Rehabilitation of the post-cardiac surgery stroke patient: Analysis of cognitive and functional assessment

Abstract

Objective: Determine whether, as expected, patients sustaining post-cardiac surgery stroke (PCS) ( n = 19) differ from other stroke (OS) patients ( n = 216). Design: A total of 235 stroke patients were surveyed. Therapist ratings of Functional Independence Measure (FIM) on admission to and discharge from a rehabilitation unit were compared. Cooperation with formal neuropsychologic evaluation was assessed. Setting: The rehabilitation unit of a tertiary care hospital. Participants: Medical records for consecutive stroke patients were reviewed (January 1994 to December 1995). Groups did not differ in age, gender, or admission FIM. Interventions: Standardized neuropsychologic evaluation of seven cognitive domains was attempted for each patient referred to the neuropsychology service. All of the patients received FIM ratings on admission to and discharge from the rehabilitation unit. Outcome Measures: Gain in FIM per week of rehabilitation unit stay (FIM efficiency) and discharge destination. Results: Contrary to expectations, PCS patients did not differ significantly from OS patients in FIM efficiency or discharge destination. However, PCS patients were significantly less able to cooperate with formal neuropsychologic testing, possibly secondary to their physical condition, higher-level cognitive deficits, or both. Conclusion: Although PCS patients may sustain medical and cognitive deficits that interfere with exhaustive neuropsychologic evaluation, these deficits do not significantly interfere with functional progress in rehabilitation and should not make PCS patients ineligible for rehabilitation services.