Is stroke rehabilitation a metabolic problem?

Background: This study looks at the impact of inflammation during the rehabilitation stage of strokes and its effect on neuro-functional recovery. Methods: This study investigated 94 patients suffering from strokes and admitted to rehabilitation. Anthropometric characteristics, serum proteins and inflammatory markers, plasma amino acids and neurofunction were all assessed. Results: 55.3% patients had an inflammatory status (Interleukin-6 = 19.24 ± 23.01 pg ml^-1 vs. 4.1 ± 1.6 pg ml^-1 for non-inflamed subjects (p <0.001). Inflammation was positively linked to positive proteins (alpha-1 globulin, p <0.02) and negatively linked to negative proteins (albumin, p <0.02; prealbumin, p <0.01; transferrin, p <0.05) of the acute-phase response. Inflammation was associated with low plasma concentrations of total amino acids. For the multiple logistic regression analysis, albumin (p <0.001) and body weight maintenance (p <0.001) were independent predictors of patient functional independence. Inflammation in dysphagic stroke (31.9%) patients was associated with more accentuated disability compared to non-inflamed dysphagics. The serum positive reactant alpha 1 globulin was the most powerful predictor of dysphagia severity (p <0.001). At discharge, dysphagia improvement was associated with improved acute-phase negative proteins. Conclusions: An inflammatory status may persist for most patients with strokes during the rehabiliation stage of the disease, its prevalence being higher in dysphagic compared to non-dysphagic subjects. The improvement in circulating albumin and body weight maintenance are predictors of neuro-function, even in dysphagic subjects.