[The evolution and prognosis of disability in patients with hemiplegia]

Abstract

Background: In order to plan the objectives of the rehabilitation treatment after a stroke, it is necessary to know the functional prognosis of the patient. The main prognostic factors of disability in the hemiplegic patient, by means of an analysis of his neurological deficits (aphasia, disorientation, urinary incontinence, hemianopsia, sensitive disorders, anosognosia, muscular paresis, and control of trunk) are investigated.

Patients and method: 73 inpatients who were admitted to a Rehabilitation department after suffering a stroke were included. The inpatients clinical and functional evaluation was carried out just when they were admitted to Rehabilitation, in the third month, sixth month, and one year after stroke. The Barthel Index, modified by Shah in 1989, was used to evaluated the degree of disability.

Results: Most of the neurological deficits (strength deficit, sensitive deficit, trunk balance, aphasia) show a similar recuperation pattern, with the main recuperation in the third month, and stabilization at about the sixth month after stroke. Fifty-seven percent of the patients reach an elemental level of independence (Barthel Index > 90) in the achievement of the activities of daily living. A severe deficit of strength in the upper extremities or a deterioration of the deep sensitivity mean 9 and 13 times more risk of obtaining a bad functional result, respectively, than the patients who don't have this conditions, independently of other associated clinical deficits. The clinical variables with more prognostic value are the level of paresis (p < 0.001; Rho = 0.66), the sensitive disorders (p < 0.001; Rho = 0.57) and the instability of trunk control (p < 0.001; Rho = 0.53).

Conclusion: There is not only one clinical variable, but a group of physical deficits which have an influence in the functional prognosis of the hemiplegic patient after stroke. The most relevant variables are the level of paresis, the deficit in deep sensitivity and the deficit in trunk control.