Can young severely disabled stroke patients regain the ability to walk independently more than three months post stroke?

Abstract

Objective: To investigate the acquisition of ability to walk independently in young severely disabled stroke patients unable to walk three months after onset. Setting: A regional rehabilitation unit providing post-acute neurorehabilitation mainly for patients aged 16–65 years. Subjects and methods: A retrospective analysis of records was undertaken for 152 stroke patients admitted consecutively over a three-year period. All had a combination of physical, cognitive and language impairments; male/female 98/54; median age 54 (IQR 47–60) years. Main outcome measures: Time taken from stroke onset to regain the ability to walk safely and independently at least 5 metres around the hospital bay. Results: Seventy-five (49%) regained the ability to walk independently between 3 and 11 months post onset. Patients with cognitive impairments and neglect took longer to walk. Time from stroke onset to admission was longer in patients who did not walk (median 16.3 weeks), than in those who regained walking (median 12.7 weeks; p = 0.009). Independent positive associations were found between the time taken to walk and time from onset to referral for rehabilitation (= 0.55; p < 0.001), and time from acceptance to admission (= 0.30; p = 0.008). Conclusion: With intensive specialist input, significant numbers of severely disabled young stroke patients can regain independent walking many months after onset, though late walkers may follow a slower recovery course. These results argue for investment in appropriate rehabilitation for these patients. Waiting list delays may prolong rehabilitation and potentially compromise cost effectiveness.