Advertisement

Prognostication in Stroke Rehabilitation

  • Murray E. Brandstater

Summary

Good early prediction of ultimate outcome following stroke rehabilitation benefits patients and health care professionals. Numerous research studies have reported stroke outcomes, but the conclusions are not always in agreement because of differences in study methodology and in patient characteristics. However, some general conclusions about prognostication can be made. Early survival is poorer in those patients who have cerebral hemorrhage, coma at onset, or heart disease. Recovery from neurological impairment such as hemiplegia is influenced by lesion-related variables such as lesion size and location. Recovery from hemiplegia follows a predictable pattern, with most motor recovery occurring within the first 6 months. The disability status of stroke patients at late follow-up depends most on initial activities of daily living (ADL) scores recorded post onset. Characteristics that predict a less favorable outcome are older age and presence of urinary incontinence, bowel incontinence, and visuospatial deficits. Social and psychological variables, especially prestroke family interaction and presence of an able spouse, may strongly influence ultimate disability status and the return of patients to their home.

Keywords

Functional Independence Measure Stroke Rehabilitation Motor Recovery Arch Phys Post Onset 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gresham GE (1990) Past achievements and new directions in stroke outcome research. Stroke 21(suppl II):II1–II2PubMedGoogle Scholar
  2. 2.
    Jongbloed L (1990) Problems of methodologic heterogeneity in studies predicting disability after stroke. Stroke 21(suppl II):II–32–II–34Google Scholar
  3. 3.
    Task Force Recommendations (1990) Symposium recommendations for methodology in stroke outcome research. Stroke 21(suppl II):II–68–II–73Google Scholar
  4. 4.
    World Health Organization (1989) Stroke 1989. Recommendations on stroke prevention, diagnosis, and therapy: report of the WHO Taskforce on Stroke and Other Cerebrovascular Disorders. Stroke 20:1407–1431CrossRefGoogle Scholar
  5. 5.
    Broderick JP, Phillips SJ, Whisnant JP, O’Fallon WM, Bergstralh EJ (1989) Incidence rates of stroke in the eighties: the end of the decline in stroke. Stroke 20:577–582PubMedCrossRefGoogle Scholar
  6. 6.
    Sacco RL, Wolf PA, Kammel WB, McNamara PM (1982) Survival and recurrence following stroke: the Framingham study. Stroke 13:290–295PubMedCrossRefGoogle Scholar
  7. 7.
    Baker RN, Schwartz WS, Ramseyer JC (1968) Prognosis among survivors of ischemic stroke. Neurology 18:933–941PubMedGoogle Scholar
  8. 8.
    Wade DT, Langton Hewer R (1987) Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry 50:177–182PubMedCrossRefGoogle Scholar
  9. 9.
    Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB (1988) The stroke data bank: design, methods, and baseline characteristics. Stroke 19:547–554PubMedCrossRefGoogle Scholar
  10. 10.
    Twitchell TE (1951) The restoration of motor function following hemiplegia in man. Brain 74:443–480PubMedCrossRefGoogle Scholar
  11. 11.
    Bard G, Hirshberg CG (1965) Recovery of voluntary motion in upper extremity following hemiplegia. Arch Phys Med Rehabil 46:567–572PubMedGoogle Scholar
  12. 12.
    Gowland C (1987) Management of hemiplegic upper limb. In: Brandstater ME, Basmajian (eds) Stroke rehabilitation. Williams and Wilkins, BaltimoreGoogle Scholar
  13. 13.
    Wade DT, Langton Hewer R, Wood VA, Skilbeck CE, Ismail HM (1983) The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry 46:521–524PubMedCrossRefGoogle Scholar
