Rehabilitative outcome in supratentorial and infratentorial stroke: the role of motor deficits

Abstract

There are few studies on the functional outcome of patients with supratentorial (STS) and infratentorial stroke (ITS). They lead to conflicting conclusions and do not define the role of motor deficits on functional recovery of STS and ITS patients. We wished to investigate this. The study was carried out on 90 consecutive patients admitted to our Rehabilitation Department with clinical evidence of acute cerebrovascular accident. Neuroimaging data, clinical evidence, and the National Institute of Health Stroke Scale (NIH) were used to select two groups of patients: 1) 45 patients with supratentorial stroke lesion (STS group), 2) 45 patients with infratentorial stroke lesion (ITS group). The STS group included patients with hemiparesis, and the ITS group patients with ataxia. Patients were evaluated through the NIH, Fugl-Meyer scale, Klockgether score, CIRS, Trunk Control Test (TCT), Lindmark scale, Barthel index, and Katz index, at both admission and discharge. At admission, there were no differences between the STS and ITS groups in disability or average Barthel, Lindmark and Katz scores. At discharge, the Katz index average scores were significantly higher (p=0.000) and disability was lower (p=0.002) in ITS patients. The efficiency in Lindmark, Barthel and Katz scores of group ITS was significantly greater than that of STS patients (p=0.003, p=0.030 and p=0.000, respectively). The final Katz score was correlated (Spearman rank method) with initial TCT (p=0.000), onset to admission interval (p=0.019) and initial NIH (p=0.044) in the STS group. Final BADL score was correlated only with initial TCT (p=0.000) in the ITS group. Our data seem to indicate that STS has a worse rehabilitative prognosis than ITS, and that hemiparesis is more difficult to rehabilitate than ataxia.