A comparison of functionally orientated medical care and formal rehabilitation in the management of patients with hemiplegia due to cerebrovascular disease.

Abstract The results of a controlled study of the rehabilitation of an unselected group of stroke patients admitted to Bellevue Hospital with hemiplegia or hemiparesis were reviewed. One group was given functionally oriented medical care (control group) while another (rehabilitation group) was given a formal rehabilitation program prescribed and carried out by members of the Department of Physical Medicine and Rehabilitation. There were 40 patients in the control group and 42 in the rehabilitation group. The patients' ages ranged from 36 to 82 years with the majority over 60 years of age. There were 50 males and 32 females in the study. The patients were drawn from a low socio-economic level with only 8 having completed high school and less than 50 per cent gainfully employed prior to hospitalization. At the time of initial examination patients in the control and rehabilitation groups revealed comparable degrees of physical impairment, but at the time of follow-up 27.5 per cent of the control group and only 12 per cent of the rehabilitation group had little or no physical impairment. Initially the rehabilitation group revealed a little more functional deficiency than the control group, but at the time of follow-up the figures in terms of functional capacity slightly favored the rehabilitation group. Only 42.5 per cent of the controls and 45 per cent of the rehabilitation group achieved a level of function where they were able to perform the activities of daily living independently in a satisfactory manner. A study was made of the relationship between physical impairment and functional status. As expected the patients with the most severe degrees of physical impairment were found to have the least functional capacity. After the period of hospitalization this relationship was not so clear cut; those patients who had a formal program of rehabilitation, rather than functionally oriented medical care (the control group), revealed somewhat greater levels of function for each level of physical impairment. Impairment of intellectual function was studied. Initially it was found that about 25 per cent of the patients had severe degrees of intellectual impairment, about 25 per cent had moderate degrees of impairment, and about 50 per cent had no impairment. Spontaneous recovery appeared to be greater in the control group than in the rehabilitation group. This improvement was comparable to the spontaneous decrease in physical impairment which was noted to be greater in the control patients. As expected, the patients with the least impairment of intellectual function improved the most functionally and were able to benefit more from the organized rehabilitation program than did the patients with severe degrees of intellectual impairment. Employment of the patients after hospital discharge was a failure. Only one of the 40 control patients and none of the rehabilitation group obtained gainful employment. The number of patients discharged home from the hospital was greater in the rehabilitation (66 per cent) than in the control group (55 per cent), but this difference was small.