  14. 14.
    Heller A, Wade DT, Wood VA, Sunderland A, Langton Hewer R, Ward E (1987) Arm function after stroke: measurement and recovery over the first three months. J Neurol Neurosurg Psychiatry 50:714–719PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly-Hayes M, Wolf PA, Kase CS, Gresham GE, Kannel WB, D’Agostino RB (1989) Time course of functional recovery after stroke: the Framingham study. J Neurol Rehabil 3:65–70Google Scholar
  16. 16.
    Smith DL, Akhtar AJ, Garraway WM (1985) Motor function after stroke. Age Ageing 14:46–48PubMedCrossRefGoogle Scholar
  17. 17.
    Ferrucci L, Bandinelli S, Guralnik JM, Lamponi M, Bertini C, Falchini M, Baroni A (1993) Recovery of functional status after stroke: a post-rehabilitation follow-up study. Stroke 24:200–205PubMedCrossRefGoogle Scholar
  18. 18.
    Gresham GE, Fitzpatrick TE, Wolf PA, McNamara PM, Kannel WB, Dawber TR (1975) Residual disability in survivors of stroke: the Framingham study. N Engl J Med 293:954–956PubMedCrossRefGoogle Scholar
  19. 19.
    Gresham GE, Phillips TF, Wolf PA, McNamara PM, Kannel WB, Dawber TR (1979) Epidemiologie profile of long-term stroke disability: the Framingham study. Arch Phys Med Rehabil 60:487–491PubMedGoogle Scholar
  20. 20.
    Wade DT, Langton Hewer R, David RM, Enderby PM (1986) Aphasia after stroke: natural history and associated deficits. J Neurol Neurosurg Psychiatry 49:11–16PubMedCrossRefGoogle Scholar
  21. 21.
    Skilbeck CE, Wade DT, Hewer RL, Wood VA (1983) Recovery after stroke. J Neurol Neurosurg Psychiatry 46:5–8PubMedCrossRefGoogle Scholar
  22. 22.
    Kertesz A (1987) Communication disorders. In: Brandstater ME, Basmajian JV (eds) Stroke rehabilitation. Williams and Wilkins, BaltimoreGoogle Scholar
  23. 23.
    Sarno MT, Levita E (1979) Recovery in treated aphasia in the first year post-stroke. Stroke 10:663–670PubMedCrossRefGoogle Scholar
  24. 24.
    Hier DB, Mondlock J, Caplan LR (1983) Behavioral abnormalities after right hemisphere stroke. Neurology 33:337–344PubMedGoogle Scholar
  25. 25.
    Hier DB, Mondlock J, Caplan LR (1983) Recovery of behavioral abnormalities after right hemisphere stroke. Neurology 33:345–350PubMedGoogle Scholar
  26. 26.
    Meerwaldt JD (1983) Spatial disorientation in right hemisphere infarction: a study of the speed of recovery. J Neurol Neurosurg Psychiatry 46:426–429PubMedCrossRefGoogle Scholar
  27. 27.
    Chin PL, Rosie A, Irving M, Smith R (1982) Studies in hemiplegic gait. In: Rose FC (ed) Advances in stroke therapy. Raven Press, New YorkGoogle Scholar
  28. 28.
    Wade DT, Wood VA, Langton Hewer R (1985) Recovery after stroke—the first 3 months. J Neurol Neurosurg Psychiatry 48:7–13PubMedCrossRefGoogle Scholar
  29. 29.
    Feigenson JS, McDowell FH, Meese P, McCarthy ML, Greenberg SD (1977) Factors influencing outcome and length of stay in a stroke rehabilitation unit. Stroke 8:651–656PubMedCrossRefGoogle Scholar
  30. 30.
    Brandstater ME, deBruin H, Gowland C, Clarke B (1983) An analysis of temporal variables in hemiplegic gait. Arch Phys Med Rehabil 64:583–587PubMedGoogle Scholar
  31. 31.
    Keith RA, Granger CV, Hamilton BB, Sherwin FS (1987) The functional independence measure: a new tool for rehabilitation. In: Eisenberg MG, Grzesiak RC (eds) Advances in clinical rehabilitation, vol 1. Springer-Verlag, New York, pp 6–18Google Scholar
  32. 32.
    Guide for the Uniform Data Set for medical rehabilitation (Adult FIM, Version 4.0) (1993) State University of New York, BuffaloGoogle Scholar
  33. 33.
