ADL Function Research Articles

Geriatric Impairments and Low Muscle Mass Are Associated with Treatment Discontinuation and Overall Survival in Newly Diagnosed Non-Transplant Eligible Multiple Myeloma Patients (nte-NDMM) Treated with Dose-Adjusted Melphalan-Prednisone-Bortezomib (MPV) — Results of the Dutch HOVON 123 Study

Geriatric Impairments and Low Muscle Mass Are Associated with Treatment Discontinuation and Overall Survival in Newly Diagnosed Non-Transplant Eligible Multiple Myeloma Patients (nte-NDMM) Treated with Dose-Adjusted Melphalan-Prednisone-Bortezomib (MPV) — Results of the Dutch HOVON 123 Study

Patterns of discrepancies in different objects of awareness in mild and moderate Alzheimer’s disease

Objectives: Awareness is considered a heterogeneous and non-linear phenomenon in dementia. We aim to investigate patterns of change of different domains of awareness (awareness of cognitive functioning and health condition, activities of daily living, emotional state, social functioning, and relationships) in people with mild and moderate Alzheimer’s disease (AD) and aspects related to each domain.Method: Cross-sectional assessment of dyads of people with AD (PwAD) and caregivers (n = 128; CDR1 = 74, CDR2 = 54). PwAD completed assessments about quality of life, cognition and their awareness of disease. Caregivers provided information about PwAD and received quality of life and burden of care assessments.Results: Mild AD group showed a mildly impaired awareness (n = 40; 54.05%), while moderate AD group, showed higher presence of moderately impaired awareness (n = 22; 40.74%). There was a significant difference between groups in awareness of cognitive functioning and health condition (p < 0.004), functional activity impairments (p < 0.001) and total score of awareness (p < 0.01). Conversely, awareness of emotional state (p = 0.22) and of social functioning and relationship (p = 0.44) presented no significant difference between groups. Unawareness of functional activity impairments showed higher discrepancy scores between PwAD and caregivers in both groups.Conclusions: Significant differences were found only in patterns of discrepancies in awareness of cognitive functioning and health condition, of ADL and socio-emotional functioning. Different factors are related to different domains in mild and moderate group, reinforcing the heterogeneity of awareness in dementia. ADL deficits have an important role in awareness phenomenon, independent of the severity of disease.

733. Incidence and Evaluation of the Change in Functional Status Associated with Respiratory Syncytial Virus Infection in Hospitalized Older Adults

BackgroundRespiratory Syncytial Virus (RSV) causes severe respiratory illnesses in infants and older adults. Mortality disproportionately affects the elderly, can exacerbate chronic cardiopulmonary conditions and may result in loss of function. The purpose of this study was to determine the incidence of RSV infection in hospitalized adults and evaluate functional changes associated with RSV hospitalization in older adults ≥60 years.MethodsAdults ≥18 years of age admitted with an acute respiratory infection (ARI) or exacerbation of chronic cardiopulmonary disease (e.g. CHF, COPD, asthma) preceded by an ARI within 14 days were screened. Subjects were included if hospitalized for ≥24 hours with laboratory confirmed RSV and residing in two catchment areas (Rochester, NY and New York, NY). Illness history, comorbidities and demographic characteristics were collected at enrollment. Enrolled subjects ≥60 years underwent functional status evaluation retrospectively 2 weeks prior to hospitalization, at enrollment, discharge and 2 months using the Lawton–Brody Instrumental Activity of Daily Living (IADL) Scale (0–8), Barthel (ADL) Index (0–100), MRC Breathlessness score (1–5) and Mini-Cog instrument.ResultsFrom October 2017 to March 2018, 2,883 adults hospitalized with ARI were tested and 322 (11%) positive for RSV. Seventy-two adults ≥60 years underwent functional assessment. Mean age was 75 years, 53% were female and 58% demonstrated impaired cognition on admission. Five subjects died during hospitalization and one prior to 2-month follow-up. Interim analysis of 2-month functional assessment was available for 39 subjects. RSV illness resulted in acute functional loss in almost all patients. Although there were no statistically significant differences between mean pre-hospitalization and 2-month functional scores, IADL (6.7 vs. 6.0, P = 0.27), ADL (90.4 vs. 88.5, P = 0.67) and MRC (2.96 vs. 2.7, P = 0.57), 23% of subjects required a higher level of care at discharge. Additionally, RSV hospitalization resulted in decreased ADL scores in 36% of subjects and worsening respiratory function in 18% assessed at 2 months (figure). ConclusionOlder adults hospitalized with RSV infection demonstrate acute functional decline which may result in prolonged loss of function in some patients.Disclosures A. Branche, Merck: Investigator, Grant recipient and Research grant. E. Granieri, Merck: Investigator, Research grant. E. Walsh, Merck: Investigator, Research grant. L. Finelli, Merck: Employee, Salary. A. R. Falsey, sanofi pasteur: Consultant and Grant Investigator, Consulting fee and Research grant. Gilead: Consultant, Consulting fee. Merck Sharpe and Dome: Investigator, Grant recipient. Janssen Pharmacueticals: Investigator, Grant recipient. Pfizer: Consultant, Research grant. Novavax: Consultant, none. A. Barrett, Merck: Investigator, Research support. L. Saiman, Merck: Investigator, Research grant.

