Patterns of recovery from hemiplegia following stroke

Abstract

The aim of this study was to consider the controversial issue of the specific difficulties suffered by right brain-damaged (RBD) patients recovering from hemiplegia. Ninety patients under rehabilitation participated. Behavioural variables (impairment and recovery of basic motor capacities, functional abilities, walking, and activities in daily living (ADL)) and visual attentional variables (contralesional neglect and ipsilesional performance) were measured. Some of the impairment and recovery variables were used in a factorial analysis (multiple component analysis) in order to obtain subgrouping of the patient sample. A majority effect was observed from the first two axes, which form a hierarchical scale and can be interpreted as a general scale of ability (impairment and recovery). The patients placed in this first group (62% of the sample) can be divided into four subgroups, ranging from mild to major impairment: recovery varied but functional improvement was consistent with basic motor improvement. A minority effect was observed in the second group (26% of the sample) where RBDs were more numerous: two subgroups were characterised by a functional lag (in walking and daily life activities, in respect to basic motor level). The subgroup data (impairment, recovery, and attentional scores) were then analysed using conventional inferential statistics. For the sample as a whole, attentional disturbances (evaluated in the visual ipsilesional hemifield as well as in the contralesional one) were linked to daily living difficulties (initial loss and recovery slowness). In the “Functional Lag” group, minority effects were again found: contralateral neglect was independent both of ipsilateral attentional performance and ADL recovery slowness, contrary to the correlations obtained in the “Consistent Recovery” group. These results do not confirm the role of contralateral neglect in hampering functional recovery but they stress the effect of more general attentional factors. Moreover they point out the necessity of taking interindividual variability into account and regarding recovery as a multidimensional process.