    Dombovy ML, Basford JR, Whisnant JP, Bergstralh EJ (1987) Disability and use of rehabilitation services follwoing stroke in Rochester, Minnesota 1975-1979. Stroke 18:830–836PubMedCrossRefGoogle Scholar
  34. 34.
    Carroll D (1962) The disability in hemiplegia caused by cerebrovascular disease: serial study of 98 cases. J Chronic Dis 15:179–188PubMedCrossRefGoogle Scholar
  35. 35.
    Andrews K, Brocklehurst JC, Richards B, Laycock PJ (1981) The rate of recovery from stroke and its measurement. Int Rehabil Med 3:155–161PubMedGoogle Scholar
  36. 36.
    Wade DT, Langton Hewer R, Skilbeck CE, David RM (1985) Stroke: a critical approach to diagnosis, treatment, and management. Year Book, Chicago, p 241Google Scholar
  37. 37.
    Ahlsiö B, Britton M, Murray V, Theorell T (1984) Disablement and quality of life after stroke. Stroke 15:886–890PubMedCrossRefGoogle Scholar
  38. 38.
    Wade DT, Skilbeck CE, Langton Hewer R (1983) Predicting Barthel ADL score at 6 months after an acute stroke. Arch Phys Med Rehabil 64:24–28PubMedGoogle Scholar
  39. 39.
    Lehmann JF, DeLateur BJ, Fowler RS, Warren CG, Arnhold R, Schertzer G, Hurta R, Whitmore JJ, Masock AJ, Chambers KH (1975) Stroke rehabilitation: outcome and prediction. Arch Phys Med Rehabil 56:383–389PubMedGoogle Scholar
  40. 40.
    Jiminez J, Morgan PP (1979) Predicting improvement in stroke patients referred for inpatient rehabilitation. Can Med Assoc J 121:1481–1484Google Scholar
  41. 41.
    Wade DT, Langton Hewer R, Wood VA (1984) Stroke: the influence of age on outcome. Age Ageing 13:357–362PubMedCrossRefGoogle Scholar
  42. 42.
    Fullerton KJ, MacKenzie G, Stout RW (1988) Prognostic indices in stroke. Q J Med 66:147–162PubMedGoogle Scholar
  43. 43.
    Shah S, Vanclay F, Cooper B (1989) Predicting discharge status at commencement of stroke rehabilitation. Stroke 20:766–769PubMedCrossRefGoogle Scholar
  44. 44.
    Wade DT, Langton Hewer R, Wood VA (1984) Stroke: influence of patient’s sex and side of weakness on outcome. Arch Phys Med Rehabil 65:513–516PubMedGoogle Scholar
  45. 45.
    Granger CV, Greer DS, Liset E, Coulowbe J, O’Brien E (1975) Measurement of outcomes of care for stroke patients. Stroke 6:34–41PubMedCrossRefGoogle Scholar
  46. 46.
    Jongbloed L (1986) Prediction of function after stroke: a critical review. Stroke 17:765–776PubMedCrossRefGoogle Scholar
  47. 47.
    Stevens RS, Ambler NR, Warren MD (1984) A randomized controlled trial of a stroke rehabilitation ward. Age Ageing 13:65–75PubMedCrossRefGoogle Scholar
  48. 48.
    Sivenius J, Pyorala K, Heinonen OP, Salonen JT, Riekkinen P (1985) The significance of intensity of rehabilitation of stroke—a controlled trial. Stroke 16:928–931PubMedCrossRefGoogle Scholar
  49. 49.
    Lehmann JF, DeLateur BJ, Fowler RS, Warren CG, Arnhold R, Schertzer G, Hurta R, Whittmore JJ, Massock AJ, Chambers KH (1975) Stroke: does rehabilitation affect outcome. Arch Phys Med Rehabil 56:375–382PubMedGoogle Scholar
  50. 50.
    Kelly-Hayes M, Wolf PA, Kannel WB, Sytkowski P, D’Agostino RB, Gresham GE (1988) Factors influencing survival and the need for institutionalization following stroke: the Framingham study. Arch Phys Med Rehabil 69:415–418PubMedGoogle Scholar
  51. 51.
    Evans RL, Bishop DS, Matlock AL, Stranahan S, Halar EM, Noonan WC (1987) Prestroke family interaction as a predictor of stroke outcome. Arch Phys Med Rehabil 68:508–512PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1996

Authors and Affiliations

  • Murray E. Brandstater
    • 1
  1. 1.Department of Physical Medicine and RehabilitationLoma Linda UniversityLoma LindaUSA

Personalised recommendations