ABSTRACT
What is the fate of our stroke patients after, say, one month? We know that up to 1/5 may die, but what about the remaining 4/5? Many of them will still be disabled and unable to care for themselves; some will recover and regain some independence in daily life, but can we be more detailed and use some measures to categorize them? This is a common problem in stroke medicine, and we stroke physicians have developed several instruments to categorize our patients (and, consequently, the results of our treatment). There are however two important questions we have to answer before deciding how to proceed: What is really relevant to measure? Do we have any instrument that picks up what is relevant (to the patient, to his or her caregivers, and to us) without losing information? To answer these two questions, we may go back to some old denitions from the World Health Organization (WHO), which relate to the impact of a biological event on our life. The old classication used by the WHO described three categories-impairment, disability, and handicap-and gave the following denitions: (1) impairment, any loss or abnormality of psychological, physiological, or anatomical structure or function; (2) disability, any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being; and (3) handicap, a disadvantage for a given individual that limits or prevents the fulllment of a role that is normal. It is widely agreed that impairment refers to a problem with a structure or organ of the body, disability is a functional limitation with regard to a particular activity, and handicap refers to a disadvantage in lling a role in life relative to a peer group. Further to these denitions, in stroke medicine, we frequently use a different word: dependency, which is a sort of mixture of disability and handicap and is used to indicate whether the patient requires help from another person for everyday activities.