Quality of life and paracetamol in advanced dementia (Q-PID): protocol of a randomised double-blind placebo-controlled crossover trial

BackgroundNo proven effective interventions on quality of life (QoL) are available for persons with dementia in a long-term care facility (LTCF). However, several interventions are effective in diminishing mediators of QoL (i.e. challenging behaviour, depressed mood, sleeping disorders), including pain treatment. Un(der)diagnosed and un(der)treated pain is a serious and frequent problem in persons with dementia. Also, although pain is difficult to assess in this group, the impact on QoL is probably considerable. There is evidence that pain has a negative impact on behaviour, mood, functioning and social participation, and benefit may be derived from use of paracetamol. Therefore, in LTCF residents with advanced dementia, this study aims to evaluate the effect of scheduled pain treatment with paracetamol on QoL, neuropsychiatric symptoms, ADL function, pain, care dependency, and (change in) use of psychotropic and pain medication.MethodsThis randomised, double-blind, placebo-controlled crossover trial will include 95 patients with: 1) age ≥ 65 years, 2) advanced dementia (Reisberg Global Deterioration Scale 5–7), and 3) QUALIDEM score ≤ 70. Exclusion criteria are the regular use of pain treatment, allergies to the study drugs, severe liver insufficiency or disease, use of > 4 units of alcohol/day, weight < 50 kg, and/or concomitant use of flucloxacillin. The two treatment periods of six weeks each (paracetamol and corresponding placebo) will be separated by a washout period of seven days. Primary outcome is effect on QoL (QUALIDEM and DS-DAT) and secondary outcome is effect on neuropsychiatric symptoms, ADL function, pain, care dependency, and (change in) use of psychotropic and pain medication (all compared to baseline).DiscussionIf regular treatment with paracetamol proves to be beneficial for QoL, this could have major implications for daily practice in long-term care. Information from this study may help professionals in their decision making regarding the prescription of pain medication to improve the QoL of persons with dementia and a low QoL.Trial registrationThe trial was registered on the Netherlands Trial Register (NTR6766); Trial registration date: 20th October, 2017.

Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: Results from the U‐Age program (SWENIS study)

We aimed to investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes. Data were collected in 2014 from a Swedish national sample of nursing home residents (n=4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association. We found that cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359685 SEK, and in severely cognitive impaired resident, the cost was 825081 SEK. Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations.

Residential greenness and activities of daily living in the Chinese elderly: a prospective cohort study

