Course Of Inpatient Rehabilitation Research Articles

Reciprocal association between pain and quality of life after newly acquired spinal cord injury.

Pain is highly prevalent in spinal cord injury (SCI) and a key determinant of quality of life (QoL). This is the first study to examine reciprocal associations between pain and QoL in patients undergoing their first inpatient rehabilitation after SCI. Longitudinal data, with three measurement time points (1month and 3months after SCI onset, and at discharge from inpatient rehabilitation) from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study. Participants were 381 individuals aged ≥ 16years with a newly diagnosed traumatic or non-traumatic SCI. 75.1% were male and the average age was 53.2years. Random intercept cross-lagged panel models were conducted to examine the reciprocal association between pain intensity and QoL, as measured with the International SCI QoL Basic Data Set three individual items (satisfaction with life, physical health, and psychological health) and total score (mean of the three individual items). Both item and total QoL scores increased over time. 1month: 5.3 (SD = 2.7), 3months: 5.9 (SD = 2.3), discharge: 6.6 (SD = 2.0). Participants reported relatively low levels of pain intensity that remained stable over the course of inpatient rehabilitation. 1month: 2.7 (SD = 2.3), 3months: 2.6 (SD = 2.4), discharge: 2.7 (SD = 2.5). There were no significant cross-lagged associations between QoL and pain intensity across time. Results indicate that pain intensity does not predict changes in QoL during first rehabilitation, and vice versa. Associations between pain intensity and QoL reported by previous studies may be attributable to individual characteristics and timely events that simultaneously influence pain and QoL.

Abstract 113: A Curious Case of Macrovascular Arteriovenous Shunting in Glioblastoma Multiforme

Introduction Arteriovenous shunting has been described in glioblastoma multiforme (GBM), also known as WHO grade 4 astrocytoma. This case report demonstrates the diagnostic dilemma of GBM, which was subsequently found to have macrovascular arteriovenous shunting. The lesion was initially treated as an ischemic stroke for months. Methods A 65‐year‐old‐man with a past medical history of hypertension, hyperlipidemia, and diabetes presented to a community hospital in February 2023 with worsening left‐sided weakness. The patient started having left‐sided weakness around December 2023, but no work‐up had been completed. The exam was notable for spastic hemiparesis. Results At the time of initial presentation, a non‐contrasted head computed tomography (NCHCT) was interpreted as normal. Magnetic resonance imaging (MRI) of the brain showed diffusion restriction and fluid attenuated inversion recovery (FLAIR) hyperintensity in the right corona radiata and was interpreted as a subacute right corona radiata and gangliocapsular infarct. Computed tomography angiogram (CTA) of the head and neck was unremarkable. He was discharged on aspirin and a high‐intensity statin. He re‐presented in April 2023 with sepsis and was found to have multiple pressure ulcers; his left‐sided weakness had worsened despite a course of inpatient rehabilitation. A repeat NCHCT demonstrated hyperdensity within the suspected infarct, interpreted as hemorrhagic transformation. The next day, he was found to be difficult to arouse and dysarthric. He was subsequently transferred to our institution for further management. On arrival, a CTA of the head and neck was performed, which suggested that the previously described hyperdensity was possibly a venous varix, and a thrombosed developmental venous anomaly or arteriovenous malformation was suggested. The patient then underwent an MRI brain with and without contrast, which noted that there was an increase in size of a heterogeneously enhancing mass centered in the posterior right basal ganglia/corona radiata with extension into right thalamus, right cerebral peduncle, and posterior right body of corpus callosum. The MRI findings were most consistent with GBM. Given the diagnostic uncertainty, the patient underwent a cerebral angiogram, which demonstrated a hypervascular posterior right basal ganglia mass with arteriovenous shunting from the middle cerebral artery to the internal cerebral veins. Shortly after, the patient underwent a brain biopsy, which demonstrated GBM (IDH‐wildtype, WHO grade 4). The patient was ultimately transitioned to hospice. Conclusion This case highlights the presence of macrovascular shunting in GBM. Intratumoral arteriovenous shunting in GBM has been described, and when present, can lead to delay in treatment due to the broadened differential diagnosis. This patient was first treated for an ischemic stroke with subsequent hemorrhagic transformation. Further imaging suggested a venous varix, thrombosed developmental venous anomaly, or arteriovenous malformation, but the combination of the cerebral angiogram and MRI led to the definitive diagnosis in a patient with a short survival period.

Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID-19 pulmonary disease.

Coronavirus disease (COVID-19) has introduced a new subset of patients with acute end-stage lung damage for which lung transplantation has been successfully performed. To describe the inpatient rehabilitation course of patients who underwent bilateral lung transplant due to severe COVID-19 pulmonary disease. Retrospective chart review. Free-standing, academic, urban inpatient rehabilitation hospital. Seventeen patients aged 28-67 years old (mean 53.9 ± 10.7) who developed COVID-19 respiratory failure and underwent bilateral lung transplant. Patients participated in a comprehensive inpatient rehabilitation program including physical, occupational, and speech therapy tailored to the unique functional needs of each individual. Primary outcome measures of functional improvements, include mobility and self-care scores on section GG of the Functional Abilities and Goals of the Improving Post-Acute Care Transformation Act, as defined as quality measures by the Centers for Medicare and Medicaid Services. Other functional measures included 6 minute walk test, Berg balance scale, Mann Assessment of Swallowing Ability (MASA), and Cognition and Memory Functional Independence Measure (FIM) scores. Wilcoxon signed rank sum test was used to evaluate statistical significance of change between admission and discharge scores. Fourteen patients completed inpatient rehabilitation. Self-care (GG0130) mean score improved from 20.9 to 36.1. Mobility (GG0170) mean score improved from 30.7 to 70.7. Mean 6-minute walk distance improved from 174.1 to 467.6 feet. Mean Berg balance scores improved from 18.6/56 to 36.3/56. MASA scores improved from 171.3 to 182.3. All functional measures demonstrated statistically significant improvements with p value ≤ .008, except for cognition and memory FIM scores, which did not show a statistically significant difference. A majority (76%) of patients discharged home. This new and unique patient population can successfully participate in a comprehensive inpatient rehabilitation program and achieve functional improvements despite medical complications.

Predicting length of stay with assessment of motor and process skills in subjects with acquired brain injury

ABSTRACT Background The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM. Methods A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM. Results Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor. Conclusions The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS.

The effect of the start date of cognitive rehabilitation after ischemic stroke on the level of recovery

The dependence of result of cognitive training in patients who have suffered an ischemic stroke (IS) on the timing of their onset continues to be discussed. The aim was to study the results of cognitive rehabilitation of patients after IS during various periods after it. 140 patients were examined during complex rehabilitation in terms up to 1, 2-3, 4-6 and 7-12 months after IS, 78 of them received drug support (DS) of rehabilitation with intravenous injections of ampasse. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) were used to monitor the effectiveness of rehabilitation. In all subgroups, there was a statistically significant increase in the MoCA score after the course, but number of people with an increase in the score by 1 or more points was highest among those who started the course 3 or more months after the development of IS (p=0.015). Among those who received DS, an increase in the MoCA was noted in 87.2%, in those who did not receive it - 38.7% (p<0.001). There was no statistically significant increase in the severity of anxiety and depression after the course of treatment in any of the subgroups. The used approach of a combination of cognitive, physical rehabilitation and DS proved to be justified for achieving results during a two-week course of inpatient rehabilitation of patients both in the early and late recovery period after IS.

