Degree Of Independence In Activities Research Articles

Time budget and behavioral synchrony of humpback whale mother‐calf pairs on a breeding ground in the southwestern Indian Ocean

AbstractUnderstanding the activity budget of mother‐young pairs can inform how energy is allocated and its relation to the development of young. Using suction cup tag data collected off Sainte Marie, Madagascar, during the calving season, we compared the time budgets of mothers and their calves in capital‐breeding humpback whales, investigated the changes with age, and assessed mother‐calf behavioral synchrony based on their swimming speed. We found that mothers and calves allocated much of their time to low‐level activities (i.e., static/quasi‐static or swimming at low speed). Young calves engaged more in slow swimming than older calves and mothers. Mothers with younger calves tended to stay static or quasi‐static less than mothers with older ones. Calves displayed some degree of independence in activities but were also observed synchronizing their activities with their mothers. Depending on the nature of the activity, the initiation of it was driven by either the calf or the mother. Our study provides additional knowledge for understanding the behavioral dynamics and interactions within humpback whale mother‐calf pairs. It provides data that can support the implementation of conservation measures.

Effects of Self-Determination, SoA, and Self-Efficacy on Degree of Independence in Activities of Daily Living in Stroke Survivors

Effects of Self-Determination, SoA, and Self-Efficacy on Degree of Independence in Activities of Daily Living in Stroke Survivors

A Prospective Randomized Trial: Does Full Weight Bearing Improve Functional Outcomes in Elderly Patients With Proximal Intramedullary Nailing After an Intertrochanteric Femur Fracture?

Introduction This study aimed to compare the functional outcomes and degree of independence in activities of daily living in patients aged >65 years who were treated with a proximal femoral nail (PFN) after an intertrochanteric femur fracture (ITFF) andunderwent full and partial load-bearing in the early stage. Methods Overall, 133 patients who were hospitalized for ITFF and treated with PFN between August 2018 and March 2021 were randomly assigned to two groups. During the follow-up period, 45 patients who underwent partial load bearing (Group 1) and 40 patients who underwent full load bearing (Group 2) were prospectively evaluated. The Harris hip score was used for functional evaluation, and the Barthel index was used to evaluate the degree of independence in activities of daily living. Results The mean age of the patients included in the study was 76.67 ± 8.62 years. Regarding the comparison among groups in terms of age, sex, direction of fracture, reduction quality, fracture type, tip-apex distance, and surgical risk, there was no statistically significant difference between the two groups (p ≥ 0.05). Moreover, regarding the comparison in terms of calcium, phosphate, alkaline phosphatase, vitamin D, and keratin levels, which affect bone metabolism, no statistical difference was observed (p ≥ 0.05). We found that the mean Harris hip score was significantly higher in Group 1 than in Group 2 (Group 1: 76.82 ± 12.48; Group 2: 67.80 ± 15.34; p = 0.004). Moreover, 73.3% (n=33) and 42.5% (n=17) of patients in Groups 1 and 2 were fully independent or mildly dependent, respectively. We also found that the independence status was significantly better in Group 1 (p = 0.004). Conclusion Mobilization of older patients treated with PFN after ITFF using partial load-bearing protocols in the early postoperative period positively impacts hip function and the ability to perform activities of daily living independently.

Characteristics of the Barthel Scale in Terms of Neurological Care

The Barthel scale assesses the ability of the tested person to function independently. It plays an important role in the professional work of nurses. Therefore, the aim of the work is to characterize the Barthel scale and use it in the care of a neurological patient. This tool measures the degree of independence in activities of daily living. Thanks to this, it also helps to determine the level of assistance required with care and activities of daily living. This scale evaluates 10 basic daily activities. In Poland, the Barthel Index is one of the most frequently used assessment scales for measuring activity limitations in patients with various diseases, e.g. nervous system. Many researchers also use BI as one of the measurement tools to conduct scientific research. That is why it is so important to deepen knowledge about this tool. (JNNN 2022;11(4):180–184)

Impact of physical therapy on the mobility, activity and independence of patients with stroke and total aphasia

The purpose of the study. To assess the effectiveness of physical therapy measures on the mobility, activity and independence indexes of patients with acute cerebrovascular accident and total aphasia at the inpatient stage of treatment.
 Materials and methods. The study involved 62 patients after acute cerebrovascular accident with sensorimotor aphasia, who were divided into 2 groups: an intervention group, n=32, and a comparison group, n=30. Patients in both groups received standardized drug therapy and rehabilitation measures that included physical therapy, occupational therapy, and speech and language therapy.
 Results. During the initial examination, the Rivermead Mobility Index and the Barthel Index indicated the complete inability of patients to independently perform any voluntary movements and their complete dependence in Activities of Daily Living. At the final examination, there was a statistically significant improvement (p<0.05) in the Barthel Index and the Rivermead Mobility Index in both groups, but the intervention group had a higher proportion of patients able to perform targeted activities independently. According to the Barthel Index, the proportion of patients who improved the degree of independence in Activities of Daily Living in the intervention group was 53.1%, while in the comparison group it was 13.3% (p=0.001). 
 Conclusions. Application of the developed algorithm of physical therapy measures at the inpatient stage of treatment contributed to a more significant improvement in mobility and independence of patients with stroke and sensorimotor aphasia, compared to the standard approach. The obtained data confirm the necessity of application a special approach to the management of the physical therapy process in patients with sensorimotor aphasia caused by acute cerebrovascular accident.