BackgroundActivities of daily living (ADL) is a measurement of the ability to care for one's self and body, including personal care, mobility, and eating. Greenness in the built environment has been shown to improve physical health and mental wellbeing. We hypothesise that greenness could delay declines in activities of daily living. MethodsUsing the prospective cohort of the China Longitudinal Healthy Longevity Survey (CLHLS) between 2000 and 2014, we explored the association between ADL and greenness in the oldest-old (people aged ≥80 years). We assessed exposure using satellite-derived Normalized Difference Vegetation Index (NDVI) in the 250 m radius around each participant's residential address and then categorised them into quartiles. Our study outcome was self-care capacity, measured by a six-item ADL survey (eating, bathing, dressing, toileting, transferring, and continence). We stratified our analysis of participants with complete independence at baseline (ADL score 0 out of 6). Both NDVI values and ADL scores were repeatedly measured in 2000, 2002, 2005, 2008, 2011, and 2014. We used mixed-effects logistic regression, adjusted for age, sex, ethnicity, marital status, childhood and adult socioeconomic status, smoking status, alcohol consumption, exercise, Mini-Mental State Examination scores, and time since study entry. FindingsAmong 3044 elderly participants at baseline, the mean age was 91 years (SD 7·1). 837 (27·5%) became dependent and needed assistance in performing any one of the ADL functions during follow-up. Participants who became dependent in ADL were more likely to be older, female, Han Chinese, and poor cognitive function at baseline. Participants in the highest quartile of greenness had an odds ratio of 0·54 (95% CI 0·43–0·68) of becoming dependent in ADL, compared with the lowest quartile. InterpretationThe ageing of China's population is an irreversible trend, and poses a challenge to the care givers who care for the elderly. Our findings suggest that increasing green space, if properly introduced into city planning, might reduce the burden of long-term care for the Chinese elderly. FundingNone

The Effects of Multifactorial Exercise Programs in Older Adults With Cognitive Impairments: A Systematic Review

To combine current evidence collected from research studies that examined the effects of multifactorial exercise programs on older adults with impaired cognition. In addition, the multifactorial programs were assessed to determine significant results in patient well-being, including ADL function and mental health, subsequently affecting caregiver quality of life.

Endoribonuclease ENDU-2 regulates multiple traits including cold tolerance via cell autonomous and nonautonomous controls in Caenorhabditis elegans

Environmental temperature acclimation is essential to animal survival, yet thermoregulation mechanisms remain poorly understood. We demonstrate cold tolerance in Caenorhabditis elegans as regulated by paired ADL chemosensory neurons via Ca2+-dependent endoribonuclease (EndoU) ENDU-2. Loss of ENDU-2 function results in life span, brood size, and synaptic remodeling abnormalities in addition to enhanced cold tolerance. Enzymatic ENDU-2 defects localized in the ADL and certain muscle cells led to increased cold tolerance in endu-2 mutants. Ca2+ imaging revealed ADL neurons were responsive to temperature stimuli through transient receptor potential (TRP) channels, concluding that ADL function requires ENDU-2 action in both cell-autonomous and cell-nonautonomous mechanisms. ENDU-2 is involved in caspase expression, which is central to cold tolerance and synaptic remodeling in dorsal nerve cord. We therefore conclude that ENDU-2 regulates cell type-dependent, cell-autonomous, and cell-nonautonomous cold tolerance.

Which client characteristics predict home-care needs? Results of a survey study among Dutch home-care nurses.

Fee‐for‐service, funding care on an hourly rate basis, creates an incentive for home‐care providers to deliver high amounts of care. Under casemix funding, in contrast, clients are allocated—based on their characteristics—to homogenous, hierarchical groups, which are subsequently funded to promote more effective and efficient care. The first step in developing a casemix model is to understand which client characteristics are potential predictors of home‐care needs. Nurses working in home care (i.e. home‐care nurses) have a good insight into clients’ home‐care needs. This study was conducted in co‐operation with the Dutch Nurses’ Association and the Dutch Healthcare Authority. Based on international literature, 35 client characteristics were identified as potential predictors of home‐care needs. In an online survey (May, 2017), Dutch home‐care nurses were asked to score these characteristics on relevance, using a 9‐point Likert scale. They were subsequently asked to identify the top five client characteristics. Data were analysed using descriptive statistics. The survey was completed by 1,007 home‐care nurses. Consensus on relevance was achieved for 15 client characteristics, with “terminal phase” being scored most relevant, and “sex” being scored as the least relevant. Relevance of the remaining 20 characteristics was uncertain. Additionally, based on the ranking, “ADL functioning” was ranked as most relevant. According to home‐care nurses, both biomedical and psychosocial client characteristics need to be taken into account when predicting home‐care needs. Collaboration between clinical practice, policy development, and science is necessary to realise a funding model, to work towards the Triple Aim (improved health, better care experience, and lower costs).

