Chang H, Wei-Te W, Tsan-Hon L, Chun-De L, Li-Fong L, Shih-Wei H. Postural
assessment scale for stroke patients scores as a predictor of stroke patient ambulation
at discharge from the rehabilitation ward. J Rehabil Med. 2016; 48(3):259-264. doi:
10.2340/16501977-2046.

 Asses the use of the Postural

assessment scale for stroke patients for
predicting ambulation in patients s/p acute
CVA.

PURPOSE • Sitting ability and strength of the paretic leg in the first 72hrs
s/p acute CVA can predict ambulation at 6 m

• Intensity of exercise in the first week after incident is an

important predictor of gait speed and time to regain ability to
walk indep.
 341

METHOD
Participants: 341/625 patients s/p CVA
from rehab ward in a university hospital in
Taiwan
95 246

Study: retrospective, comparing patients

able to ambulate 10m + at discharge vs. Non- Ambulato
patients that are non-ambulatory. amb. ry

Program: 60 min session of PT and OT for

5 consecutive days; SLP as needed

Measurements: Pre/post PASS as primary

balance outcome measure
RESULTS
® Highly significant differences
• Variables: Static/dynamic/total PASS scores, rolling ability, UTI, nasogastric tube,
foley catheter

• Predictors for indep ambulation at discharge

Rolling ability (p=0.05)
Static PASS score(p=0.03)
Dynamic PASS score (p=0.04)

• Odds of walking at discharge

Static PASS (3.5 +) 2.95x higher
Dynamic PASS (8.5+) 3x higher
CONCLUSION
Significant correlation found between PASS
scores and…
• FIM scores at discharge
• Change in FIM scores during rehab
• Discharge destination
High PASS score at admission predicted
greater likely hood of walking at discharge
(static & dynamic scores)

Rolling also a predictor of ambulation

PREVENTION OF CVA
RECURRENCE
® Of 795,000 CVAs/yr, 185,000 are recurrent events.
® Cost of direct medical care
• 2012: $71.6 billion  2030: $184.1 billion1
WHEN IS THE RISK THE HIGHEST
FOR A RECURRENT EVENT? (WEIN)
Historically
• Risk first 90 days of recurrent CVA after acute CVA 12-20%
• The greatest risk within the first 2 days after symptoms present
• Patients with multiple risk factors the first 7 day risk of recurrent CVA 2

With proper education and medical treatment risk significantly

decrease
• CVA risk the first 2 days (1.5%), 7 days (2.1%), 30 days (2.8%), 90 days(3.7%),
365 (5.1%)2
 UNMODIFIABLE RISK
FACTORS

Age Sex Ethnicity Genetics

- After 55 yrs old rate - Male 4
- Black/African
of CVA increases American
twice for men and - Hispanic 4
women every 10 yrs
- 65% of CVAs
occurred after 65 yrs
old; mean age 74 yrs
old3
WHAT MODIFIABLE FACTORS
INCREASE THE RISK?
DM
• Increases 2x risk of recurrent CVA (gulsen)

HTN
• Increases 4x the risk or recurrent CVA (gulsen)
• 60-75% of CVAs occur with pts that have HTN

Disability s/p CVA/TIA  lack of physical activity

STOP SMOKING!!!
Alcohol use (2+ drinks/day)
Increased weight 1-3
 WHAT CAN WE DO?
Reduce drinking (men:1-2/day;
women 1/day)
Exercise!!!

EDUCATE!!!
• 120-150 min of aerobic exercise/wk
• Moderate  High intensity (brisk walking)

HTN
 Reduce sodium intake
 Regular aerobic exercise
 Medication especially BP > 140/901
REFERENCES
1. Oza R, Rundell K, Garcellano M. Recurrent ischemic stroke: Strategies for
prevention. Am Fam Physician. 2017; 96(7):436-440.
https://www.aafp.org/afp/2017/1001/p436.html.
2. Wein T, Lindsay M P, Côté R, et al. Canadian stroke best practice
recommendations: Secondary prevention of stroke, sixth edition practice
guidelines, update 2017. Int J Stoke. 2018; 13(4);420-443. doi:
10.1177/1747493017743062.
3. Kocaman F, Dürüyen, Koçer A, Asil T. Recurrent ischemic stroke characteristics
and assessment of sufficiency of secondary stroke prevention. Noro Psikiyatr Ars.
2015; 52(2):139-144. doi: 10.5152/npa.2015.7499.
4. Wolf P A, Clagett G P,Easton J D, et al. Preventing ischemic stroke in patients
with prior stroke and transient ischemic attack: A statement for healthcare
professionals from the stroke council of the American heart assosciation. Storke.
1999; 30(9):1991-1994. doi: 10.1161/01.str.30.9.1991.