STROKE-PROGNOSTIC FACTORS
SUMMARY
A. DEMOGRAPHICS & COMORBIDITIES
1. Age: younger patients demonstrate greater neurological and functional recovery and hence have a better prognosis.
2. Presentation (poor prognosis): delayed presentation, delayed rehabilitation, premorbidly dependent (patient admitted from nursing home), decreased consciousness.
3. Medical comorbidities (poor prognosis): arrhythmias, previous stroke, DM, cardiac disease, previous disability, alcohol abuse.
B. STROKE
4. Stroke severity & size: the initial severity of the stroke is inversely proportional to the final functional outcome (Garraway et al. first proposed the concept of 3 levels of initial stroke severity based on FIM scores[1][2]).
5. Stroke type: patients with hemorrhagic strokes have lower functional score upon admission but achieve higher functional outcome scores when compared to those with ischemic strokes.
6. Stroke site: bilateral hemispheres (poor prognosis), brainstem involvement (poor prognosis), right hemisphere (poor prognosis).
C. DEFICITS
7. Deficits (poor prognosis): neglect, sensory & visual deficits, global aphasia (poor long-term prognosis), poor sitting balance (if persists > 5 days), incontinence (if persists > 1-2 weeks).
8. Trunk balance (sit independently > 30sec). Non-ambulant patients who regained sitting balance and some voluntary movement of the hip, knee and/or ankle within the first 72 hours post stroke predicted 98% chance of regaining independent gait within 6 months[3].
E. UPPER LIMB FUNCTION
9. Potential predictors of upper extremity recovery include active finger extension and shoulder abduction:
a. Active finger extension was found to be a strong predictor of short, medium and long term post-stroke recovery[4]
b. Minimal shoulder abduction and upper motor control of the paretic limb upon admission to rehabilitation had a reasonably good chance of regaining some hand capacity whereas patients without proximal arm control had a poor prognosis for regaining hand capacity[5]
c. The EPOS study demonstrated that patients with some finger extension and shoulder abduction on Day 2 after stroke onset had a 98% probability of achieving some degree of dexterity at 6 months; this was in contrast to only 25% in those who did not show similar voluntary motor control
d. In addition, 60% of patients with finger extension within 72 hours had regained full recovery of upper limb function according to Action Research Arm Test (ARAT) score at 6 months[6]
10. Timing of recovery of hand movement: good prognosis (70% chance of recovery) in patients who recover hand function within 4 weeks of stroke.
F. REHABILITATION
11. Low score on the Barthel index at time of rehabilitation discharge: poor long-term prognosis.
12. Prolonged rehabilitation length of stay: poor long-term prognosis.
Reference(s)
- ↑ Garraway M. Stroke rehabilitation units: concepts, evaluation, and unresolved issues. Stroke 1985;16:178-181.
- ↑ Garraway WM, Akhtar AJ, Smith DL, Smith ME. The triage of stroke rehabilitation. J Epidemiol Community Health 1981;35:39-44.
- ↑ Veerbeek, J. M., Van Wegen, E. E. H., Harmeling Van Der Wel, B. C., & Kwakkel, G. (2011). Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study. Neurorehabilitation and Neural Repair, 25(3), 268-274.
- ↑ Smania N, Paolucci S, Tinazzi M et al. Active finger extension- A simple movement predicting recovery of arm function in patients with acute stroke. Stroke 2007; 38:1088-1090.
- ↑ Houwink A, Nijland RH, Geurts AC, Kwakkel G. Functional recovery of the paretic upper limb after stroke: Who regains hand capacity? Arch Phys Med Rehabil 2013; 94(5):839-844.
- ↑ Nijland RHM, van Wegen EEH, Harmeling-van der Wel BC, Kwakkel G. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery. Stroke 2010; 41:745-750.
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