Use of the Spanish Version of the Frail-NH Scale to Predict Adverse Outomes in a Nursing Home in Mexico City

Few studies assert the prevalence of Frailty in Latin America and Mexico . Most of these studies are from data of community dwelling elders. To our knowledge, there is no study showing the prevalence or outcomes of frailty among the nursing home residents in Mexico. Frailty has proven to predict falls, worsening of ADL function, hospitalization and death in nursing homes . The timely identification of frailty in nursing homes is necessary to enhance measures in care plan and reevaluate goals of care. The FRAIL-NH scale was developed as a tool to identify frail persons in nursing homes, with potentially treatable conditions . The objective of this study was to observe the applicability of the FRAIL-NH Spanish version in the nursing home of the Spanish Hospital in Mexico City and review a longitudinal assessment of this scale to report adverse outcomes of functional decline, hospitalizations and death.

What Works Best For Whom? Exploring the Efficacy of Two Psychosocial Interventions in Palliative Care (FR419D)

•Understand two approaches to addressing emotional well-being and preparation for end of life in patients living with serious illness.•Understand sub-population differences in which approach works best for whom, among two interventions. Attention to psychosocial aspects of care are central to comprehensive palliative care. Yet, our understanding of which interventions are best applied to which patient populations is in its infancy requiring increased evidence. Identify the optimal treatment to address psychosocial well-being by comparing the efficacy of two psychosocial interventions among palliative care patients. This secondary analysis of a trial (n=135) included patients with advanced cancer, CHF, or ESRD; one arm received the Outlook intervention, designed to address issues of life completion and preparation, and a second arm received relaxation meditation (RM). Primary outcomes: completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACITsp) sub-scales of faith, meaning, and peace. This study employed QUINT analyses to examine these RCT data to determine how best to address preparation for end-of-life and emotional well-being. This recently developed methodology explores and identifies which patient subgroup(s) shows greater improvements with which intervention. Sample: 56% male; 70% cancer; 54% married; and 51% White. Different sub-groups of patients responded variably to the different treatments. For example, those with low spiritual well-being at baseline showed greater improvements in emotional well-being and decreases in anxiety with RM compared to Outlook. In contrast, for those with high spiritual well-being at baseline, Outlook resulted in greater improvements in emotional well-being and decreases in anxiety. Outlook showed greater improvements in preparation for the end of life for those with low preparation at baseline; RM showed greater improvement in preparation for patients with high preparation at baseline but poor ADL function. Identifying the optimal treatment for a given patient is a primary goal of palliative care. We demonstrated that different interventions work variably for unique patient sub-populations.

Phenotype and genotype of muscle ryanodine receptor rhabdomyolysis-myalgia syndrome.

Rhabdomyolysis and myalgia are common conditions, and mutation in the ryanodine receptor 1 gene (RYR1) is suggested to be a common cause. Due to the large size of RYR1, however, sequencing has not been widely accessible before the recent advent of next-generation sequencing technology and limited phenotypic descriptions are therefore available. We present the medical history, clinical and ancillary findings of patients with RYR1 mutations and rhabdomyolysis and myalgia identified in Denmark, France and The Netherlands. Twenty-two patients with recurrent rhabdomyolysis (CK>10000) or myalgia with hyperCKemia (>1.5×ULN) and a RYR1 mutation were identified. One had mild wasting of the quadriceps muscle, but none had fixed weakness. Symptoms varied from being restricted to intense exercise to limiting ADL function. One patient developed transient kidney failure during rhabdomyolysis. Two received immunosuppressants on suspicion of myositis. None had episodes of malignant hyperthermia. Muscle biopsies were normal, but CT/MRI showed muscle hypertrophy in most. Delay from first symptom to diagnosis was 12years on average. Fifteen different dominantly inherited mutations were identified. Ten were previously described as pathogenic and 5 were novel, but rare/absent from the background population, and predicted to be pathogenic by in silico analyses. Ten of the mutations were reported to give malignant hyperthermia susceptibility. Mutations in RYR1 should be considered as a significant cause of rhabdomyolysis and myalgia syndrome in patients with the characteristic combination of rhabdomyolysis, myalgia and cramps, creatine kinase elevation, no weakness and often muscle hypertrophy.

Burden among Family Caregivers of Dementia in the Oldest-Old: An Exploratory Study.

