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Prediction of walking function in stroke patients with initial lower extremity paralysis: the Copenhagen Stroke Study
A Wandel1, H S Jørgensen, H Nakayama
1Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Objectives:
The majority of stroke patients with initial leg paralysis do not regain independent walking. We characterize the minority who, despite initial leg paralysis, regained independent walking.
Design:
Consecutive and community based.
Setting:
A stroke unit receiving all stroke patients from a well-defined community.
Patients:
A total of 859 acute stroke patients; 157 (15%) initially had leg paralysis.
Main Outcome Measures:
Scandinavian Stroke Scale (SSS) and Barthel index (BI) on admission and weekly during rehabilitation. Univariate and multivariate statistics were considered.
Results:
Of the 157 patients with initial leg paralysis, 84 (60%) died; 73 (40%) survived. Fifteen (21%) survivors regained walking function (the walking group), and 58 (79%) did not (the nonwalking group). The BI on admission was the only factor of significant predictive value (p < .03). Mean admission BI was 50 in the walking group versus 3 in the nonwalking group (p < .001). Age, gender, lesion size, total SSS score, and comorbidity had no predictive value. Within the first week, the walking group gained 3.2 points in the SSS subscore for leg strength versus 0.5 points in the nonwalking group (p < .02).
Conclusion:
Only 10% of stroke patients with initial leg paralysis regained independent walking. In these patients, BI on admission was high and leg strength improved quickly in the first week.