PATIENTS WITH STROKE CONFINED TO BASAL GANGLIA HAVE DIMINISHED RESPONSE TO REHABILITATION EFFORTS

Prediction of the functional outcome for patients with stroke has depe nded on the severity of impairment, location of brain injury, age, and general medical condition. This study compared admission and discharg e functional outcome (Functional Independence Measure, FIM) and defici t severity (Fugl-Meyer, F-M) scores in a retrospective study of patien ts with similar neurologic impairments: homonymous hemianopia, hemisen sory loss, and hemiparesis. CT-verified stroke location was the indepe ndent variable: cortical (n = 11), basal ganglia and internal capsule (normal cortex and thalamus, n = 13), or combined (cortical, basal gan glia, and internal capsule, n = 22). By 3 months on average after stro ke, all groups demonstrated significantly improved motor function as m easured by F-M scores. Patients with cortical lesions had the least CT -imaged damage and the best outcome. Patients with combined lesions an d more extensive brain injury had significantly higher FIM scores (p < 0.05) than patients with injury restricted to the basal ganglial inte rnal capsule. Patients with basal ganglia/internal capsule injury were more likely to have hypotonia, flaccid paralysis, and persistently im paired balance and ambulation performance. While all patients had a co mparable rehabilitation experience, these results suggest that patient s with stroke confined to the basal ganglia and internal capsule benef ited less from therapy. Isolated basal ganglia stroke may cause persis tent corticothalamic-basal ganglia interactions that are dysfunctional and impede recovery.