With >85 years, the fastest growing age segment in developed countries, dementia in the oldest-old is projected to increase exponentially. Being older, caregivers of dementia in oldest-old (CDOO) may experience unique challenges compared with younger-age groups. Thus, we aim to explore demographic characteristics and burden pattern among CDOO. We studied 458 family caregiver-patient dyads attending an outpatient memory clinic. We classified patients into three age-groups: <75, 75-84, and ≥85 years. We measured caregiver burden using the Zarit Burden Interview (ZBI) 4-factor structure described by Cheah et al. (1). We compared care recipient characteristics, caregiver demographics, and ZBI total/factors scores between the three age-groups, and performed 2-way analysis of variance (ANOVA) to ascertain the effect of age-group by disease severity interaction. Oldest-old care recipients were more impaired in cognitive function and instrumental ADL; there was no difference in behavior and basic ADL. Compared with the other two age-groups, CDOO were older (mean age: 50.4 vs 55.5 vs 56.8 years, P < 0.01), and overwhelmingly adult children (85.9%) as opposed to spouses (5.3%). CDOO also had higher ZBI total score, role strain, and personal strain (all P < 0.05). However, there was no difference in worry about performance scores. 2-way ANOVA did not reveal significant age-group by disease severity interaction for ZBI total and factor scores, although distinctive differences were seen between role/personal strain with worry about performance in mild cognitive impairment and very mild dementia. Our study highlighted that CDOO were mainly older adult children who experienced significant role and personal strain independent of disease severity while caring for their family member with more impaired cognitive and physical function. These results pave the way for targeted interventions to address the unique burden faced by this rapidly growing group of caregivers.

Evaluation of a transitional care programme for frail older adults and the effectiveness for the oldest old

Introduction: Older adults with multimorbidity, aged 70 years and older, experience a complex of both medical and social problems and frequently require continuous care in multiple settings. They move between acute and non-acute care settings, such as hospitals, home, intermediate care unit, primary care center, nursing home and hospice. It is within that context, that the transitional care programme for this group has been developed in the IJsselland hospital in the Netherlands, and will be evaluated. In this programme the Transmural Care Bridge is incorporated. The programme: The identification of seniors at risk starts at the Emergency Department with the ISAR- HP, the identification of seniors at risk- hospitalized. Patients at high risk for functional decline will fill out a triage questionnaire with their informal caregivers developed by the Geriatricians of the hospital. In all cases a registered nurse on the ward were the patient is admitted will start with screening on delirium, malnutrition, ADL functions, mobility and fall risk. If nessecary the geriatric consultation team will visit the patient and a systematic comprehensive geriatric assessment (CGA) will be done. The geriatrician will develop a care plan. In the programme one day before discharge from hospital a community nurse (CN) visits the patient inside the hospital and within 48 hours after discharge from hospital and after 2, 6, 12 and 24 weeks. Main issues during these visits are medication safety, appropriateness of care arranged during hospital admission resources, social network and support for the informal caregiver. The CN will discuss the care plan with the General Practitioner (GP) of the patient. In a prospective cohort study 100 older patients, 50 patients before and 50 patients a after the start of this programme, are asked to fill out a questionnaire at the start of the program in het hospital, and after one and three months after discharge from hospital, to measure morbidity, functional limitations, cognitive functioning, social functioning, self-perceived health, self-perceived quality of life, experiences, GP visits and admissions. Also the effectiveness of the program on self-management abilities will be measured by the CN through the Self Sufficiency Matrix. 30 professionals inside and outside the hospital who provide care for this group of older adults, specialist, nurses, general practitioners and community nurses will be asked to provide their perspectives on the programme and on inter-professional collaboration. Effectiveness for the oldest old: Because preliminary research findings showed that many people aged 85 years and older, who we consider in this study as the oldest old, said they felt lonely, useless, lost spouses, friends and sometimes children and sometimes were waiting to die, an additional question arose about how the oldest old would percieve this care programme and if this would meet their needs. This question will be adressed by in depth interviews with the oldest old. Aim: This research project aims to contribute to changes in transitional care for older adults who are admitted to the hospital and add to the current body of knowledge of the perspectives of the oldest old on their care.

