Assessment Of Functional Independence Research Articles

Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries.

This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI). Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally. In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets. The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.

Functional Impairment in Pediatric Cancer Survivorship

Care for pediatric cancer survivors must include scheduled, thorough evaluations of potential chronic and late effects resulting from multidimensional cancer treatments. Assessment of functional independence with activities and participation is critical in assuring that survivors can optimally access their environments and pursue educational, occupational, and leisure activities appropriate to their interests and capabilities. Owing to their expertise in both rehabilitation and habilitation, pediatric physiatrists are of great benefit in the care of survivors of pediatric cancer.

Application effect of multidisciplinary collaborative nursing process in emergency care of patients with hypertensive cerebral hemorrhage.

The aim of the study was to analyze the effect of applying multidisciplinary collaborative nursing process (MCNP) in the emergency care of patients with hypertensive cerebral hemorrhage. A total of 124 patients with hypertensive cerebral hemorrhage admitted to Qinghai University Affiliated Hospital from January 2020 to January 2021 was divided into control group (treated with regular emergency care, n=64) and study group (treated with MNCP, n=58). The effect of emergency treatment was compared between the two groups. Compared to the control group, initial treatment time, time of opening peripheral veins, first blood drawing time, time of imaging examination, emergency room treatment time, and hospital stay time were lower in MCNP group, the difference was significant (p<0.05). There were significant differences in Functional Independence Assessment (FIM) and National Institutes of Health Stroke Scale (NIHSS) scale scores between the control group and the MCNP group in treatment for 1 week in hospital (p<0.05). The level of total bile acid (TBA) and activated partial thromboplastin time (APTT) in the MCNP group were significantly lower than in the control group (p<0.05). The nursing satisfaction in MCNP was also improved compared to that in the control group (p<0.05). MCNP enhances the rational improvement of patients' awareness, improves the comprehensive quality of emergency treatments and optimizes prognosis; therefore, it is worthy of clinical promotion and application.

Assessment of Functional Independence in different levels of traumatic spinal cord injury (SCI) patients of Pakistani Population; A Cross-Sectional Survey

Spinal Cord injury (SCI) is a serious public health problem as it not only causes serious functional impairment in the individual but also affects the family and social circle of the patient. The main objective of the study was to investigate the level of functional independence in different levels of SCI patients in Pakistani population. We hypothesized that different levels of SCI experience different levels of functional independence. Methods: An exploratory cross-sectional survey was designed, and data was collected from Lahore General Hospital, Ghurki Hospital, and Jinnah Hospital, Lahore, Pakistan. 52 patients suffering from acute spinal cord injury were enrolled in study by using convenient sampling technique. Overall health status of patients was measured using functional independence measure (FIM) tool.  Results: Total 52 patients were assessed in this study. Out of which 50% injuries were reported at cervical level, 15% injuries were reported at thoracic level and 34% were reported at lumbar level.  Percentage of males suffering from SCI (62%) was higher than female (38%). The lowest functional independence level was recorded for cervical injury (FIM score: 40), moderate for thoracic injury (FIM score: 84) and maximum for lumbar injury (FIM score: 102). Conclusion: Within the studied population, the percentage of cervical injuries was more than thoracic and lumbar. Gender proportion in traumatic spinal cord injury showed that men were more prone to injury as compared to female. However, functional independence was associated with level of SCI injury as cervical injuries patients were least independent while lumbar injury patients had high functional independence. 