PSAT362 Hypothyroidism Associated Colonic Rupture

Abstract A 59 year old female with history of thyroid cancer status post thyroidectomy presented with sudden onset severe and diffuse abdominal pain. CT Abdomen Pelvis with contrast showed extensive pneumoperitoneum suggestive of perforated viscus. The patient was taken to emergent diagnostic laparoscopy showing sigmoid perforation with fecal contamination and multiple large stool balls. Sigmoidectomy and end colostomy was performed for perforated sigmoid diverticulitis with feculent peritonitis. On admission, tests evaluating for thyroid function were consistent with hypothyroidism (TSH 39.700, n 0.400 - 4.500 uIU/mL). Over the previous two years, thyroid function studies were variable with both elevated and low TSH values (range 0.221-117 uIU/ml), although TSH values over the prior 12 months were not elevated. The patient reported adherence to taking levothyroxine 137 mcg daily in the outpatient setting. Furthermore, she endorsed appropriate administration of levothyroxine prior to food and was not taking the medication with any offending vitamins or minerals. Review of systems was negative for alternative causes of colonic rupture including trauma or chronic constipation. A thorough literature review was performed and revealed only 10 cases between 2004-2007 of spontaneous perforation of the colon in the absence of tumors, diverticulosis, or external injury.1 Only two reports were found linking spontaneous perforation of the colon with hypothyroidism, and proposed the causative mechanism as intestinal motility dysfunction causing chronic constipation, megacolon, or even pseudo-obstruction eventually leading to stercoral perforation.[2-3] Hypothyroid status was addressed by increasing levothyroxine dosage to 150 mcg daily. The patient recovered from septic shock and performed a 2 week course of inpatient rehabilitation from which she was discharged home with good functional status. Follow up labs evaluating thyroid status will be performed 4-6 weeks after initial testing and are still pending. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Possibilities of post-COVID medical rehabilitation in the context of the ongoing pandemic

Introduction. Effective and available rehabilitation methods are necessary in the context of the ongoing pandemic of COVID-19 (CoronaVirus Disease 2019).The objective was to develop a personalized rehabilitation program for patients who have undergone COVID-19 based on the proven effectiveness of methods.Methods and materials. Three months after COVID-19, 855 patients were examined by the method of standardized phone interview, according to the rehabilitation routing scale (RRS). 200 patients have got through the 10-days inpatient rehabilitation course. Breathing exercises, exercise regimen designed to strengthen basic muscles groups, Nordic walking were used. The physical activity level, heart rate and saturation (SpO2) have been monitored by wearable devices (fitness-trackers) during 3 months.Results. Inpatient rehabilitation was required for 1 % of patients, outpatient – 19 %. 42 % did not need rehabilitation, but they had respiratory symptoms and decreased exercise tolerance. There was an improvement in flexibility, muscle strength; the duration of breath holding, 6-minutes walk test, exercise tolerance test; reducing the severity of shortness of breath (mMRC scale) and respiratory symptoms (САТ scale). The achieved level of daily physical activity was maintained for 3 months after the end of the rehabilitative program.Сonclusion. Using the rehabilitation routing scale in the post-COVID period allows stratifying patients according to the degree of need for rehabilitation. Clinically significant and persistent positive effect in most patients can be achieved by physiotherapy methods during 10-days course. Wearable devices of monitoring biometric data are useful additional instruments for monitoring recovery after COVID-19.

Prevalence and Treatment Characteristics of Spastic Hypertonia on First-Time Admission to Acute Inpatient Rehabilitation.

The aim of the study was to report the prevalence of spasticity and treatment patterns during first-time admission to inpatient rehabilitation after acute stroke, traumatic brain injury, and spinal cord injury. This is a retrospective cohort study. A review of 285 adult patients consecutively admitted to inpatient rehabilitation was conducted. Patients with a history of spasticity and inpatient rehabilitation course and those younger than 18 yrs were excluded. Main outcome measures are as follows: admitting diagnosis, length of stay, time from injury to admission, acute transfer rate, prevalence and severity of spasticity using Modified Ashworth Scale at admission and discharge, Functional Independence Measure scores at admission and discharge, Functional Independence Measure efficiency, and treatments for spasticity. Stroke patients had the highest prevalence of spasticity: 68% on admission and 50% at discharge. In traumatic brain injury, spasticity prevalence was 55% on admission and 30% at discharge. In spinal cord injury, spasticity prevalence was 48% on admission and 46% at discharge. Patients with spinal cord injury received the most medications to control spasticity, whereas those with traumatic brain injury and stroke received the most procedural interventions. Spasticity is a common sequela of upper motor neuron injury for patients admitted to inpatient rehabilitation. Early recognition and management are essential to prevent contractures, minimize pain, and maximize functional recovery.