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury.

Objective: In spinal cord injury (SCI), heterotopic ossification is a frequent secondary complication, commonly associated with limited range of motion of affected joints, which could lead to secondary disability in activities of daily living. Additionally, heterotopic ossifications might challenge the effect of regeneration-promoting therapies on neurological and functional recovery. This study evaluated the impact of heterotopic ossification on clinical recovery within the first year after SCI.Methods: The study was conducted as a monocentric longitudinal paired cohort study. Recruitment was based on consecutive sampling in the framework of the European Multicenter about Spinal Cord Injury (EMSCI). Recovery profiles were determined using standardized neurological and functional clinical assessments within the 1st year following SCI. All study participants underwent at least two comprehensive standardized neurological and functional clinical examinations according to the International Standards for Neurological Classification of SCI and the Spinal Cord Independence Measure, respectively. Data regarding the diagnosis and treatment of heterotopic ossification were obtained by reviewing the patient medical records. The most similar “digital twin” from the entire EMSCI database were matched in terms of age, acute neurological and functional status to each individual with SCI, and heterotopic ossification.Results: Out of 25 participants diagnosed with heterotopic ossification, 13 individuals were enrolled and matched to control individuals. Most individuals presented with motor complete injury (75%). Ossifications were most frequently located at the hip joints (92%) and mainly occurred within the first 3 months after SCI. Individuals with heterotopic ossification achieved around 40% less functional improvement over time compared to their matched counterparts, whereas neurological recovery was not altered in individuals with SCI and heterotopic ossification.Conclusion: Heterotopic ossification—a common complication of SCI—unfavorably affects functional recovery, which in the end is most relevant for the best possible degree of independence in activities of daily living. Upon presentation with heterotopic ossification, neurological improvement achieved through potential restorative therapies might not translate into clinically meaningful functional improvement. Diagnostic algorithms and effective early prevention/treatment options for heterotopic ossification need to be established to ensure the best possible functional outcome.Clinical Trial Registration: NCT01571531 (https://clinicaltrials.gov).

Non-sedation-Does it improve health-related quality of life after critical illness? A 3-month follow-up sub-study of the NONSEDA trial.

Critical illness is associated with severely impaired health-related quality of life (HRQoL) for years following discharge. The NONSEDA trial was a multicenter randomized trial on non-sedation versus sedation with a daily wake-up trial in critically ill, mechanically ventilated patients in Scandinavia. The aim of this sub-study was to assess the effect of non-sedation on HRQoL and degree of independence in activities in daily living (ADL) 3months post-ICU. All survivors were asked to complete the Medical Outcomes Study Short-Form 36 questionnaire (SF-36) and the Barthel Index 3months post-ICU. To limit missing data, reminders were sent. If unsuccessful, telephone interviews could be used. Outcomes were the level of HRQoL and ADL-function in each group. All outcomes were assessed blinded. Of the 700 patients included 412 survived to follow-up. A total of 344 survivors participated (82%). Baseline data were equal between the two groups. Mean SF-36 scores for the non-sedated vs sedated patients were as follows: Physical Function 45 vs 40, P=.69, Bodily Pain: 61 vs 52, P=.81, General Health: 50 vs 50, P=.84, Vitality: 42 vs 44, P=.85, Social Function: 75 vs 63, P=.85, Role Emotional: 58 vs 50, P=.82, Mental Health: 70 vs 70, P=.89, Role Physical: 25 vs 28, P=.32, Physical Component Score: 38 vs 37, P=.81, Mental Component Score: 48 vs 46, P=.94, Barthel Index: 20 vs 20, P=.74. Randomization to non-sedation neither improved nor impaired health-related quality of life or degree of independence in activities in daily living 3months post-ICU discharge.

