Functional status of cortical and subcortical nonhemorrhagic stroke survivors and the effect of lesion laterality

The purpose of this study is to examine the effects of cortical and subcortical infarcts and lesion laterality on the functional status of stroke survivors. Medical records of 72 stroke survivors admitted to an acute inpatient rehabilitation facility with a single nonhemorrhagic lesion were retrospectively reviewed. Multivariate analysis of variance was used to assess the effects of lesion level and hemisphere on admission and discharge Functional Independence Measure (FIM(TM)) and FIM gain. Admission FIM-Total and its subdimensions exhibited significant overall level (Wilk's λ = 2.5; P = 0.03) and hemisphere-specific (Wilk's λ = 2.3; P = 0.04) effects. Significant interaction between factors was noted only for the communication subdimension. Significant level and hemisphere-specific main effects were noted for admission FIM-Total (P < 0.01 and P = 0.02, respectively). There were significant level-specific main effects for self-care (P = 0.01) and mobility (P = 0.03) and hemisphere and level-specific main effects for communication (P < 0.01 and P < 0.01, respectively) and social cognition (P = 0.02 and P = 0.01, respectively). Discharge FIM-Total and its subdimensions exhibited significant overall level (Wilk's λ = 2.5; P = 0.03) and hemisphere-specific (Wilk's λ = 3.4; P = 0.01) effects. Discharge FIM subdimensions did not exhibit significant interaction between factors. Discharge FIM-Total was significant with respect to lesion level (P = 0.01) but not with respect to hemisphere (P = 0.08). There was a significant level- specific main effect for self-care (P = 0.01) and level and hemisphere- specific main effects for communication (P < 0.01 and P < 0.01, respectively) and social cognition (P = 0.01 and P = 0.01, respectively). FIM gain scores did not exhibit significant level (Wilk's λ = 1.1; P = 0.36) or hemisphere- specific (Wilk's λ = 1.4; P = 0.24) effects. The data suggest that the lesion level and hemisphere are important determinants of the function of nonhemorrhagic stroke survivors during inpatient rehabilitation.