Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines.
BACKGROUND
The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice.


METHODS
Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient's chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated.


RESULTS
Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia).


CONCLUSIONS
Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.
Program in Occupational Therapy, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO 63108, USA. Edwardsd@msnotes.wustl.edu
Dorothy F
DF
Edwards
Michele G
MG
Hahn
Carolyn M
CM
Baum
Monica S
MS
Perlmutter
Catherine
C
Sheedy
Alexander W
AW
Dromerick
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020380:Needs Assessment; D009483:Neuropsychological Tests; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012678:Sensation Disorders / Q000175:diagnosis* / Q000209:etiology; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation