Is the Kennard effect supported by clinical evidence?

The objective of the study was to evaluate the so-called Kennard effect, i.e., the existence of a negative correlation between recovery and age. Thirty-eight elderly patients(median age 71 years, range 60-81) suffering from their first stroke were enrolled. The mean interval since the stroke was 15 days. Patients entered a 60-day rehabilitation pro -gram. Their functional condition was assessed by means of the functional independence measure (FIM). Only FIM values under 36 at admission were considered. Computerized tomographic (CT) or magnetic resonance imaging (MRI) scans were performed in all cases. The type of lesion was ischemic in 24 cases, hemorrhagic in 7 cases and 7 cases had more than one lesion. The patients' families were contacted after one year for a follow-up and all of them gave their consent. The survivors were examined again. The FIM score at discharge and the corresponding values at follow-up were statistically compared by means of Wilcoxon test (two-tailed). The FIM value at admission of the whole population had the median value of 27.5. None of these patients died during their stay at our rehabilitation center and their median FIM value at discharge was 34.5, a value still indicating high disability. After one year, 22 were still alive at home (57.9 %). Their FIM median value was 46. The difference was significant compared to discharge (Z = -3.228, p = 0.001). Three patients scored 85, 87 and 88, respectively, although none of them received rehabilitation treatment. In conclusion, our results indicate that restorative processes are still active in elderly patients, despite previous stroke and existing comorbidities. Some of the elderly patients of our group could approach to independence, although they displayed a very low FIM value at admission.

Comorbidity and rehabilitation.

Screening patients admitted to a rehabilitation center has become important. Actually, co-existing diseases are not very often evaluated and their importance is underestimated. At our department 166 consecutive patients were enrolled. The Cumulative Illness Rating Scale (CIRS) appeared to be the most suitable for these cases. In this series, stroke patients presented with higher severity and higher comorbidity than the hip fracture patients. The hip fracture cases were older but the stroke cases had higher severity and comorbidity. Comorbidity, also, showed a significant negative correlation with FIM in the stroke patients. These data show that severe comorbid conditions influence the functional autonomy. Severity and comorbidity were correlated both in the hip fracture and stroke cases. A review of geriatric literature demonstrates lower values in patients in rehabilitation. The difference is due to our accurate selection of patients at admission, where general health conditions are considered. In conclusion, the CIRS should be used as a method for selecting patients at admission and as a prognostic index for improvement at discharge. The CIRS, however, has some inconveniences and amelioration is necessary, such as the inclusion of a double testing (admission-discharge), psychiatric disturbances and a new item for skin alone. The Severity Index was higher in women, who were older than men, whereas, comorbidity was the same. In the patients suffering from hip fracture, the age was higher in women, but dependence, severity and comorbidity did not statistically differ between the groups.