Functional outcome in brain stem stroke patients after rehabilitation.

Abstract

To document functional outcome before and after rehabilitation in a group of brain stem stroke patients and to analyze possible factors influencing outcome. A case series of 53 consecutive inpatients admitted to a rehabilitation facility with confirmed brain stem strokes over a period of 6 years. 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. 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. 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.