Patterns of recovery from hemiplegia following stroke.
Authors: Blanc Garin J
Source: Neuropsychological Rehabilitation 4(4):359-385.
Abstract: The controversial issue of difficulties suffered by right brain-damaged (RBD) patients recovering from hemiplegia is considered in this study. The behavioral variables (impairment and recovery of basic motor capacities, functional abilities, walking, and activities in daily living (ADL)) and visual attentional variables (contralesional neglect and ipsilesional performance) were measured on ninety patients under rehabilitation. In order to obtain subgrouping of the patient sample some of the impairment and recovery variables were used in a factorial analysis (multiple component analysis). From the first two axes, a majority effect was observed, which form a hierarchical scale that can be interpreted as a general scale of ability. The patients placed in this first group, comprising of 62% of the sample, can be divided into four subgroups, ranging from mild to major impairment. The recovery varied, but functional improvement was consistent with basic motor improvement. Observations were made of a minority effect in the second group (26% of the sample) where RBDs were more numerous. Two subgroups were characterized by a functional lag in walking and daily life activities, in respect to basic motor level. Using conventional inferential statistics, the subgroup data (impairment, recovery, and attentional scores) were analyzed. Attentional disturbances were linked to daily living difficulties for the sample as a whole. Minority effects were again found in the 'Functional Lag' group. Contralateral neglect was independent both of ipsilateral attentional performance and ADL recovery slowness, contrary to the correlations obtained in the 'Consistent Recovery' group. Results stress the effect of more general attentional factors but do not confirm the role of contralateral neglect in hampering functional recovery. Results highlight the necessity of taking interindividual variability into account and regarding recovery as a multidimensional process. (CIRRIE Abstract)
Institution: Neuropsychologie, Hopital de la Timone, 13385 Marseille, Cedex 5, France
Subject headings: Abstracts, Ambulation, Attention deficit disorders, Daily living, Functional evaluation, Functional status, Hemiplegia, Outcome, Psychological aspects, Rehabilitation, Secondary condition, Stroke