Disablement following stroke

Purpose: Stroke is the most disabling chronic condition, newly affecting 35 000 persons in Canada each year. Because of declining fatality, a growing n umber of persons will have to cope with stroke-related disability. The purp ose of this paper is to describe the disabilities experienced by persons wi th stroke during the first year and explore the evolution of impairment, di sability, handicap and health-related quality of life. Subjects: The data for this paper come from a series of longitudinal and cr oss-sectional studies, collectively known as the McGill Stroke Rehabilitati on Research Program. Results: Within the first week post-stroke, getting out of bed and walking over a short distance, even with assistance, was a strong predictor of disc harge home. Most of the improvement in measures of impairment and disabilit y occurred during the first month and, by 3 months, there was still conside rable room for improvement in all measures: 85 % of persons were still impa ired on gait speed, 78 % had not reached age-specific norms for upper extre mity function, 68 % still demonstrated slow physical mobility, 37 % needed some assistance with basic activities of daily living and 29 % were still i mpaired on balance. By 1 year, 73 % of persons scored the maximum for basic activities of daily living but 51 and 67 % of persons reported their physi cal health and mental health to be lower than expected. Among a hardy group of stroke survivors, still living in the community 1 year post-stroke, the most striking area of difficulty was endurance, as measured by the 6 minut e walk test. Those subjects well enough to complete this task (50 % of samp le) were able to walk, on average, only 250 metres, equivalent to 40 % of t heir predicted ability. This series of snapshots taken at different points in time suggests that much of the improvement in impairment and disability occurs during the first month and then reaches a plateau. Handicap and qual ity of life continue to be issues later. Rehabilitation strategies need to consider the multifaceted nature of disablement, which in itself changes wi th time post-stroke.