Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. A matched comparison.
BACKGROUND
Aphasia is considered a risk factor for disability after stroke. The aim of this study was to assess the specific influence of aphasia on rehabilitation results.


METHODS
A case-control study in consecutive left brain-damaged stroke inpatients, enrolled in three homogeneous subgroups [nonaphasic (NA) patients, aphasic with comprehension deficit (CD), and without comprehension deficit (NCD)] matched for age and onset-admission interval. Rehabilitation results (gain, efficiency, effectiveness of treatment, percentage and odds ratio of dropouts and of each degree of therapeutic response, assessed by Barthel Index and Rivermead Mobility Index) were compared among the subgroups.


RESULTS
Two hundred and forty patients with sequelae of a first stroke were enrolled. CD patients, as compared with NCD and NA ones, had a significantly more severe basal neurological and functional status at admission, minor effectiveness on ADL and mobility, a higher percentage of low responders on ADL and urinary incontinence at discharge, and a risk of low therapeutic response on ADL nearly 4 times higher than the other patients (OR = 4.22, 95% CI = 1.90-9.38). The rehabilitative behavior between NCD and NA was similar. However, all subgroups (NA, CD and NCD) showed a significant improvement (p < 0.001) between their basal and discharge score, both on BI and RMI.


CONCLUSIONS
Comprehension language deficit was confirmed to be a strong negative rehabilitation prognostic factor despite the speech therapy done by all CD patients.
Paolucci
Stefano
S
Fondazione IRCCS Santa Lucia, Rome, Italy. s.paolucci@hsantalucia.it
Matano
Alessandro
A
Bragoni
Maura
M
Coiro
Paola
P
De Angelis
Domenico
D
Fusco
Francesca Romana
FR
Morelli
Daniela
D
Pratesi
Luca
L
Venturiero
Vincenzo
V
Bureca
Ivana
I
D000368:Aged; D001037:Aphasia / Q000453:epidemiology / Q000208:ethnology; D002545:Brain Ischemia / Q000453:epidemiology / Q000534:rehabilitation*; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000453:epidemiology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013070:Speech Therapy; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation