Aphasia and activities of daily living in stroke patients.

BACKGROUND: Few studies have investigated the relationships between aphasia and activities of daily living (ADLs) in stroke patients. AIM: This study was aimed firstly to determine which task within the ADLs has poorer functional recovery in stroke patients with aphasia after rehabilitation, second to identify which specific task is related to aphasia. DESIGN: This is a prospective and observational study. SETTING: Inpatients of our Rehabilitation Unit. POPULATION: The study was carried out in 219 patients with primary diagnosis of stroke with (104) and without aphasia (115). METHODS: All patients underwent usual rehabilitation. Aachen Aphasia Test and Functional Independence Measure scale were used to assess severity of aphasia and ADLs, respectively. Gain in ADLs was the main outcome measure. RESULTS: At the end of rehabilitation patients with aphasia had lower gain in bathing, dressing upper body, dressing lower body, toileting, stair climbing, and higher gain in social interaction, problem solving, and memory with respect to patients without aphasia. However, when data were adjusted for side of hemiplegia, Fugl-Meyer score and trunk control test, patients with aphasia showed lower gain in dressing upper body (P=0.027), dressing lower body (P=0.009), lower toileting (P=0.027), and higher gain in social interaction (P<0.001). In the multivariate regression analysis, aphasia was an important determinant of gain in bathing (β=0.26), dressing upper body (β=0.24), dressing lower body (β=0.22), lower toileting (β=0.22), and social interaction (β=-0.29). CONCLUSIONS: The current study points out that, after usual rehabilitation, the patients with aphasia show a poor gain in personal care activities and higher gain in social interaction. CLINICAL REHABILITATION IMPACT: Knowledge of these findings: 1) can guide the rehabilitation team in selecting specific and appropriate therapies aimed to give patient with aphasia the highest possible functional independence in ADLs; 2) is useful to family members and social rehabilitation services for domiciliary management of patients with aphasia.