NeuroRehabilitation 30 (2012) 247–254 247

DOI 10.3233/NRE-2012-0752
IOS Press

Gender and stroke lateralization: Factors of

functional recovery after the first-ever
unilateral stroke?
Sanja Drača
Clinic Dr. M. Zotović, Sokobanjska 13, Belgrade 11000, Serbia
Tel.: +381 112062513; Fax: +381 112667623; E-mail: odracha@EUnet.rs

Abstract. Purpose: The goal of this prospective study was to evaluate gender differences in rehabilitation outcome in patients
after the first-ever unilateral stroke.
Methods: A total of eighty right-handed patients were prospectively enrolled, 35 (44%) women, and 45 (56%) men. A degree
of neurological deficit was quantified by the National Institutes of Health Stroke Scale. Functional outcome was assessed by the
Motor Status Scale, Chedoke Arm and Hand Activity Inventory, Rivermead Mobility Index and Barthel Index.
Results: At the time of hospital admission there was no significant gender difference in clinical stroke severity. At discharge,
we registered significantly better motor and functional recovery in men compared to women. Further, we found significantly
better rehabilitation outcome in women with stroke in dominant left hemisphere (LH) than in women with stroke in subdominant
right hemisphere (RH). Conversely, men with stroke in subdominant RH had significantly better rehabilitation outcome than men
with stroke in dominant LH. Using a multivariate analysis we have found that men with stroke in RH had significantly higher
probability to reach not only high response in mobility, but also more autonomy in ADL. The frequency of stroke in LH was
significantly higher in both genders aged less than 51 years, as well as in women, while the frequency of stroke in RH was
significantly higher in men.
Conclusion: This paper places particular emphasis on substantial gender-based differences in functional recovery of patients with
their first-ever unilateral stroke.

Keywords: Gender, functional outcome, the first-ever unilateral stroke

1. Introduction at older ages in women. However, after adjustment for

Gender differences in symptoms and outcomes of
cerebrovascular diseases have been receiving increas-
ing interest in research in the past several years. More-
over, accumulating data suggest that stroke is a sex-
ually dimorphic disease, and that biological genders
shape the outcome of cerebral ischemia [1,2]. Also, the
findings suggest that response to rehabilitation after the
stroke is influenced by gender: females who survive
stroke have less favorable outcomes than their male
counterparts. Women are more likely to have physical
impairments and limitations in the activities of daily
living (ADL) or basic components of self-care [3,4].
Women also experience more depression [5],fatigue [6]
and lower overall quality of life (QOL) [7,8]. Some of
these differences may be related to the onset of stroke
age, women also have poorer outcomes, such as greater
post-stroke disability and mental impairments [9].
The objective of this study was to evaluate the spe-
cific influence of gender on rehabilitation outcome in
patients after the first-ever unilateral stroke.
2. Methods
2.1. Participants
All patients in the subacute phase of stroke, admitted
to our Clinic for rehabilitation during the 3-year peri-
od (between March 2007 and April 2010), were reg-
istered prospectively and considered for inclusion for
this study. The mean duration from the onset of illness

ISSN 1053-8135/12/$27.50  2012 – IOS Press and the authors. All rights reserved
248 S. Drača / Gender-related post-stroke functional recovery
to the admission was 91.7 days. During the acute phase
of stroke these patients were hospitalized at neurolo-
gy department of several hospitals, where diagnosis of
stroke was based on history, clinical examination and
neuroradiological findings on head computed tomogra-
phy (CT) or magnetic resonance imaging (MRI).
On admission, patients were submitted to clinical,
neurological, neuropsychological, and functional ex-
aminations. A degree of neurological deficit was quan-
tified by the National Institutes of Health Stroke Scale
score (NIHSS) [10]. According to CT and/or MRI find-
ings, the patients were classified based on localization
of the cerebral lesion in the right hemisphere (RH)/ left
hemisphere (LH) or in cortex/ subcortex.
The inclusion criteria consisted of: the first-ever uni-
lateral stroke, both genders, age 20–80 years, presence
of hemiparesis/ hemiplegia, CT or MRI examination
performed in the acute hospital phase of stroke and
right-handedness (defined by the Clinical test of hand
dominance, Kimura and Vanderwolf, 1970). The ex-
clusion criteria were: history of previous stroke, bilat-
eral or multiple cerebral lesions caused by stroke, his-
tory of previous psychiatric illness, severe post-stroke
cognitive impairment (assessed by neuropsychologi-
cal testing), post-stroke dysphasia, which was severe
enough to prevent reliable communication (assessed by
language testing) and presence of other chronic dis-
abling conditions. The inclusion criteria were fulfilled
by a total of eighty right-handed patients. The patients
were included into the study after they gave informed
consent.
The rehabilitation plan was designed by the same
physiatrist for all patients. The patients’ daily ther-
apy schedule started within 24 hours from admission
and consisted of one 45-minute physical therapy ses-
sion, one 45-minute occupational therapy session, and
if necessary, one 30-minute speech therapy session.
The rehabilitation program was performed twice dai-
ly, 5 days per week during 6–8 consecutive weeks. In
all, it consisted of 10 sessions for one week, and 60–
80 sessions throughout the hospital stay. All included
patients completed the rehabilitation program. At the
time of discharge, in average 5.5 months after stroke
onset (range 3.5–6 months), we made the assessment
of functional outcome.
2.2. Variable and measures instruments
2.2.1. Stroke severity
A degree of neurological deficit was quantified by
the National Institutes of Health Stroke Scale score
(NIHSS) [10], widely used and validated tool for as-
sessment of clinical stroke severity. The NIHSS score
strongly predicts the likelihood of a patient’s recov-
ery after stroke: a score of greater than 16 forecasts a
high probability of death or severe disability, whereas
a score of less than 6 forecasts a good recovery [10].
2.2.2. Outcome measures
Motor performance of the upper limb was assessed
by the Motor Status Scale (MSS) [11]. This scale
isolates and grades movements of the shoulder, elbow,
forearm, and wrist. The MSS for shoulder/elbow (MSS
s/e) consists of the sum of measures of 12 shoulder
movements and 5 elbow/forearm movements. Also, the
MSS measures the patient’s ability to hold 5 shoulder
and 1 elbow positions that correspond to the end of a
composite motion (maximum score for MSS s/e = 40).
The MSS for wrist/ hand (MSS w/h) consists of the
sum of measures for 3 wrist and 15 hand movements,
and 3 hand-based functional tasks (maximum score for
MSS w/h = 42). A maximum score for MSS = 82.
The performance of the paretic arm in the comple-
tion of activities of daily living (ADLs) was evaluat-
ed by the Chedoke Arm and Hand Activity Invento-
ry (CAHAI) [12]. The original CAHAI consisted of
13 functional tasks of daily living. We used the short-
ened version of 7 items. Scoring is done on 7-point
ordinal scale (1 = total assistance, 7 = complete inde-
pendence), based on the percentage of contribution to
each task by the paretic arm/hand. A maximum score
= 49.
Mobility of stroke patients was assessed by the River-
mead Mobility Index (RMI) [13]. The RMI is clinical-
ly relevant in testing functional abilities such as gait,
balance, and transfers. It consists of 15 questions; each
item is coded 0 or 1, depending on whether the client
can complete the task according to specific instructions.
A maximum score = 15, higher scores indicate better
mobility performance.
A patient’s performance in ADLs was evaluated by
the Barthel Index (BI) [14]. The BI is considered a
reliable disability scale for stroke patients. The items
can be divided into a group that is related to self-care
(feeding, grooming, bathing, dressing, bowel and blad-
der care, and toilet use) and a group related to mo-
bility (ambulation, transfers, and stair climbing). The
maximal score = 100 if 5-point increments are used,
indicating that the patient is fully independent in phys-
ical functioning. The lowest score is 0, representing a
totally dependent bedridden state.
 S. Drača / Gender-related post-stroke functional recovery
Table 1
Demographic data for study population
n %
Total 80 100.00
Gender M/W 45/35 56/44
Side of stroke RH/LH M 25/20 55/45
Side of stroke RH/LH W 15/20 43/57
Localization C/Sc M 18/27 40/60
Localization C/Sc W 20/15 57/43
M = men, W = women, C = cortical, Sc = subcortical.
2.3. Statistical analysis
Characteristics of the participants are described by
mean and standard deviation (SD) for continuous vari-
ables and by frequency and percentage for categori-
cal variables. A difference in median values of mea-
sure instruments between two groups of patients was
determined by Student t-test. Chi square test was
used to assess differences in categorical variables be-
tween genders. Associations were assessed by Pear-
son’s and Spearman’s correlation analysis. The gender-
related effect on the stroke disability was also evaluat-
ed through multivariate analysis, using functional tests
as dependent variables. Probability value < 0.05 was
considered significant.
3. Results
A total of eighty right-handed patients (mean age
55.4 years, SD 10.6 years, range 25–80 years) in the
subacute phase of their first-ever unilateral stroke were
prospectively enrolled. In all, 35 (44%) were female,
and 45 (56%) were male. There was no significant
difference in age between men and women (55.1 ±
11.6 years and 55.6 ± 10.8 years, respectively). De-
mographic characteristics of this cohort have been pre-
sented in Table 1.
3.1. Gender differences in functional outcome
At the time of hospital admission the mean NIHSS
score of 6.51 for men and 6.57 for women was simi-
lar (p > 0.05) (Table 2). At discharge, we registered
highly significant gender differences in motor and func-
tional recovery of paretic arm (MSS, MSS s/e, MSS
w/h and CAHAI-7 score), mobility (RMI score) and
independence in ADL (BI score).
Men (N = 45) had highly significant (p < 0.01)
advantage in motor and functional recovery of paretic
arm, mobility and independence in ADL compared to
women (N = 35). Similarly, men aged < 51 years
249
(N = 12) had highly significant (p < 0.01) advantage
in motor and functional recovery of paretic arm com-
pared to women aged < 51 years (N = 11) (Table 2).
The correlation analysis revealed significant positive
association (p = 0.036) between male gender and mo-
tor recovery of paretic arm. There was no significant
association between female gender and any of param-
eters of functional outcome (p = 0.759) (Table 3).
Among the women recruited into the study, women
with stroke localized in dominant LH (N = 20) had
highly significant (p < 0.01) advantage in motor and
functional recovery of paretic arm, mobility, and in-
dependence in ADL compared to women with stroke
localized in subdominant RH (N = 15). On the con-
trary, men with stroke localized in subdominant RH
(N = 25) had highly significant (p < 0.01) advantage
in motor and functional recovery of paretic arm and in-
dependence in ADL, as well as a significant (p < 0.05)
advantage in mobility compared to men with stroke lo-
calized in dominant LH (N = 20) (Table 4). There was
no significant difference in frequencies of independent
walking, walking with cane or using a chair between
men and women with unilateral stroke (Chi square test
= 2.309, DF = 6, p > 0.05). Nevertheless, a greater
proportion of men with lesion in subdominant RH were
independent in walking (48%), while a greater propor-
tion of women with lesion in subdominant RH used a
cane or chair (60% and 7%, respectively).
Multivariate analysis, using as dependent variables
the motor and functional recovery of paretic arm, mo-
bility and autonomy at discharge, has shown that func-
tional parameters of outcome were not related to male
or female gender (Table 5).
3.2. Gender and stroke localization
We registered a significant difference for the fre-
quencies of stroke localization in RH or LH between
men and women (Chi square test = 10.035, DF = 3,
p < 0.05), as well as between men and women aged <
51 years (Chi square test = 10.313, DF = 3, p < 0.05).
Women were more likely to have a stroke in LH than
in RH (57% vs. 43%), while men were more likely to
have a stroke in RH than in LH (56% vs. 44%). Both
genders aged < 51 years were more likely to have a
stroke in LH (67% women, 59% men). All women
aged < 51 years had stroke localized in cortex, and the
same site of stroke was also more common in women
(57%). Men and men aged < 51 years were more likely
to have a stroke localized in subcortex (60% and 59%,
respectively).
250 S. Drača / Gender-related post-stroke functional recovery

