Criteria for referral of CVA patients for rehabilitation.

A multi-stage follow-up project is in progress at the Loewenstein Rehabilitation Hospital. In the first stage, a group of 153 patients was examined while in the acute phase of CVA (1 to 5 days from stroke), and again 6 months later, by a physician, a physiotherapist and an occupational therapist. Medical, demographical and functional profiles were determined. The most severe cases were admitted for rehabilitation and those with apparently good functioning ability were discharged to their homes. Six months later, the group referred for rehabilitation remained at a very low functional level (35% of them were still at the rehabilitation hospital); on the other hand, those sent home were lacking in general function (37%), in spite of their good ADL and hand performance. Most strikingly, 72% were not engaged in any meaningful activity. Age proved to be a strongly limiting factor. A more selective criterion for referral is required, while allowing patients with medium-grade cognitive and locomotor disturbances the chance of admission to rehabilitation.

Prognostic factors in rehabilitation after severe head injury. Assessment six months after trauma.

After initial neurosurgical treatment, 40 patients who regained consciousness 1 to 90 days after major cerebral trauma, were admitted for rehabilitation. Six months after their injury they were assessed in terms of: 1) Locomotor function, 2) Intellectual performance, 3) Communication disorder, and 4) behaviour disturbances. The usefulness of these parameters as prognostic factors in rehabilitation is discussed. Eight patients without significant disabilities in all 4 parameters returned to normal life. Patients who showed locomotor, communicative and behaviour impairment but no gross intellectual deficits, were considered capable of being retrained. The poorest prospects for social and vocational rehabilitation were found in 15 patients with cognitive defects.