SUMMARY A retrospective analysis of 248 patients with stroke (average age 67, range 17-98) admitted to a stroke rehabilitation unit over a sixteen month period showed that 80% of these patients were able to return home after an average length of stay (LOS) of 43 days. At discharge 85% of the group were ambulatory and 56% required no help in daily living activities. Severity of weakness on admission, long onsetadmission intervals, the presence of severe perceptual or cognitive dysfunction or a homonymous hemianopsia in addition to a motor deficit were related to unfavorable outcome and increased LOS. The age of the patient, dysphasia or a hemisensory deficit in addition to weakness, or diabetes, hypertension, or ASHD were unrelated to the patients' functional status on discharge, discharge disposition, or LOS. Many patients with "unfavorable prognostic signs" made significant improvement after admission and were subsequently discharged. Thus, while the above findings may predict which patients can make maximal gains in a short term treatment facility, they also show that most patients, even those with "poor prognostic signs," can make enough functional improvement to be managed at home after a relatively short hospitalization.

SUMMARY A comparison of outcome and length of stay (LOS)between a control group of 248 unscreened patients (reported in Part 1) and a second group of 318 patients, medically and socially screened prior to admission, -all discharged from the same 30-bed stroke unit over a 33 month period -showed that preadmission medical, neurological, and social service screening did not improve overall outcome or reduce length of stay (LOS). A program aimed at identifying and treating perceptual and cognitive dysfunction did improve functional status and discharge disposition in patients having perceptual but not cognitive deficits. A detailed analysis of the factors influencing outcome and LOS confirmed and extended earlier findings that: 1) severe weakness on admission and long onset-admission intervals were adversely related to outcome as were the presence of perceptual or cognitive dysfunction, poor motivation, a homonymous hemianopsia, multiple neurologic deficits, and poor functional status on discharge; and 2) dysphasia, the presence of a hemisensory loss, age (under 80) and/or the presence of ASHD/hypertension/diabetes were unrelated to outcome. It was again demonstrated that most patients -even those with unfavorable prognostic signssignificantly improved after appropriate treatment programs.

Mental symptoms increased in frequency among 100 patients with parkinsonism treated with levodopa. Dementia was found in about one-third of patients throughout the 6-year treatment period. Thirteen patients became demented during the study, and dementia worsened severely in seven others. Agitated confusion became increasingly frequent and was observed in 60 percent of patients taking levodopa for 6 years. Withdrawal from levodopa decreased agitation, but not dementia. Ten patients received L-tryptophan along with levodopa, but no change in mentation was observed. In view of previous studies of mentation in Parkinson's disease and reports of widespread neuronal changes in the brain of autopsied patients with parkinsonism, our results suggest that the high incidence of dementia in patients with Parkinson's disease who take levodopa reflects prolongation of the course of the illness rather than a direct effect of the medication.

SUMMARY Many investigators have analyzed the effectiveness of the cardiac care unit (as a model of a disability oriented, specially staffed, geographically isolated unit) in altering outcome following acute myocardial infarction. Little data are available, however, on the efficacy of caring for patients with stroke on specially staffed disability oriented units. Of 667 patients with stroke recently discharged from the Burke Rehabilitation Center, 589 were admitted to the stroke unit (SU group) and 78 were admitted to other units (NSU group). Statistical analysis showed that the SU patients were significantly weaker, had longer onset-admission intervals, and exhibited more concurrent medical problems and neurologic deficits. There were no statistically significant intergroup differences in age, sex, and distribution of weakness. Both groups had similar treatment programs provided by staff who had rotated through the stroke unit. Ability to perform activities of daily living (dressing, feeding, hygiene, bowel and bladder routines) and length of hospitalization were similar for both groups. SU patients walked better and went home more frequently than NSU patients. These data indicate that even in a rehabilitation center specializing in treating functional disabilities, patients with stroke are more likely to improve if placed on a disability oriented unit than if they are admitted to mixed disability units which are scattered throughout the hospital.

No abstract