Table 2
Differences in parameters of functional outcome between genders, as well as between genders aged < 51 years
Men Women Men < 51 Women < 51
(n = 45) (n = 35) t (n = 12) (n = 11) t
Parameter Mean ± SD Mean ± SD (DF = 78) p Mean ± SD Mean ± SD (DF = 21) p
NIHSS 6.51 ± 2.15 6.57 ± 2.24 0.306 (p > 0.05) 6.17 ± 2.20 6.45 ± 1.97 0.373 (p > 0.05)
MSS 46.18 ± 23.46 33.66 ± 22.43 9.687 (p < 0.01)∗∗ 51.20 ± 25.74 34.38 ± 25.49 6.445 (p < 0.01)∗∗
MSS s/e 23.71 ± 11.02 18.06 ± 10.90 6.282 (p < 0.01)∗∗ 26.50 ± 11.67 18.73 ± 11.75 4.352 (p < 0.01)∗∗
MSS w/h 22.47 ± 10.01 15.60 ± 11.12 7.282 (p < 0.01)∗∗ 24.67 ± 10.50 15.64 ± 9.01 4.709 (p < 0.01)∗∗
CAHAI-7 31.31 ± 16.45 24.89 ± 16.90 6.975 (p < 0.01)∗∗ 34.08 ± 17.45 26.18 ± 16.99 4.298 (p < 0.01)∗∗
RMI 11.62 ± 3.28 10.91 ± 3.27 1.737 (p > 0.05) 12.17 ± 2.86 11.91 ± 2.17 0.371 (p > 0.05)
BI 78.55 ± 22.65 74.71 ± 20.90 3.661 (p < 0.01)∗∗ 82.08 ± 21.37 78.64 ± 18.72 1.760 (p > 0.05)
NIHSS = National Institutes of Health Stroke Scale, MSS = Motor Status Scale, MSS s/e = Motor Status Scale shoulder/elbow, MSS w/ h =
Motor Status Scale wrist/hand, CAHAI-7 = Chedoke Arm and Hand Acitivity Inventory, RMI = Rivermead Mobility Index, BI = Barthel Index,
∗∗ = highly significant.

