Stroke, Vol 24, 1794-1800, Copyright © 1993 by American Heart Association
T Galski, RL Bruno, R Zorowitz and J Walker
BACKGROUND AND PURPOSE: Research in recent years has revealed factors that
are important predictors of physical and functional rehabilitation:
demographic variables, visual and perceptual impairments, and psychological
and cognitive factors. However, there is a remaining uncertainty about
prediction of outcome and a need to clinically apply research findings.
This study was designed to identify the relative importance of medical,
functional, demographic, and cognitive factors in predicting length of stay
in rehabilitation, functional outcome, and recommendations for
postdischarge continuation of services. METHODS: The influence of these
factors was determined by comparing diagnostic, medical, demographic,
functional, and neuropsychological information that was retrospectively
obtained by reviewing the records of 86 patients admitted for comprehensive
rehabilitation due to stroke (n = 36) or orthopedic injury (n = 50).
Multiple linear regression with statistical adjustment to control for
overprediction of variance was used to predict outcomes. RESULTS: The study
revealed the primary importance of higher-order cognitive impairments
(comprehension, judgment, short-term verbal memory, and abstract thinking)
in extending length of stay and increasing referrals for outpatient
therapies and home services after discharge for the cerebrovascular
accident patients in comparison with orthopedic cohorts. CONCLUSIONS: The
need is discussed for early, comprehensive assessment of deficits in
cognition that affect a stroke survivor's ability to participate in a
rehabilitation program and remediation that facilitates functional
improvement by building on residuals of impaired abilities or teaching
compensatory behaviors.
ARTICLES
Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition
Department of Psychology and Neuropsychology, Kessler Institute for Rehabilitation, East Orange, NJ 07018.
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