Recovery ofFunctional Status After Stroke

Background andPurpose: Information on predictors oflong-term change infunctional capacity after a rehabilitation program instroke patients isscant. Thisstudydescribes thelong-term evolution of self-reported functional ability after discharge fromrehabilitation anditsrelation withage,level ofneural impairment atdischarge, andchanges inneural impairment during follow-up. Methods: Fifty patients (31men and19women; mean±SDage,66.0±9.9 years;range,47-86years) with a first unilateral stroke andno severecognitive impairment were consecutively enrolled. Self-reported disability inactivities ofdaily living andneural impairment measuredbytheFugl-Meyer Scale were evaluated after discharge froma rehabilitation programand3and6monthslater. Results: Functional disability was significantly reduced after 3and6months. Attenuation ofdisability occurred mainly among thosepatients withmore severebaseline neuralimpairment. Inthisgroup, patients aged265yearswere more disabled atbaseline thanyoungerindividuals, buttheyhadthesame rateofimprovement. Inpatients aged<65years,changes indisability overtimecouldbeattributed to changes inneural function, whereas olderpatients' functional recoverywas greater thanthatexpected fromtheir improvement inneural impairment alone. Conclusions: Theseresults suggest thatinstroke patients with severeneural damagefurther functional improvement occurseven after completion ofa rehabilitation program. Thereisevidence thatolder patients may bemore likely toemploy compensatory strategies toovercome some oftheneural impairment thatremains after stroke. (Stroke 1993;24:200-205)