Table 3
Correlation analysis of MSS with other variables
numerous experimental studies, using clinically rele-
vant models of stroke, support the concept of stroke as
Variable Pearson’s r Spearman’s r p
a sexually dimorphic disease, as well as the efficacy
Gender (M) / 0.235 0.036∗
Gender (W) / 0.035 0.759 of female gonadal steroids in treating cerebral stroke
MSS s/e 0.982 / 0.001∗∗ injury. However, negative findings have also been pre-
MSS w/h 0.985 / 0.001∗∗ sented. The factors determining the balance between
CAHAI-7 0.979 / 0.001∗∗ neuroprotective and negative (pro-excitatory) effects of
RMI 0.789 / 0.001∗∗
BI 0.858 / 0.001∗∗ female gonadal steroids are unknown, although the bal-
∗∗ = highly significant, ∗ = significant. ance has usually been shifted towards neuroprotection,
particularly in models of focal ischemia. In fact, the
Interestingly, using a multivariate analysis we have ability of female gonadal steroids to affect the outcome
found some clinical differences related to gender and of cerebral ischemia seems to be dependent on numer-
stroke lateralization. Male patients with stroke in RH ous factors, including brain region, model and duration
had a significantly higher probability to reach not of ischemia, precise dose of steroids (physiological/
only high response in mobility (p = 0.021; 95% supraphysiological level), time of hormone administra-
CI = −14.75–1.33), but also more autonomy in ADL tion (before/ after stroke) and gender of experimental
(p = 0.029; 95% CI = 0.16–2.55) (Table 6). animals [15,16].

