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Functional outcome in brain stem stroke patients after rehabilitation
Objective:
To document functional outcome before and after rehabilitation in a group of brain stem stroke patients and to analyze possible factors influencing outcome.
Design And Setting:
A case series of 53 consecutive inpatients admitted to a rehabilitation facility with confirmed brain stem strokes over a period of 6 years.
Patients And Outcome Measures:
Patients were selected by physiatrists for admission into the rehabilitation program. Outcome was measured by the Modified Barthel Index (MBI) for mobility and activities of daily living.
Results:
The mean age of this cohort was 57.9 +/- 11.9 years and the pons was involved in 55% of cases. Ataxia (68%) and hemiplegia (70%) were the most frequent neurological deficits. Twenty-one patients (40%) had significant dysphagia with risk of aspirin and 16 patients (30%) were incontinent of urine. Aspiration pneumonia and urinary tract infection were present in 8 (15%) and 13 (25%) patients, respectively. Significant improvements in functional status, motor strength, swallowing, and continence status were documented on discharge (p < .05). The total admission MBI was the only significant factor influencing total discharge Barthel Index ( Beta = .597, adjusted R2 = .476, p < .0001). Fifty-one (96%) were discharged home after rehabilitation.
Conclusions:
Despite multiple physical deficits, this cohort of brain stem stroke patients made functional gains during rehabilitation with significant improvements in mobility and self-care skills, motor strength, severity of ataxia, continence and swallowing status.