Multidisciplinary outpatient rehabilitation of physical and neurological sequelae and persistent symptoms of covid-19: a prospective, observational cohort study

Purpose This prospective, observational cohort study investigated the effects of multidisciplinary rehabilitation of post Covid-19 sequelae and persistent symptoms and their impact on patients’ functioning and quality of life. Methods From 58 patients referred for neurorehabilitation, 43 were eligible for and participated in the present study. Before and after 8 weeks of rehabilitation, patients underwent physical, neuropsychological and respiratory evaluations and assessment of functional independence, impact of fatigue and quality of life. Results Forty of 43 individuals (52 ± 11.4 years, 24 male) completed the rehabilitation program. Fatigue (87.5%), dyspnea and/or shortness of breath (62.5%), and cognitive impairment (37.5%) were reported by both previously hospitalized and home-confined patients. Neurological sequelae (35.5%) were present only in hospitalized patients. After 8 weeks of rehabilitation, patients reported significant improvements in motor functional independence, upper and lower limb functionality, impact of fatigue on daily activities, respiratory muscle strength, cognitive performance, and quality of life. Conclusions Post Covid-19 patients present with heterogeneous neurological, physical, and respiratory impairments requiring a multidisciplinary rehabilitation approach to reduce disability and improve functionality and quality of life. A comprehensive assessment of clinical profiles and responses to rehabilitation may facilitate the identification of rehabilitation candidates and help to design effective rehabilitation interventions. Implication for rehabilitation Post Covid-19 patients present multiple, heterogeneous neurological, physical and respiratory impairments that are observed in both previously hospitalized and home-confined patients. Eight weeks of multidisciplinary rehabilitation may significantly reduce disability and improve functionality and quality of life. A comprehensive assessment of their clinical profile and response to rehabilitation may facilitate the identification of rehabilitation candidates and help to design more effective rehabilitation interventions.

Case presentation of a patient with an onset of psychotic disorder, polytraumatized by defenestration from 10th floor, with thoraco-lumbar SCI and multiple somatic fractures, with favorable neuro-motor and psychiatric evolution after rehabilitation

Introduction: Traumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability. Most of them occur due to motor vehicle injuries and falls from a height. Since these are high-velocity injuries, thoracolumbar fractures are commonly associated with other injuries like rib fractures, pneumo-hemothorax, and rarely great vessel injuries, hemopericardium and diaphragmatic rupture. Materials and Methods: In this article - having the patient and the THEBA Bioethics Committee approval (no. 3159/30.01.2020) – it is presented the case of a 26-year-old patient who suffered a polytrauma due to defenestration from the 10th floor - about 30 m high -resulted in thoraco-lumbar SCI associated with other severe injuries, hospitalized in Neuromuscular Clinical Division by transfer from the Neurosurgery Clinic of our hospital, for neuromotor recovery, presenting a L1 AIS/ Frankel C quadriplegia and neurogenic bladder. During the hospitalization, the patient presented psychomotor agitation, food and medication rejection, which is why repeated psychiatric evaluations were requested and performed. Following the recovery program, the patient's evolution was favorable: recovered the weight deficit, improved the motor control and sensitivity, the urethral indwelling catheter was suppressed and the intermittent catheterization program was started with later regaining of the micturition control. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Assessment (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL/IADL). Results:The patient benefited from a complex program of neuromuscular rehabilitation, with a favorable evolution, with the increasing scores from the evaluated scales and, thus, with a final performance of walking with support on short distances, as well as a sphincter reeducation with the neurogenic bladder remission. Conclusions: Associating interdisciplinary approach with a customized rehabilitation program in a patient with an onset of psychotic disorder, polytraumatized by defenestration from the 10th floor, with thoraco-lumbar SCI and other severe injuries led to neuromotor and psychiatric improvements, and sphincter function reeducation with an important improvement in patient's quality of life. Keywords: neuromuscular rehabilitation, traumatic spinal cord injury, psychiatric disorder, polytrauma,

Study on the Immediate Effect of Passive Motion in Patients with Hemiplegia Based on Brain Functional Magnetic Resonance Imaging