4.1. Gender and functional cerebral asymmetries

4. Discussion
Our study indicates gender differences in functional
outcome after the first-ever unilateral stroke. Prior to
the initiation of rehabilitation the initial stroke severity
was balanced between genders. Previous data indicate
the association of more severe stroke with more impor-
tant functional deficits [8]. Also, there was no gender-
related difference in age prior to the initiation of study.
In previous studies less favorable functional outcome
in women has been found to be related with the onset
of stroke at older ages.
The results of our study revealed significantly poor-
er rehabilitation outcome in women, including motor
and functional recovery of paretic arm, mobility and
performance in ADL. The results of our study are con-
sistent with previous clinical data emphasizing better
functional recovery in male stroke survivors [2–9]. A
In our study we registered better functional outcome
in women with lesion in dominant LH compared to
women with lesion in subdominant RH. On the con-
trary, men with lesion in subdominant RH had better
functional outcome compared to men with lesion in
dominant LH. In men with stroke in RH we also found
higher probability to reach better mobility performance
and more autonomy in ADL.
Gender-specific differences in functional cerebral
asymmetries (FCAs) have been receiving increasing in-
terest during the past decade. In general, it has been hy-
pothesized that women are less lateralized than men for
a variety of functions [17,18]. Women show decreased
magnitude of inter-hemispheric cortical lateralization,
while men exhibit a greater degree of cortical asymme-
try for components of cognitive and perceptual process-
ing. According to positron emission tomography (PET)
 S. Drača / Gender-related post-stroke functional recovery 251

Table 4
Differences in parameters of functional recovery between genders with right-sided or left-sided stroke
Women RH Women LH Men RH Men LH
(n = 15) (n = 20) t (n = 25) (n = 20) t
Parameter Mean ± SD Mean ± SD (DF = 33) p Mean ± SD Mean ± SD (DF = 43) p
MSS 27.27 ± 20.52 38.45 ± 22.36 5.583 (p < 0.01)∗∗ 50.92 ± 25.01 40.25 ± 21.27 6.020 (p < 0.01)∗∗
MSS s/e 14.73 ± 10.64 20.55 ± 11.03 4.152 (p < 0.01)∗∗ 26.36 ± 10.71 20.40 ± 10.86 4.873 (p < 0.01)∗∗
MSS w/h 12.53 ± 10.37 17.90 ± 11.00 3.683 (p < 0.01)∗∗ 24.56 ± 10.78 19.85 ± 11.12 3.614 (p < 0.01)∗∗
CAHAI-7 20.60 ± 15.74 28.10 ± 17.42 5.218 (p < 0.01)∗∗ 33.40 ± 17.70 28.70 ± 14.78 3.782 (p < 0.01)∗∗
RMI 9.8 ± 3.67 11.75 ± 2.73 3.130 (p < 0.01)∗∗ 12.16 ± 3.09 10.95 ± 3.46 2.186 (p < 0.05)∗
BI 67.33 ± 21.95 80.25 ± 18.74 8.187 (p < 0.01)∗∗ 81.80 ± 21.35 74.50 ± 24.11 5.005 (p < 0.01)∗∗
MSS = Motor Status Scale, MSS s/e = Motor Status Scale shoulder/elbow, MSS w/ h = Motor Status Scale wrist/hand, CAHAI-7 = Chedoke
Arm and Hand Acitivity Inventory, RMI = Rivermead Mobility Index, BI = Barthel Index, ∗∗ = highly significant.