Introduction of the Watzmann Severity Scale: A sensorimotor approach to estimate the course of inpatient rehabilitation in multiple sclerosis

Multiple sclerosis is an autoimmune disease with a plethora of potentially arising impairments and a coarse standard clinical estimation of severity, the expanded disability status scale (EDSS). In this study, we introduced the Watzmann Severity Scale (WSS), a sensorimotor function based statistical model of the EDSS of 113 patients. Using the WSS, we examined the rehabilitation course of 87 patients. The WSS revealed to be a reliable estimate of the EDSS with an R²adjusted of 0.81, although lower EDSS grades were systematically overestimated. Further, patients slightly improved during their inpatient stay of in average 17d by 0.21 on the WSS, with changes in gait performance being the driving factor (|β|-weight of 0.84). We were not able to reliably predict changes in the WSS and found no association with the duration of hospitalization. We conclude and advise that rehabilitation should start earlier, if lower EDSS grades were not overestimated, to emphasize gait less in rehabilitation, and to change from a perspective of impairment and disability to performance in order to maximize patient rehabilitation.

Dynamic body-weight support to boost rehabilitation outcomes in patients with non-traumatic spinal cord injury: an observational study

BackgroundDynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI).MethodsThis retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). The primary outcome was change in the Functional Independence Measure scores (FIMgain).ResultsDuring an inpatient rehabilitation course, participants in the experimental group (n = 11), achieved a mean (SD) FIMgain of 48 (11) points. For the historical control group (n = 11), participants achieved a mean (SD) FIMgain of 36 (12) points. From admission to discharge, both groups demonstrated a statistically significant FIMgain. Between groups analysis revealed no significant difference in FIMgain (p = 0.022; 95% CI 2.0–22) after a post hoc correction for multiple comparisons. In a secondary subscore analysis, the experimental group achieved significantly higher gains in sphincter control (p = 0.011: 95% CI 0.83–5.72) with a large effect size (Cohen’s d 1.19). Locomotion subscores were not significantly different (p = 0.026; 95% CI 0.37–5.3) nor were the remaining subscores in self-care, mobility, cognition, and social cognition.ConclusionsThis is the first study to explore the impact of overground therapy with DBWS on inpatient rehabilitation outcomes for persons with NT-SCI. Overground therapy with DBWS appears to significantly improve functional gains in sphincter control compared to the standard-of-care. Gains achieved in locomotion, mobility, cognition, and social cognition did not meet significance. Findings from the present study will benefit from future large prospective and randomized studies.

Pharmacologic Treatment and Early Rehabilitation Outcomes in Pediatric Patients With Anti-NMDA Receptor Encephalitis

ObjectivesTo describe the immunotherapy and pharmacologic treatments administered to pediatric patients with N-methyl-D-aspartate receptor encephalitis (NMDARE) during inpatient rehabilitation as well as to examine clinical and demographic variables associated with early functional outcomes. DesignRetrospective chart review and post hoc analysis. SettingPediatric inpatient rehabilitation unit. ParticipantsPediatric patients (N=26; mean age, 10.79±5.17y) admitted to an inpatient rehabilitation unit with a confirmed diagnosis of NMDARE. InterventionsInpatient rehabilitation; pharmacologic treatments. Main Outcome MeasureFIM for Children (WeeFIM) Developmental Functional Quotient (DFQ). ResultsAll patients received first-line immunotherapies to treat NMDARE, and 69% also received second-line immunotherapies. Patients were prescribed an average of 8 medications for symptom management (range, 3-15 per patient), most often for the treatment of agitation (100%), psychiatric symptoms (92%), and seizures (65%). Sixty-five percent of patients demonstrated an improvement in Total WeeFIM DFQ over the course of inpatient rehabilitation, with 35% demonstrating limited to no change in Total WeeFIM DFQ (“unfavorable early outcome”). Those with unfavorable early outcome were significantly younger than those showing more favorable outcome. Pharmacologic treatment for seizures, movement disorders, and decreased arousal or level of consciousness were each associated with unfavorable early outcome independent of age differences. ConclusionFindings highlight the symptomatic heterogeneity and polypharmacy involved in the care and treatment of patients with NMDARE, with patients receiving a variety of immunotherapies and medications for symptom management. The presence of (and treatment for) seizures, movement disorders, and deteriorated neurologic status may each be associated with poor early outcomes in this population. Further investigation is needed to better classify presentations and treatments for this disease and to determine how differences are associated with long-term outcomes.