Comparison of early stage clinical symptoms, cognitive, affective and ADL functions between PDD and DLB

Background: Although PDD and DLB develop similar symptoms in the advanced stage, they show some different symptoms in the early stage. We evaluated 52 PDD patients (30 men, 73.8 ± 8.4 years old) and 46 DLB patients (19 men, 72.2 ± 7.1 years old).

Effects of high-intensity robot-assisted training in hand function recovery and adl independence in individuals with multiple sclerosis: A randomized controlled single-blinded trial

Effects of high-intensity robot-assisted training in hand function recovery and adl independence in individuals with multiple sclerosis: A randomized controlled single-blinded trial

脳血管障害患者における障害によるストレスの認知的評価に関する研究 : ADL,認知能力によるストレスの認知的評価とコーピング行動の特徴

脳血管障害患者における障害によるストレスの認知的評価に関する研究 : ADL,認知能力によるストレスの認知的評価とコーピング行動の特徴

Physiotherapy for Ankylosing Spondylitis: Systematic Review and a Proposed Rehabilitation Protocol.

Ankylosing Spondylitis (AS) is a chronic inflammatory disease with gradual onset, largely affecting the axial skeleton. As leads to varying degrees of restricted spinal mobility, pain and loss of functional capacity. Rehabilitation, especially physiotherapy and exercises, are considered integral components of its management. Various rehabilitation modalities are available for the benefit of individuals with AS, but a sequenced protocol has not been reported. A scientific review was performed using the following search engines: MEDLINE (Pubmed), COCHRANE Library and Physiotherapy Evidence Database (PEDro). Studies, which had at least one of the groups receiving rehabilitation, and the major outcomes studied including pain, stiffness, mobility (spine and chest wall) and physical function (disease activity, ADL, QOL and global function) were selected. A total of 28 studies were shortlisted for the review which included a total of 1926 subjects with AS. The review of literature showed that individuals with AS had beneficial effects from exercise programmes compared to no exercise. Patient education, active involvement and motivation of individuals with AS played an important role in the overall treatment outcomes. Based on the review, a four-phase sequenced rehabilitation protocol has been laid down for the benefit of individuals with AS.

PROMOTING ADL INDEPENDENCE IN VULNERABLE ELDERLY: SIX-MONTH FOLLOW-UP OF A PILOT COMPARATIVE TRIAL

Muscle strength is essential but insufficient to reduce ADL disability in older adults. A parallel-group randomized controlled trial was conducted to compare whether adding functional and task-oriented training to resistance exercise would generate a greater improvement on ADL performance relative to resistance exercise alone. Fifty-two older adults who showed muscle weakness, lived a sedentary life style, and had ADL difficulty were recruited from local subsidized housing properties. They received 10 weeks of resistance exercise or the 3-Step Workout for Life, which included practicing functional movements and ADL tasks at home in addition to resistance exercise. The Box and Blocks test, Timed Up and Go, and Assessment of Motor and Process Skills were used to measure physical function and ADL performance. At six-month follow-up, all three outcomes in the 3-Step Workout for Life group were not different from the baseline while the resistance exercise only group showed a significant decline (mean change in the Box and Blocks = -4.05, p = 0.02; mean change in the Timed Up and Go = 1.84, p = 0.01; mean change in the Assessment of Motor and Process Skills = -0.25, p = 0.01). More importantly, the 3-Step Workout for Life group showed a greater improvement in ADL performance when compared to the resistance exercise only group (group mean difference = 0.37, p < 0.01). Adding functional, task-oriented training to resistance exercise may help retain physical function and delay the decline of ADL performance after six months of detraining in vulnerable older adults.

IMPROVEMENT OF FINE MOTOR SKILLS IN CEREBRAL PARETIC PATIENTS

The aim of this review is to give an overview of the ADL functions in children and young adults with cerebral palsy and our planned studies. For measuring the ADL functions, the Functional Independence Measure (FIM) and the Functional Independence Measure for Children (WeeFIM) will be used. The hand functions will be analyzed by the Quality of Upper Extremity Skills Test (QUEST). The fine motor skills of the hand will be revealed by using the selected subtests of the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). Based on the outcomes of the measures, a complex therapeutic protocol will be implemented including the elements of the ergo and manual therapy, proprioceptive neuromuscular facilitation (PNF), and piano therapy. It is anticipated that the complex therapy adapted to individual needs will result in significant improvement in the ADL functions in disabled children and young adults.