Average Modified Barthel Index Scores Research Articles

The efficacy of median nerve electrical stimulation in rehabilitating post-stroke cognitive impairment and its mechanism

Objective To test the effectiveness of electrical stimulation of the median nerve (MNES) for relieving post-stroke cognitive impairment (PSCI) and explore the possible mechanism. Methods Thirty patients with PSCI were randomly divided into a routine treatment group (the control group) and an MNES group, each of 15. Both groups were given routine rehabilitation treatment, including cognitive rehabilitation training, medications and acupuncture. The MNES group additionally received 30 minutes of MNES on their right hands every day, five times a week for six weeks. One electrode was positioned over the median nerve 2cm up from the rasceta of the right wrist. The other was on the muscles of the thenar eminence. Forty seconds of stimulation were applied with intervals of 20 seconds, for 30 min daily. Before and after 3 and 6 weeks of treatment, both groups were evaluated using the mini-mental state examination (MMSE), the Montreal cognitive assessment (MoCA), the modified Barthel index (MBI) and the Fugl-Meyer assessment (FMA). In another 15 patients oxyhemoglobin levels in the brain before and during the MNES were observed using near-infrared spectroscopy. Results After 3 weeks of treatment, a significant improvement was observed in the average MMSE, FMA and MBI scores of both groups, and the average MoCA score of the observation group. Three weeks later, the average MMSE, FMA, MBI and MoCA scores of both groups had improved significantly compared with before the treatment, with the average MMSE and MoCA improvements in the MNES group significantly greater than the control group′s averages. After 6 weeks of treatment the significant improvements persisted in both groups. Both group′s average FMA scores had also improved significantly, as had the average MBI score of the control group. After 6 weeks of treatment, the observation group′s average time orientation, location orientation, language instant memory, attention, calculation and short-term memory in MMSE had all improved significantly along with visual space capacity, executive capacity, attention, language, orientation and memory in MoCA. The spectroscopic results showed significantly improved oxyhemoglobin concentration in the bilateral frontal lobes after the MNES. Conclusions Electrical stimulation of the median nerve can help to improve cognition after a stroke. It increases oxyhemoglobin concentration in the bilateral frontal lobes. Key words: Median nerves; Electrical stimulation; Stroke; Cognitive impairment; Rehabilitation

Diaphragm muscle training for reducing post-stroke fatigue

Objective To investigate the effect of diaphragm training on respiratory function and the activities of daily living after cerebral apoplexy. Methods Seventy-eight patients with post-stroke fatigue were randomly divided into a treatment group and a routine therapy group, each of 39. Both groups were given conventional rehabilitation treatment, while the treatment group was additionally provided with diaphragm muscle training. Before and after 4 weeks of treatment, both groups were evaluated using pulmonary function tests, a fatigue severity scale (FSS), Fugl-Meyer motor function assessment (FMA) and the modified Barthel index (MBI). Results Vital capacity, forced vital capacity, forced vital capacity during the first second, and especially the maximum ventilatory volume of the treatment group were all significantly improved after the treatment. There was also significant improvement in that group′s average FSS score, but not in that of the control group. The average FMA and MBI scores for both groups had improved significantly after the intervention, with the average FMA score of the treatment group significantly higher than that of the control group. However, no significant differences in the average MBI score were observed after the treatment. Conclusion Diaphragm training can significantly improve motor function and the daily life of stroke survivors. The mechanism may be related to improved respiratory function and decreased severity of fatigue. Key words: Post-stroke fatigue; Respiratory function; Diaphragm muscle training; Daily life ability

The Singapore experience: understanding the older persons who utilize community rehabilitation services

Objectives: We seek to understand the demographic profile, functional status and rehabilitation needs of older persons who attend centre-based facilities in Singapore. These centres offer rehabilitation services for older persons who have been recently discharged from acute care or community hospitals. Baseline data for such services in Singapore is scarce. Methodology: 1263 clients from 36 centres were interviewed and the interview questions included medical history, previous and current functional ability and other rehabilitation needs. Data from the clients' case files were also extracted, which included reviewing the clients' individualised care plans. Results: 55% were female and 45% were male, with a mean age of 69.4 years old. Stroke (48.7%) followed by fractures (9.7%) were the most common diagnoses. The average Modified Barthel Index (MBI) score as at date of admission was 73.0 while the average MBI score as at date of interview was 76.2. In terms of caregiving arrangements, 77% had a carer taking care of them, while 23% were capable of self-care. Close to half of the clients (45%) relied on a domestic helper, which appeared to be a unique local phenomenon in Singapore [1]. 56.6% were under-going 'active' rehabilitation, whilst 43.4% were on 'maintenance' therapy Trends on the functional status and rehabilitation needs of the clients would be discussed. Conclusion: The preliminary findings provide a baseline understanding of the profile and needs of the older person undergoing community-based rehabilitation in Singapore. Further research can be aimed at evaluating the prognostic factors of community-based rehabilitation.

Rehabilitation outcomes in C6 tetraplegia.

This study reports on the rehabilitation outcome of 69 C6 tetraplegic patients admitted to the Rehabilitation Institute of Chicago during an 8 year period. All patients' last normal level was C6 bilaterally. A 100-point modified Barthel Index was used to obtain measures of functional independence in 15 self-care and mobility tasks. The population consisted of 54 males and 15 females with an average age of 29.2 years. The average number of days from injury to admission to the rehabilitation unit was 58.6 and the average length of rehabilitation stay was 108.4 days. The average Modified Barthel Index score increased from 16.6 on admission to 50.1 on discharge. The Self-Care Subscore increased from 12.8 to 32.2 and the Mobility subscore from 3.7 to 17.9. There were statistically significant increases in the number of patients able to perform all tasks except ability to don an orthosis and ability to walk 50 yards. This study documents a significant increase in function of C6 spinal cord injured patients during rehabilitation.