PHYTOSORTS «FAMILY HEALTH» IN OPTIMIZING THE REHABILITATION OF PATIENTS WITH VERTEBROGENIC PAIN SYNDROMES

The subject of the study is the establishment of the value of the effectiveness of the application of a complex of phytosbores obtained with the help of bioenergetic technologies in patients with vertebral pathology of the spine. The use of therapy using the standard treatment regimen and the integrated use of 5 phytosolves Family Health obtained with the help of bioenergetic technologies is substantiated. For this purpose, 45 patients with pain syndrome of cervicothoracic and lumbosacral localization were examined, who, in the course of the planned course of in-patient rehabilitation, along with the standard treatment scheme, received a phytocomplex from 5 phytospores. The control group was also made up of 45 patients with the presence of a similar pain syndrome without using a complex of phytospores in the rehabilitation process. Complex therapy from phytospores was taken internally. Patients of the main group after completion of the course of treatment noted significant subjective improvement, correlating with the results of clinical objective examination and with the data of scales. The advantage of this method is the absence of side effects and complications, the possibility of using both inpatient and outpatient settings, both during the planned course of treatment, and to achieve a supportive effect during periods of remission. Key words: phytotherapy, phytospora complex, phytotherapy, phytospora complex, cervicalgia, osteochondrosis, lower back pain. *Доктор медицины и философии, профессор Павлусенко И. И., *старший научный сотрудник, доцент Макеева М. А., **врач-ревматолог высшей категории, Жерновенков А. А., ** * Павлусенко В. И. Фитосборы «Здоровье семьи» в оптимизации реабилитации больных с вертеброгенными болевыми синдромами / * E вропейский университет функциональной медицины, Украи на, Киев; **Харьковская клиническая больница на железнодорожном транспорте № 2, Украина, X арьков; ** * Национальный медицинский университет им. Богомольца, Украина, Киев Предметом исследования является установление значения эффективности применения комплекса фитосборов, полученных с помощью биоэнергетически x те x нологий, у пациентов с вертеброгенной патологи е й позвоночника. Обосновано применение терапии с использованием стандартной схемы лечения и комплексного использова ния 5 фитосборов «Здоровь е семьи» полученных с помощью биоэнергетически x те x нологий. С этой целью обследовано 45 больных с болевым синдромом шейно-грудной и пояснично-крестцовой локализации, которые в процессе планового курса стационарной реабилитации, наряду с использованием стандартной с xe мы лечения получали фитокомплекс из 5 фитосборов. Контрольную группу составили также 45 пациентов с наличием аналогичного болевого синдрома без использования комплекса фитосборов в процессе реабилитации. Комплексная терапия из фитосборов принималась внутрь. Больные основной группы после завершения курса лечения отмечали значительное субъективное улучшение, коррелирующее с результатами клинического объективного осмотра и с данными шкал. Достоинством данного метода является отсутствие побочных действий и осложнений, возможность применения как в стационаре, так и в амбулаторных условиях, как в процессе планового курса лечения, так и для достижения поддерживающего эффекта в периоды ремиссий.

Rehabilitation Outcomes for Total Knee Arthroplasties: Continuous Adductor Canal Block Versus Continuous Femoral Nerve Block.

Objective:To determine whether any strength, range of motion (ROM), or functional improvement exists in the adductor canal block (ACB) group after completion of inpatient rehabilitation and following the removal of the continuous block.Design:Retrospective cohort.Setting:Inpatient rehabilitation at discharge and outpatient orthopedic clinic for follow-up.Participants:Two hundred forty-six consecutive primary total knee arthroplasties (TKAs; N = 221 patients) performed by a single surgeon in a single institution between July 2013 and August 2015 for a diagnosis of osteoarthritis.Interventions:All TKA cases received a continuous femoral nerve block (FNB) from July 2013 to August 2014 for postoperative pain control. From August 2014 through August 2015, all TKAs received a continuous ACB.Main Outcome Measures:Manual muscle tests (MMTs; 0-5 scale) of the quadriceps and passive ROM of the knee were assessed at 3 time periods (hospital discharge [HD], 1-2 weeks, and 1 month). Patient-oriented outcomes and clinical knee scores were examined preoperatively and postoperatively at 3 and 6 months.Results:63.6% of FNB cases had an MMT less than 3 at HD and 36.4% of FNB cases had an MMT of 3 or greater at HD. Conversely, 46% of ACB cases had an MMT less than 3 at HD and 54% had an MMT of 3 or greater at HD. There were no statistically significant differences in all postoperative variables at all tested time periods.Conclusions:This study showed no short-term postoperative advantages in the ACB group after catheter removal. The superior inpatient rehabilitation course in the continuous ACB group is likely not long enough to translate into any maintained benefit following catheter removal. Nevertheless, the trend toward greater strength in the ACB group in the immediate short term at HD warrants further investigation.