In order to explore the immediate effect of passive motion in patients with hemiplegia based on brain functional magnetic resonance imaging (fMRI), a total of 100 patients, who were diagnosed as stroke hemiplegia and underwent fMRI examination at a hospital designated by this study from December 2016 to December 2018, were chose as study subjects and were divided into observation group and control group according to the random number table method with 50 cases of patients in each group. The fMRI examinations were performed in the 2 groups of patients within 1 week after treatment; 10 voxels were taken as effective activating voxels to obtain statistical parameter maps for region of interest analysis; and bilateral cerebral hemispheres, sensorimotor cortex and supplementary motor area were selected as the region of interest to calculate the number of activated voxels respectively; the clinical neurological deficit scale, simplified motor function scale, and functional independence assessment table are used for the evaluation of the 2 groups of patients at the beginning and after 8 weeks of treatment. The results show that all patients’ fMRI examinations are characterized by motor function area cerebral infarction or corresponding corticospinal tract cerebral infarction; the healthy side finger movement function area is basically normal in the brain function imaging examination; the cortical signal regions are concentrated in the vicinity of the central frontal first motion zone and the central posterior proprioception zone with strong repeatability when the active, passive and resistance-inducing active movements are respectively performed on the healthy side; and the contralateral sensorimotor cortex and bilateral auxiliary exercise areas were activated. The hemiplegia patients had increased activation of the hemisphere during hand movement, and the fMRI results were basically the same as those of the normal subjects. Therefore, the fMRI examination can provide imaging data for cortical functional zone localization of active and passive movements of the fingers, and provide assistance for clinical rehabilitation and prognosis assessment. The results of this study provide a reference for further researches on the immediate effects of passive motion in patients with hemiplegia based on brain functional magnetic resonance imaging.

[Funtional tenodesis as a predictor of functional outcome in patients with cervical tetraplegia].

To determine the value of functional tenodesis (FT) of the hand as a predictor of the degree of disability in patients with cervical tetraplegia (CT) at different periods after a spinal injury. We examined 190 patients (79% - men) with CT (92.5% of cases of traumatic origin) at the age of 27 [21.0; 36.0] years with a neurological level of CІІІ-DІ, and a share of complete motor damage (A - B according to AIS) 70%. The examination included determination of neurological, motor levels and completeness of spinal cord injury (according to ISNSCI), assessment of functional independence (FIM motor domain), FT of the hand, and the severity of contractures of the joints of the hand. Using logit-regression analysis, creation of contingency tables, ROC analysis, depending on the timing of spinal injury, 4 classification models were studied: Disease duration less than 6 months, assessment of the functional outcome 6 months after spinal injury (model A); disease duration less than 6 months, assessment after 12 months (model B); disease duration less than 12 months, assessment after 12 months (model C); disease duration more than 12 months, evaluation after more than 12 months (model D, primary one). FT developed in the first 6 months after spinal injury in 12 (24%) patients, in 6-12 months - in 15 patients (20%), in more than 12 months - in 1 (less than 1%) patient. The incidence of joint contractures of the hand in group A (20%) and C (24%) did not have a statistical difference (χ2=0.22; p=0.64). Hand contractures in the first 6 months were observed in 20% of patients, in the first 12 months - in 24%, more than 12 months after spinal injury - in 28% of patients. In model A, the FT sensitivity was 80%, specificity was 64%, AUC - 0.65; in model B - 85%, 36%, 0.36, respectively; in model C (log-regression χ2=19.1; p was not determined) - 69%, 100%, 0.59, respectively; in model D (log-regression χ2=55.3; p was not determined) - 65%, 100%, 0.71, respectively. FT and contracture of the joints of the hand form during the first year after the debut of CT. As a predictor of a pronounced limitation of self-care, the sensitivity of FT in the first 6 months after spinal injury was 80-85%, in the later period, the specificity of FT was 100%, and sensitivity was 65-69%; in general, the predictive power of FT was low (AUC 0.36-0.71) and increased with the assessment of the functional outcome in the period of more than 12 months after the injury.

