Rehabilitation of left brain-damaged ischemic stroke patients: The role of comprehension language deficits - A matched comparison

Background: Aphasia is considered a risk factor for disability after stroke. The aim of this study was to assess the specific influence of aphasia on rehabilitation results. Method: A case-control study in consecutive left brain-damaged stroke inpatients, enrolled in three homogeneous subgroups [ nonaphasic (NA) patients, aphasic with comprehension deficit ( CD), and without comprehension deficit (NCD)] matched for age and onset-admission interval. Rehabilitation results ( gain, efficiency, effectiveness of treatment, percentage and odds ratio of dropouts and of each degree of therapeutic response, assessed by Barthel Index and Rivermead Mobility Index) were compared among the subgroups. Results: Two hundred and forty patients with sequelae of a first stroke were enrolled. CD patients, as compared with NCD and NA ones, had a significantly more severe basal neurological and functional status at admission, minor effectiveness on ADL and mobility, a higher percentage of low responders on ADL and urinary incontinence at discharge, and a risk of low therapeutic response on ADL nearly 4 times higher than the other patients ( OR = 4.22, 95% CI = 1.90 - 9.38). The rehabilitative behavior between NCD and NA was similar. However, all subgroups (NA, CD and NCD) showed a significant improvement ( p < 0.001) between their basal and discharge score, both on BI and RMI. Conclusions: Comprehension language deficit was confirmed to be a strong negative rehabilitation prognostic factor despite the speech therapy done by all CD patients. Copyright (C) 2005 S. Karger AG, Basel.