Poster 304 Protracted Course of Inpatient Rehabilitation in a Patient with Severe Acute Demyelinating Polyneuropathy

Poster 304 Protracted Course of Inpatient Rehabilitation in a Patient with Severe Acute Demyelinating Polyneuropathy

Impact of Physical Therapy for a Patient with Multiple Limb Amputations Secondary to Legionnaires' Disease: A Case Report

ABSTRACT Background and Purpose Collaboration between the physical therapist and prosthetist is essential for patients with any type of amputation. This case report describes a patient with multiple limb amputations due to medical complications resulting from community acquired Legionnaires' disease (LD). The physical therapy evaluation, examination, diagnosis, interventions, and outcomes along with collaboration with the prosthetist are discussed. Case Description A 55-year-old previously healthy male contracted LD and subsequently developed multiple medical complications in acute care. This resulted in left transradial and bilateral transtibial amputations due to hypotension-induced ischemia from sepsis. A 2-month course of inpatient rehabilitation is described, including changes in functional status and progression to safe discharge home. Outcomes Physical therapy interventions resulted in an improvement from total assist for all functional mobility to ambulating at a standby assist level with bilateral lower limb and left upper limb prosthesis. He improved his 10-m walk test score from 0.07 to 0.60 m/s, 6-minute walk test to 133 m, and timed up and go test to 47 seconds. Discussion A comprehensive list of physical therapy interventions needs to be included for successful rehabilitation of a medically complex patient with multiple limb amputations. Collaboration with the prosthetist is inherent and critical. Future research may include a series of case reports or a study using practice-based evidence. This would allow for more associations to be made regarding interventions for patients with multiple limb amputations.

Do Performance-Based Wheelchair Propulsion Tests Detect Changes Among Manual Wheelchair Users With Spinal Cord Injury During Inpatient Rehabilitation in Quebec?

ObjectiveTo quantify and compare the responsiveness and concurrent validity of 3 performance-based manual wheelchair propulsion tests among manual wheelchair users with subacute spinal cord injury (SCI) undergoing inpatient rehabilitation. DesignQuasi-experimental repeated-measures design. SettingPublicly funded comprehensive inpatient SCI rehabilitation program. ParticipantsConsenting adult manual wheelchair users with a subacute SCI admitted and discharged from inpatient rehabilitation (N=14). InterventionParticipants performed 20-m propulsion at both self-selected natural and maximal speeds, the slalom, and the 6-minute propulsion tests at rehabilitation admission and discharge. Main Outcome MeasuresTime required to complete the performance-based wheelchair propulsion tests. Standardized response means (SRMs) were computed for each performance test and Pearson correlation coefficients (r) were calculated to explore the associations between performance tests. ResultsThe slalom (SRM=1.24), 20-m propulsion at maximum speed (SRM=.99), and 6-minute propulsion tests (SRM=.84) were the most responsive. The slalom and 20-m propulsion at maximum speed were strongly correlated at both admission (r=.93) and discharge (r=.92). ConclusionsThe slalom and 6-minute propulsion tests best document wheelchair propulsion performance change over the course of inpatient rehabilitation. Adding the 20-m propulsion test performed at maximal speed provides a complementary description of performance change.

Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward.