Table 5
Outcome and treatment data according gender
Variable Women Men
β (SE) p 95% CI β (SE) p 95% CI
MSS −0.46 (2.07) 0.826 −4.71–3.79 −3.13 (2.77) 0.265 −8.75–2.48
MSS s/e 0.19 (2.16) 0.927 −4.23–4.63 3.21 (2.81) 0.259 −2.47–8.89
MSS w/h 0.48 (2.07) 0.815 −3.76–4.73 3.65 (2.84) 0.205 −2.09–9.38
CAHAI-7 0.11 (0.46) 0.816 −0.84–1.05 −0.56 (0.66) 0.409 −1.90–0.79
RMI −2.66 (1.70) 0.129 −6.14–0.82 1.57 (3.18) 0.625 −4.88–8.02
BI 0.42 (0.34) 0.236 −0.28–1.12 −0.23 (0.49) 0.641 −1.23–0.77
SE = standard error, CI = confidence interval.

data there are more inter-hemispheric metabolic corre-
lations in women, and more intra-hemispheric metabol-
ic correlations in men [19]. There are reports on gender-
specific differences in FCAs for various cognitive func-
tions and motor skills [20–22]. Moreover, reports on
gender-specific difference in hemispheric recruitment
suggest that men are believed to be RH dominant, while
the female pattern of dominance is characterized by
LH. A glucose PET investigation has shown more LH
intra-hemispheric correlations in women, and more RH
intra-hemispheric correlations in men [19]. Accord-
ing to functional MRI (fMRI) study combined with
maze exploration, in navigation performance women
engaged a right parietal and a right prefrontal area,
whereas men recruited the left hippocampal region,
right parahippocampal region, and left posterior cingu-
late cortex [23].
Nevertheless, there are just a few reports on the im-
portance of gender-related right-left difference in the
functional outcome after the brain damage. It has been
suggested that women are more able to recover from
LH lesion, while men better recover from RH lesion
for visual memory abilities following temporal lobec-
tomy [24]. The analysis of neuropsychological per-
formance in unilateral brain-damaged subjects showed
that females with lesion in LH were better than males
with the same lesion, whereas males with lesion in RH
were better than females with the same lesion for vari-
ables related to LH function (verbal intellectual, right
motor, right sensory) [25]. These results appear to be
consistent with results of our study which have shown a
significant advantage of motor and functional recovery
in women with left-sided stroke, as well as in men with
right-sided stroke.
4.2. Menstrual cycle, steroid fluctuation and
functional cerebral asymmetry
It has also been shown that changing levels of female
gonadal steroids affect FCAs: low steroid phase (men-
strual phase) enhances lateralization patterns, where-
as high steroid phase (follicular and luteal phase) re-
sults in more bilateral lateralization [26–28]. It seems
unlikely that high concentrations of gender hormones
selectively activate or inhibit RH or LH. The atten-
uation of FCAs, as found in younger women during
the luteal phase, may be the result of estrogen and/or
progesterone-related modulation of inter-hemispheric
inhibition [29]. An imaging study reported a reduced
inter-hemispheric inhibition between homotopic brain
areas along with reduced behavioral asymmetries in
women during the follicular phase compared to menses,
with the strength of inter-hemispheric inhibition to be
significantly related to estrogen levels [30]. The re-
sults of study investigating hormone therapy-related ef-
fects on FCAs in postmenopausal women suggested
 252

