Assessment for rehabilitation after stroke

Abstract

There is some evidence that the rehabilitation of patients who have suffered a stroke may be more successful if conducted in a specialist unit, especially if started soon after the stroke. Departments of Geriatric Medicine are often unable to accept all invitations to take over the rehabilitation of elderly patients who have suffered a stroke. As specialist rehabilitation resources are scarce, it is necessary to be able to distinguish the patients whose outcome will be improved by specialist rehabilitation from those whose recovery (whether good or bad) will not be significantly influenced. Patients with an Edinburgh prognostic score of 5.6 four weeks after the stroke are very likely always to require total nursing care even after specialist rehabilitation. A Guy's Hospital prognostic score of 10 or more seems to indicate that functional independence will be recovered even without specialist rehabilitation. Patients with an Edinburgh prognostic score of 3-4 within the first 4 weeks after the stroke should not be denied specialist rehabilitation; there is evidence, admittedly weak, that it is for them that the benefits may be greatest. A major study is now required to validate the Edinburgh and Guy's prognostic scores prospectively and to test whether it is valid to use them for the triage of elderly patients for specialist rehabilitation. In addition, it is possible that a specialist unit would be better able to help patients with specific 'barriers' to rehabilitation. Adequate tools for the identification and objective assessment of these barriers are essential if this possibility is to be tested.