The Postural Assessment Scale for Stroke Patients (PASS) is used to assess static and dynamic balance of stroke patients. PASS has demonstrated good measurement properties for reliability and validity, but its predictive effect for ambulation in stroke patients has not been investigated. The aim of this study was to investigate the predictive value of PASS for ambulation in patients with stroke after inpatient rehabilitation. In this retrospective study, a total of 341 stroke patients were recruited from a rehabilitation ward of a medical university hospital. Patients were assessed at baseline using PASS and observation of rolling ability, and divided into 2 groups at discharge: independently ambulatory (n = 246) and non-ambulatory (n = 95). Receiver operating characteristic curve and adjusted bivariate logistic regression was applied to analyse the predictive value of baseline PASS scores, variables of demographic data, and rolling ability at admission to inpatient rehabilitation. For all stroke patients, mean admission to the rehabilitation ward was 34.40 days after stroke and mean length of hospitalization 18.12 days. The receiver operating characteristic curve was obtained with a cut-off score of 3.5 points for static PASS, 8.5 points for dynamic PASS, and 12.5 points for total PASS, demonstrating the highest percentage of accurately predicted ability of independently walking at discharge. Adjusted bivariate logistic regression found rolling ability, static PASS and dynamic PASS to be predictors for ambulation of stroke patients at discharge. Initial static PASS score, dynamic PASS score and rolling can be predictors for independent ambulation of stroke patients after a course of inpatient rehabilitation.

Psychotropic Medication Use During Inpatient Rehabilitation for Traumatic Brain Injury

ObjectiveTo describe psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and their relation to patient preinjury and injury characteristics. DesignProspective observational cohort. SettingMultiple acute inpatient rehabilitation units or hospitals. ParticipantsIndividuals with TBI (N=2130; complicated mild, moderate, or severe) admitted for inpatient rehabilitation. InterventionsNot applicable. Main Outcome MeasuresNot applicable. ResultsMost frequently administered were narcotic analgesics (72% of sample), followed by antidepressants (67%), anticonvulsants (47%), anxiolytics (33%), hypnotics (30%), stimulants (28%), antipsychotics (25%), antiparkinson agents (25%), and miscellaneous psychotropics (18%). The psychotropic agents studied were administered to 95% of the sample, with 8.5% receiving only 1 and 31.8% receiving ≥6. Degree of psychotropic medication administration varied widely between sites. Univariate analyses indicated younger patients were more likely to receive anxiolytics, antidepressants, antiparkinson agents, stimulants, antipsychotics, and narcotic analgesics, whereas those older were more likely to receive anticonvulsants and miscellaneous psychotropics. Men were more likely to receive antipsychotics. All medication classes were less likely administered to Asians and more likely administered to those with more severe functional impairment. Use of anticonvulsants was associated with having seizures at some point during acute care or rehabilitation stays. Narcotic analgesics were more likely for those with history of drug abuse, history of anxiety and depression (premorbid or during acute care), and severe pain during rehabilitation. Psychotropic medication administration increased rather than decreased during the course of inpatient rehabilitation in each of the medication categories except for narcotics. This observation was also true for medication administration within admission functional levels (defined by cognitive FIM scores), except for those with higher admission FIM cognitive scores. ConclusionsMany psychotropic medications are used during inpatient rehabilitation. In general, lower admission FIM cognitive score groups were administered more of the medications under investigation compared with those with higher cognitive function at admission. Considerable site variation existed regarding medications administered. The current investigation provides baseline data for future studies of effectiveness.

Measurement of Distance Walked by Older Adults Participating in Subacute Rehabilitation

BackgroundManaging in the community without accommodation requires that persons be able to walk an adequate distance. However, little information is available regarding how walking distance changes over the course of inpatient rehabilitation. ObjectivesTo describe, for inpatients participating in subacute rehabilitation, the distances walked without stopping at admission and discharge and to document the reliability and responsiveness of the measure. DesignObservational longitudinal study. SettingSubacute rehabilitation. PatientsMale and female inpatients of multiple diagnostic groups who were at least 60 years old (n = 130). MethodsParticipants were asked to walk at a self-selected speed as far as they could without stopping. They walked on a 15.2-m out-and-back course for a maximum of 2 minutes upon admission, the next day, and at discharge. ResultsThe mean distances walked upon admission, the next day, and at discharge were 35.6, 39.9, and 77.0 m, respectively. Good test-retest reliability was demonstrated for the distances walked upon admission and the next day (intraclass correlation coefficient = 0.948). The distance walked increased significantly between admission and discharge (t = 22.22, P < .001). The effect size and standardized response mean for these distances were large—2.36 and 1.95, respectively. The minimum detectable change was 11.1 m. The minimal clinically important difference determined by receiver operator characteristic curve analysis ranged from 28.8 m to 43.6 m depending on the anchor used. The associated areas under the curve ranged from 0.700-0.897. ConclusionsBased on our findings, we conclude that distance walked without stopping is an informative, reliable, and responsive measure of gait performance for patients undergoing subacute rehabilitation. We therefore encourage the systematic documentation of distance walked among inpatients undergoing subacute rehabilitation.