Table 6
Outcome and treatment data according gender and stroke lateralization
Variable Women RH Women LH Men RH Men LH
β (SE) p 95% CI β (SE) p 95% CI β (SE) p 95% CI β (SE) p 95% CI
MSS 1.17(2.48) 0.650 −4.56–6.89 −1.43(2.48) 0.575 −6.78–3.93 −4.83(6.59) 0.473 −1.9E+14−9.01E+13 0.87(3.21) 0.790 −6.07–7.81
MSS s/e −1.76(2.67) 0.529 −7.92–4.41 1.36(2.78) 0.632 −4.65−7.37 4.83(6.59) 0.473 −9E+13−1.87E+14 0.46(3.12) 0.884 −6.28–7.21
MSS w/h −0.77(2.34) 0.751 −6.17–4.64 1.24(2.45) 0.623 −4.07–6.54 4.83(6.59) 0.473 −9E+13−1.87E+14 1.28(3.15) 0.691 −5.53–8.09
CAHAI −0.17(0.73) 0.820 1.85–1.51 0.18(0.99) 0.860 −1.98–2.34 0.15(0.53) 0.787 0.97–1.26 −3.87(2.25) 0.108 8.74–0.98
RMI −3.38(2.89) 0.275 −10.05–3.28 −3.27 (3.04) 0.301 −9.85–3.30 −8.03(3.19) 0.021∗ −14.75–1.33 6.67(4.91) 0.197 −3.94–17.28
BI 0.66(0.66) 0.349 −0.87–2.19 0.51(0.54) 0.369 −0.67–1.68 1.35(0.57) 0.029∗ 0.16–2.55 −0.83(0.73) 0.279 −2.41–0.76
∗ = significant.
S. Drača / Gender-related post-stroke functional recovery
 S. Drača / Gender-related post-stroke functional recovery
an estrogen-related modulation of RH processing in
particular [31]. In our study we did not present the
menopausal status of women, but the mean age of in-
cluded female stroke survivors (55 years) is much low-
er than mean age of women with stroke in epidemio-
logical studies (75 years) [9]. We might assume that
presence of gender steroids in female patients aged less
than 51 years contributes to increased inter-hemispheric
inhibition between homotopic brain areas along with
increased behavioral asymmetries.
4.3. Gender and stroke localization
Our data indicate that stroke was more frequently
localized in LH in both genders aged less than 51 years.
This finding is consistent with previous data indicating
higher incidence of infarction in left middle cerebral
artery territory compared to right middle cerebral artery
territory among young men (age 15–49 years) [32].
We also registered that cortical localization of stroke
was significantly more frequent in women. This result
might correlate with the finding obtained in the exper-
imental model of focal ischemia which has shown that
endogenous estrogens are associated with a striking
preservation of striatal, but not cortical ischemic blood
flow [33].
We recognize that this study has limitations. The
sample size is small, although some previous studies
evaluated a similar number of patients [25,34]. The
stroke patients participating in the study cannot be con-
sidered to be a random sample; we recruited only the
patients with the first-ever unilateral stroke, with no his-
tory of previous psychiatric illness, with no severe post-
stroke cognitive impairment and post-stroke dysphasia
which prevent reliable communication. We evaluated
motor recovery and independence in ADL, but not sen-
sory and affect. For all these reasons, the results of this
study could not be generalized to the whole population
of unselected stroke survivors. Despite these shortcom-
ings, this study has several implications. This paper
places particular emphasis on substantial gender-based
differences in functional recovery of patients with their
first-ever unilateral stroke. The results of the present
study demonstrate that women, for reasons which are
currently unclear, are functionally more impaired by
stroke than men. The results also indicate the impor-
tance of gender-dependent right-left difference on the
functional outcome.
253
5. Conclusion
Awareness of gender differences in post-stroke func-
tional status may enable better understanding of differ-
ences in functional outcome between men and women
after unilateral cerebral lesion (stroke, traumatic brain
injury) and better targeting of rehabilitation services to
relevant populations. Although the first review on gen-
der differences in lateralization has been written thir-
ty years ago (Harris, 1980), there is still no consen-
sus about gender differences in lateralization and it re-
mains a much debated topic. This hypothesis should
be investigated further. More studies that assess stroke
survivors in both subjective and objective measures are
needed.
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