Mehool Patel

Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes.

OBJECTIVES: To identify factors that were associated with cognitive impairment 3 months after stroke, and to examine the associations of cognitive impairment with stroke outcomes up to 4 years after stroke.

Recovery from Poststroke Urinary Incontinence: Associated Factors and Impact on Outcome

OBJECTIVES: To determine factors associated with recovery from poststroke urinary incontinence and to estimate the impact of this recovery on stroke outcome at 3 months.

The Process of Rehabilitation and Discharge Planning in Stroke A Controlled Comparison Between Stroke Units

BACKGROUND AND PURPOSEnStroke units improve outcome for stroke patients. Comparative controlled studies between stroke units are required to determine which components of stroke unit rehabilitation influence outcome and which may be investigated further in randomized controlled trials. This study compares 2 stroke units with regard to the effect differences in practice have on functional recovery (Barthel Index score) and discharge planning (length of stay).nnnMETHODSnStroke unit patients with moderate disability (Barthel score of 4 to 10 at week 1) admitted over 18 months were studied. Barthel measurements were obtained weekly from week 1 to discharge. Details of stroke unit function were recorded. The core features of stroke units were in place in both units. Rehabilitation was impairment focused (theoretically driven) on one unit and disability oriented (pragmatic) on the other.nnnRESULTSnNumbers of patients were comparable (85 versus 99). Median Barthel score at week 1 (6 versus 6), time to maximal Barthel score (14 versus 14 weeks), discharge Barthel score (14 versus 14), and institutionalization (32% versus 28%) were similar in both units. Median lengths of stay differed (68 versus 49 days; P<0.001).nnnCONCLUSIONSnComparisons with regard to the rehabilitation process can be made between stroke units. Differences in rehabilitation process between 2 units showed no effect on the rate of functional recovery. Length of stay was significantly different between units, an effect that cannot be attributed to functional recovery and therefore reflects differences in discharge planning, including postdischarge support.

DYNAMICS OF FUNCTIONAL RECOVERY FROM STROKE IN SPECIALIST SETTINGS

Delayed-type hypersensitivity responses to tuberculin upon skin testing was significantly smaller in patients than in controls (5.7 [1.4] mm vs 14.0 [2.0] mm; P < .002). Likewise, negative tuberculin responses (< lo mm) were recorded in 81% of patients and 24% of controls (P < .01). The number of CD4 lympocytes differed significantly between patients and controls (672 [66] X 106/L vs 954 [91] X 106/L; P < .02). Likewise, the number of T h l cells was significantly lower in patients than in controls (138 [14] X 106/L vs 243 [42] X 106/L; P < .01). However, Th2 cells were similar between patients and controls (19 [3] x 106/L vs 25 [3] X 106/L; P > .20). T h l cells produce interferon-y and tumor necrosis factor-p, which activate macrophages and are involved in delayed-type hypersensitivity reaction^.^ The depression of delayed-type hypersensitivity responses to ubiquitous antigens with advancing age has been reported to correlate with mortality in old people. The delayed-type hypersensitivity responses to tuberculin,. presumed to be dependent on T h l cells, were clearly diminished in our older patients with functional disability, and this supplements a previous report of impaired responsiveness of human lymphocytes to phytohemagglutinin with ageing. The impaired, cell-mediated immunity may predispose to more numerous and more frequently fatal infections, especially illnesses associated with seasonal epidemics caused by new types or strains of bacterial or viral pathogens. The increased mortality associated with disability, therefore, could be explained in part by impaired cell-mediated immune functions in older patients.