To determine whether the clinical pathway in acute phase rehabilitation contributes to the early recovery of walking ability in elderly stroke patients, we developed a pathway for acute stroke patients over 65 years old who had lower extremity paresis. The pathway goal was to have patients walking within four weeks after the start of physiotherapy. We compared the improvement in walking ability during their stay in the stroke unit, length of stay and discharge destination between the two groups, namely the pre-pathway group that comprised 41 patients admitted before the introduction of the pathway and the post-pathway group that comprised 54 patients admitted after its introduction. In the post-pathway group, 68.5% of the patients achieved the goal, and the days required to achieve the goal were 9.6±6.0 days after the start of physiotherapy. The proportion of patients whose walking ability improved was significantly higher in the post-pathway group than the pre-pathway group (66.7% versus 39.0%, p=0.007). The efficiency of improvement was also higher in the post-pathway group (p=0.024). Logistic regression analysis showed that the use of the pathway was a factor that independently contributed to the improvement of walking ability (odds ratio, 2.80 ; 95% CI, 1.04 to 7.56 ; p=0.042). No significant differences were noted between the two groups in length of stay or discharge destination. From these results, it is suggested that the clinical pathway in acute phase rehabilitation promotes the recovery of walking ability in elderly stroke patients.

BACKGROUND: Although organotin compounds are widely used as PVC stabilizers, catalysts and biocides, their effects on humans are not well known. However, their acute intoxication is known to cause neurotoxicity in the central nervous system, renal toxicity, and hepatotoxicity. As there has been no previously published case of organotin intoxication in Korea, we report here the first Korean case of acute exposure to organotin. CASE REPORT: A 43-year-old male with disorientation and behavioral change was admitted to a hospital. He had been working as a tank cleaner for several different companies in the previous 8 years and a week before admission, he had cleaned a tank containing dimethyltin (DMT) for 4 days. A day after finishing the job, he suffered decreased memory, behavioral change and progressive mental deterioration when he arrived at the emergency room. The result of spinal tapping was negative but on the 4th day of admission he deteriorated into a state of coma along with metabolic acidosis and severe hypokalemia. High levels of DMT and trimethyltin (TMT) were detected in a highly sensitive urine analysis. After conservative treatment and chelation therapy, the patient showed some clinical improvement but the neurological defects persisted. CONCLUSION: The patient appeared to have been intoxicated from the acute exposure to a high level of organotin while cleaning the tank.
Acidosis ; Adult ; Central Nervous System ; Chelation Therapy ; Coma ; Disinfectants ; Emergency Service, Hospital ; Humans ; Hypokalemia ; Korea ; Male ; Memory ; Organotin Compounds ; Poisoning* ; Spinal Puncture