Relationship between side of hemiparesis and functional independence using activities of daily living index

IntroductionStroke is the third most common cause of death in the Western Hemisphere and the most common cause of adult disability and balance problems. The purpose of this study was to find the relation between dependency of performing functional activities of daily living (ADL) with side of hemiparesis in patients with stroke using Barthel Index. MethodsThis was a study of 130 patients with onset of first stroke in their life. Barthel (ADL) Index was used to assess functional ability and independence of stroke patients. The Barthel Index consists of 10 items assessing the ability to achieve certain activities without assistance. This scale gives a score between 0 and 20 in one point increments. The top score of 20 implies functional independence (slight dependency), not necessarily normality. Patients were divided into 5 categories according to their score: totally dependent (0–4), severely dependent (5–9), moderately dependent (10–14), mildly or slightly dependent (15–19) and independent (20). Then, we analyzed the results to find the relation between side of hemiparesis and functional independence. ResultsOf 130 patients with stroke, 61 patients were having right-sided hemiparesis and 69 had left sided. Out of 69 patients with left-sided hemiparesis, 16 were independent (mildly and moderately dependent) and out of 61 with right-sided hemiparesis, 35 were independent (mildly and moderately dependent). Cross tabulation and chi-square tests revealed significant relationship between side of hemiparesis and functional independence in patients with stroke (χ2 = 18.779, p < 0.001). Phi-square test value (0.380) is also significant (p < 0.001). DiscussionsThis suggests that side of hemiparesis/weakness could be taken into consideration as a factor in functional independence assessment and further retraining of hemiparetic stroke survivors. Strong relationship exists between side of hemiparesis and functional independence in patients with stroke.

Assessment of functional independence according to the WeeFIM score in children with cerebral palsy after postoperative rehabilitation

Assessment of functional independence according to the WeeFIM score in children with cerebral palsy after postoperative rehabilitation

Correlation between musculoskeletal function and radiological joint scores in haemophilia A adolescents

The functional independence score in haemophilia (FISH) is a performance-based instrument used to assess musculoskeletal function in patients with haemophilia. We aimed to evaluate the functional independence of haemophilia A adolescents and its correlation to radiological joint scores. A cross-sectional study was carried out on 50 adolescent haemophilia A patients. Musculoskeletal function was assessed using the FISH and individual joints were assessed radiologically using the Pettersson score and MRI scale. The mean age of our patients was 16 ± 1.1 with a mean FISH of 23.32 ± 4.69 (range 13-28) and a mean Pettersson score of 2.32 ± 3.09 (range 0-13) for the knees, 1.86 ± 2.67 (range 0-11) for ankles and 1.42 ± 2.17 (range 0-10) for elbows. The mean MRI score for the knees was 3.92 ± 2.74 (range 0-10) while that for ankles was 3.16 ± 2.64 (range 0-10) and for elbows was 2.34 ± 2.63 (range 0-10). There was highly significant correlation between both radiological joint scores and FISH and between degree of factor VIII deficiency and each of FISH, Pettersson score and MRI score. MRI was superior to conventional radiography in detection of subchondral cyst formation and erosions at joint margins. Given the highly significant correlation with both radiological joint scores, FISH appears to be a reliable tool for assessment of functional independence in adolescents with haemophilia A. MRI is more sensitive than conventional radiography in detection of early joint abnormalities.

Correlation among tools for the assessment of functional independence and physical activity levels in infants

Assessment tools to quantify functional independence and physical activity levels are particularly useful for making decisions and monitoring rehabilitation programs. There are many tools available to assess independence in children. However, such tools can be more or less responsive to independence conditions. The aim of this study was to verify the correlation between functional independence parameters and physical activity levels quantified by different assessment tools in 4 and 5 year-old children. For this, 20 children whose motor development was appropriate for their age were assessed by the following tools: (1) Pediatric Evaluation Disability Inventory (PEDI), (2) Evaluation Questionnaire of Independence Level for Daily Life Activities in 4 to 8 year-old children (Questionnaire), and (3) Physical Activity Questionnaire for Children (PAQ-C). Delineation of a Cross-sectional study was utilized, with the measurements taken at just one moment describing the variables and their distribution and association patterns. For that age group, only for the self-care functional skills assessed by PEDI, significant correlation was observed with the age indicating higher independence values for the older children. For all other PEDI categories and for the other tools utilized in this study, that independence-age correlation was not significant. Despite the independence-age correlation having not been found in infants assessed by the Questionnaire, other significant correlations were observed between the Questionnaire values obtained and some PEDI values. No significant correlations were observed between the PAQ-C values obtained and the other tools. In conclusion, some categories quantified by PEDI are not correlated with functional independence changes detected by other categories by the same tool. Still, the correlation between Questionnaire values and PEDI values was observed in just some categories assessed by PEDI. Finally, PAQ-C did not correlate with the other two tools, suggesting the need for a better investigation into the responsiveness of the measurements from psychometric studies.

