[Rehabilitation after stroke in patients with diabetes mellitus].

Diabetes mellitus is not only one of the fundamental risk factors for stroke, but it may also constitute a significant impediment and limitation of rehabilitation process in diabetic patients after stroke. Insufficiently controlled diabetes or insufficient insulin therapy inadequately carried out, especially during the period of acute cerebrovascular complications, may increase the risk of repeated stroke or increase the size of ischaemic area. In patients suffering from diabetes the course of stroke is more severe, cerebral oedema appears more often and mortality is higher. In the present paper methods of rehabilitation and results achieved in a group of patients with stroke and a group of patients with stroke and diabetes mellitus are described, as well as effects of rehabilitation in both those groups. Fifty one (20%), out of 251 patients with cerebral stroke in the past who were rehabilitated in a Rehabilitation Department in 1997, had diabetes mellitus lasting, on average, 21 years. Individual rehabilitation programme for each patient was arranged collectively, taking into consideration restrictions necessary in the course of diabetes, including education of patients. Multidirectional assessment of initial condition and condition after termination of the rehabilitation was carried out taking into consideration the scale of lesions (the Brunnstrom stages), functional scales and the quality of life index (the Barthel index). More objective parameters, i.e. the index of symmetry of loading of lower extremities and walking speed, were also applied. All the patients with both stroke and diabetes mellitus completed the planned rehabilitation programme, although the initial condition of patients with concomitant diabetes was worse than that of patients with stroke only, as far as most of the applied parameters of assessment were concerned. Also improvement achieved in diabetic patients was not observed in each of the parameters examined and differed from that achieved in the group of patients with stroke alone. We found, that in-hospital rehabilitation of patients with stroke and concomitant diabetes mellitus (even long lasting) resulted in a measurable and significant improvement of their condition evaluated multidirectionally, and that diabetes mellitus coexisting with stroke is not a contraindication to in-hospital rehabilitation. In patients with concomitant diabetes mellitus significant disturbances of during the rehabilitation were not found course diabetes mellitus. However they all required meticulous care and monitoring of carbohydrate metabolism, and the average time of their hospitalisation was longer by about 3 days.