Approaches to Stroke Rehabilitation

Prognosis for Stroke Rehabilitation

The prognosis for recovery from stroke varies with the severity of the stroke and with the presence of other medical conditions. Mortality rates among patients undergoing rehabilitation are 2-4%. Up to 20% of patients in rehabilitation are estimated to be readmitted to acute care hospitals due to complications, mostly of a cardiopulmonary nature. It is thought that rehospitalization for other complications may remain low because the nature of rehabilitation is to improve function and compensate for deficits which prevents many complications from occurring and treats others that may have occurred.

Patients who start rehabilitation immediately or very soon after the stroke onset have better functional outcomes at 6 months than those where rehabilitation is delayed. The majority of stroke patients remain with some deficits whether physical, social, and/or emotional even after rehabilitation but many are able to function independently or at least with varying levels of assistance. In some patients, the deficits following stroke may be so severe that they require long-term supervised care.

• 70-85% of first strokes result in hemiplegia. For patients who experience hemiparesis (weakness), only 60% of the patients achieve functional independence in simple activities of daily living 6 months after the stroke.
• Up to 35% of stroke patients with paralysis of a leg do not regain useful function.
• Up to 25% of all stroke patients require varying levels of assistance with walking.
• At 6 months after a stroke, 65% of patients do not have sufficient function in the hand affected by the stroke (paralysis or paresis) to use it effectively in activities of daily living.
• If the hemiplegic stroke survivor cannot move a leg by 2 weeks after the stroke, and cannot move or open the affected hand by 4 weeks after stroke, the prognosis for functional outcome of the upper extremity is poor.
• Approximately 25% of stroke patients return to their pre-stroke levels of physical functioning.
• Patients who do not require assistance at 3-4 months after a stroke may still not be able to use their affected hand, walk with speed, or live alone.
• Cognitive, language, and motor skills may continue to improve even after 6 months as new learning takes place and brain tissue recovers.
• Patients with sensorimotor and visual-field deficits are much more dependent on caregivers than those with motor deficits alone.
• Recurrent stroke is frequent - approximately 25% of people who recover from a first stroke will have another stroke within 5 years.

Multidisciplinary stroke rehabilitation programs with intensive therapy and programs to train caregivers offer the best prognosis for stroke outcome at 6 months. Randomized trials indicate patients who go through intensive outpatient rehabilitation in community based settings have similar outcomes as those who go through inpatient rehabilitation programs.