Valoración del impacto funcional producido en participantes de Taller Laboral Protegido Los Coihues

The main goal of this study is to demonstrate that maintaining an active work life has a determining impact on people's functional tasks. We also considered important to objectively assess the benefits of programs developed for disabled adults. We propose the use of the Functional Independence Assessment (FIA) to fulfil these goals. This instrument was administered to 14 inpatients, 80% of which had suffered disabling traumatic brain injury, and 20% with spinal cord injury, all of whom have had attended the sheltered workshop of Clínica Los Coihues during a two year period. Their ages ranged between 29 and 74 years old, with an average of 56 years, and their average time of hospitalisation was of 8 years. The FIA considers five performance areas and abilities: motor, social, cognitive, activities of daily living, and work. We observed achievements in all of these areas, specially in the social and work aspects, although all areas were facilitated. Patients demonstrated high levels of personal satisfaction as well as direct benefits in their interpersonal relationships and mood. It is important to emphasize a sense of belonging to a group, a greater identity in social roles, and an increase in significant verbal and non verbal expression, which represent volitional indicators that are inherent to the human being as a person. These factors are demonstrated in the FIA.

Aspects of Caregiver Distress After Severe Head Injury

The caregivers of 22 severely head-injured individuals were interviewed at 6 and 12 months post injury to obtain information about the extent of their distress and to in vestigate the relationship between their distress and two aspects of burden: caregivers' perceptions of the head-injured person's problems and an objective assessment of func tional independence. Caregivers reported high levels of distress. The factors associated with caregiver distress included the number of perceived problems at 6 months post injury, the overall level of disability, and certain aspects of functional independence at both 6 and 12 months, particularly if the person required assistance with self-care and home-based tasks. Implications for rehabilitation of both the head-injured indi vidual and his or her caregivers are examined, especially with reference to issues sur rounding return to the community. Key Words: Caregivers—Head injury—Psycho logical distress—Functional outcome—Newcastle Independence Assessment Form (N1AF)—...

A Comparison between the Stanford Health Assessment Questionnaire and the Barthel Index in Patients with Rheumatoid Arthritis

Disability was measured in 33 patients with rheumatoid arthritis (RA) using the Stanford Health Assessment Questionnaire (HAQ) and a self-administered version of the Barthel index (BI). There was no significant disagreement between the two methods, although the HAQ showed a tendency to overestimate the degree of disability slightly. The findings suggest that the B1 is as reliable as the HAQ in the assessment of functional independence with activities of daily living in patients with RA. it also has the advantage of evaluating bladder and bowel control which is often affected in these patients. Most therapists are more familiar with the B1 than with the HAQ. The B1 could, therefore, be recommended for measuring rehabilitation gains in patients with RA.

The Extended Activities of Daily Living scale: a further validation.

The Extended Activities of Daily Living scale was validated as an overall assessment of functional independence in stroke patients discharged from hospital. Analysis of results from 49 patients discharged from a stroke unit and 299 from a trial of domiciliary rehabilitation supported previous work indicating that the four subsections--mobility, kitchen, domestic, and leisure--each formed a unidimensional hierarchical scale. Results also indicated that the scores from the subsections could be added to provide an overall score. The scale is suggested as appropriate for studies evaluating rehabilitation outcome after stroke, and is suitable for postal surveys.