A prospective study was undertaken to define the incidence, duration, and consequences of dysphagia in an unselected group of 91 consecutive patients who had suffered acute stroke.

Progress in science is dependent upon, and frequently follows, the development of new measurement techniques. In the context of controlled trials of physiotherapeutic techniques, the major requirements are that any measure should be: valid, reliable when used by different observers, simple enough to be used on patients who are often old and suffering other problems, and sensitive enough to detect clinically significant differences. This paper discusses measures of arm function which might fulfil these criteria.

SUMMARY Actual functional performance of 976 acute stroke patients was assessed using the Bar-thel index: the data were analysed to determine the frequency of disability after stroke, the validity of the Barthel index, and the recovery seen. At 6 months, over 45% of survivors were functionally independent. Validity of the Barthel index was confirmed: it related as expected with motor loss and factor analysis showed a single major factor. The items of the Barthel index form an hierarchical scale. There was some recovery between 3 weeks and 6 months in almost all patients: the major prognostic factors were urinary incontinence, functional ability, sitting balance and age.Stroke accounts for nearly 5% of National Health Service expenditure in Britain,1 and is the fourth most expensive disease to the economy of the United States, after motor vehicle injuries, cancer and ischaemic heart disease.2 Much of the cost of stroke probably relates to the physical disability which determines time in hospital more than any need for prolonged investigation or treatment. However, there is little detailed information about the epidemiology of stroke-induced disability, and only recently has prognosis for functional recovery attracted attention.Four studies based upon community surveys3-6 have reported on disability after stroke, and suggest that 60%-75% of survivors are totally independent, and 3%-9% totally dependent in self-care. These studies included patients who had not been admitted to hospital but gave little detail about the actual disabilities.We have conducted a community survey of acute stroke emphasising self-care functions and attempting to assess the frequency of dependence in self-care activities. Analysis has been conducted to establish the validity of the Barthel Activity of Daily Living scale; the order of recovery of function; and the predictability of outcome soon after stroke. Patients and methods

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This study aims to establish the frequency of paralysis and other arm problems after stroke; the recovery of lost function; and to compare various tests of the affected arm. Thirteen per cent of the sample had no arm paralysis when first seen within 14 days. At 3 months 24 per cent of survivors had moderate or severe paralysis; 57 per cent could place nine pegs into holes within 50 seconds; 19 per cent had significant sensory disturbance; 5 per cent had shoulder pain; 8 per cent had restricted passive shoulder movement; and 17 per cent had some paralysis of the dominant arm. Between 3 and 6 months, improvement of motor power was seen in 40 per cent of patients, and 13 per cent of patients improved their function. Severity of initial paralysis was an important prognostic factor.