PACIENTŲ PO GALVOS SMEGENŲ INSULTO FUNKCINĖS BŪKLĖS POKYČIAI REABILITACIJOS PROCESE

Visuomenėje pripažinta, kad galvos smegenų insultas (GSI) yra gyvybei pavojinga būklė. Nors mirtingumas nuo insulto mažėja, cerebrovaskulinės ligos lieka viena pagrindinių mirties ir negalios priežasčių daugelyje Europos Sąjungos šalių, o aukšti sergamumo rodikliai ir sunkios insulto pasekmės yra viena svarbiausių šiandieninės medicinos problemų. Darbo tikslas buvo įvertinti asmenų po GSI funkcinės būklės pokyčius reabilitacijos procese. Tirti 112 GSI sergančių ir besigydančių reabilitacijos įstaigoje pacientų, kurių amžiaus vidurkis 46 metai. Iš jų 53,6 proc. sudarė moterys. Pacientams buvo taikomas kompleksinis reabilitacinis gydymas, kurio metu su pacientais dirbo visa reabilitacijos komanda. Duomenų analizei buvo panaudoti ligos istorijos duomenys. Pacientų sveikatos būklė buvo vertinama du kartus, pacientams atvykus ir išvykstant iš gydymo įstaigos. Jų pažintinės funkcijos buvo vertintos naudojant standartizuotą trumpą protinės būklės tyrimą (MMSE), o savarankiškumas kasdieniame gyvenime vertintas standartizuotu funkcinio nepriklausomumo testu (FNT). Tyrimo duomenys apdoroti SPSS ir STATSTICA programiniais paketais. Statistinės duomenų analizės rezultatai parodė, kad pacientų po GSI funkcinės būklės pokyčiai kito teigiamai, nes reabilitacijos metu pagerėjo tiek pažintinės, tiek kasdienės apsitarnavimo funkcijos. Bendra pacientų pažintinių funkcijų būsena statistiškai reikšmingai skyrėsi, reabilitacijos eigoje gautas stiprus teigiamas ryšys, ką parodo p koeficientas (0,85), kuris reiškia stiprų teigiamą ryšį. O analizuojant bendrą tiriamųjų būklę priklausomai nuo insulto tipo, buvo išsiaiškinta, kad pacientų, sergančių išeminiu GSI, bendroji pažintinių funkcijų būklė buvo geresnė prieš reabilitaciją negu pacientų, sergančių hemoraginiu GSI. Sveikdami jie taip pat pasiekė geresnių rezultatų, jų duomenys statistiškai reikšmingai skiriasi (p0,05). Bendra pacientų savarankiškumo kasdieniame gyvenime būsena taip pat statistiškai reikšmingai skyrėsi reabilitacijos eigoje, o koreliacijos koeficientas p (0,93) parodė labai stiprų teigiamą ryšį. Mūsų tyrimo rezultatai parodė, kad pagerėjo pacientų po GSI, tiek pažintinės, tiek savirūpos funkcijų pokyčiai stacionarinės reabilitacijos eigoje. Taip pat nustatyta, kad gerėjant pažintinėms funkcijoms gerėja ir apsitarnavimas kasdieniame gyvenime. Tą parodo koreliacijos koeficientas p (0,54). Analizuojant sergančiųjų GSI reabilitacijos efektyvumą priklausomai nuo demografinių rodiklių, išsiaiškinta, kad pacientų funkcinės būklės dinamika statistiškai reikšmingai gerėjo priklausomai nuo insulto tipo. Taip pat nustatyta, kad geriau jautėsi pacientai, gyvenantys mieste, negu kaime, nors šie duomenys statistiškai reikšmingai nesiskiria. Išanalizavus funkcinės būklės pokyčius priklausomai nuo lyties, nustatyta, kad geresnė bendra savijauta buvo vyrų nei moterų. Taip pat jų reabilitacija buvo sėkmingesnė nei moterų, nors šie duomenys statistiškai reikšmingai nesiskyrė.