Poststroke Fatigue at Admission is Associated With Independence Levels of Activities of Daily Living at Discharge From Subacute Rehabilitation Wards

ObjectiveTo determine whether poststroke fatigue at admission is associated with the degree of independence in activities of daily living in patients with stroke at discharge from subacute rehabilitation wards. DesignRetrospective cohort study. SettingSubacute rehabilitation hospital. ParticipantsA consecutive sample of patients (N=156) with stroke who were admitted to a subacute rehabilitation ward between December 2012 and November 2013 were enrolled in the study. InterventionsNot applicable. Main Outcome MeasuresPoststroke fatigue was assessed using the Fatigue Severity Scale within 2 weeks of admission. Poststroke fatigue was defined as the mean score of 4 points or more from among 9 items in the Fatigue Severity Scale. Functional outcome was assessed by using FIM motor items. ResultsFifty-six (35.9%) of the 156 participants had poststroke fatigue at admission. The scores of the FIM motor items at admission and discharge were significantly lower in the fatigue group than in the nonfatigue group (P<.05). Multiple regression analysis with potentially confounding variables revealed that poststroke fatigue was a significant independent factor for discharge FIM motor items score (P<.05). ConclusionPoststroke fatigue at admission was significantly associated with functional outcome at discharge from subacute rehabilitation wards. Our findings emphasize that rehabilitation professionals need to manage poststroke fatigue in addition to providing the interventions to improve daily activities in patients with subacute stroke.

Frailty Level Monitoring and Analysis after a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre.

Background: Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Exercise using interactive videos, known as exergames, is being increasingly used to increase physical activity by improving health and the physical function in elderly adults. The purpose of this study is to ascertain the reduction in the degree of frailty, the degree of independence in activities of daily living, the perception of one’s state of health, safety and cardiac healthiness by the exercise done using FRED over a 6-week period in elderly day care centre. Material and Methods: Frail volunteers >65 years of age, with a score of <10 points (SPPB), took part in the study. A study group and a control group of 20 participants respectively were obtained. Following randomisation, the study group (20) took part in 18 sessions in total over 6 months, and biofeedback was recorded in each session. Results: After 6 weeks, 100% of patients from the control group continued evidencing frailty risk, whereas only 5% of patients from the study group did so, with p < 0.001 statistical significance. In the case of the EQ-VAS, the control group worsened (−12.63 points) whereas the study group improved (12.05 points). The Barthel Index showed an improvement in the study group after 6 weeks, with statistically significant evidence and a value of p < 0.003906. Safety compliance with the physical activity exceeded 87% and even improved as the days went by. Discussion: Our results stand out from those obtained by other authors in that FRED is an ad hoc-designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. It in turn improves the degree of independence in activities of daily living and the perception of one’s state of health, proving to be a safe and cardiac healthy exercise. Conclusions: The study undertaken confirms the fact that the FRED game proves to be a valid technological solution for reducing frailty risk. Based on the study conducted, the exergame may be considered an effective, safe and entertaining alternative.

Watch your step! Who can recover stair climbing independence after stroke?

After discharge, most patients who have suffered a stroke remain with some limitations in their stair climbing ability. This is a critical factor in order to be independent in real-life mobility. Although there are several studies on prognostic factors for gait recovery, few of them have focused on the recovery of stair climbing. The aim of this study was to identify prognostic risk factors for the recovery of stair climbing ability in a large sample of subjects with subacute stroke. Observational study. Neurorehabilitation Inpatient Unit. Subjects within the first month after stroke that had been admitted to an inpatient rehabilitation unit and discharged after an intensive inpatient rehabilitation. Demographical and clinical data were collected. Barthel Index (BI), Trunk Control Test and Motricity Index (MI) scores were recorded at admission and at discharge. Patients received two daily 40-minute sessions of motor rehabilitation, six days per week, during approximately two months. Forward Binary Logistic regressions were used to identify the role of risk factors, using as dependent variables the recovery of stair climbing ability and walking ability at discharge. As independent variables we used age, gender, onset-to-admission interval, side of hemiparesis, trunk control, Motricity Index (MI), presence of obesity, presence of neglect, presence of depression, classification of cerebral infarction (total anterior circulation, partial anterior circulation, posterior circulation or lacunar infarcts), degree of independence in activities of daily living, and cognitive state, all assessed at admission. A total of 257 subjects were enrolled. BI-Score, MI-Score and presence of unilateral spatial neglect at admission were able to explain 83% of variance for the recovery of stair climbing ability. Subjects with a BI >40 at admission were about 17 times more likely to be able to climb stairs again than other patients, and those with MI ≥25 were about 9 times more likely than the rest. The presence of unilateral spatial neglect reduced this possibility of recovering stair climbing ability by about 5.5 times. Of these factors, only MI ≥25, together with a score at Trunk Control Test >12, significantly predicted also walking recovery. This study highlights the different prognostic factors for recovering stair climbing and walking abilities, with a major role of unilateral spatial neglect in the former. There is a need for specific rehabilitation of stair climbing, also for improving the independence in activities of daily living, especially in patients who the clinical staff already knows should manage stairs in their community after being discharged.

Living Arrangement, Social Connectedness, and Life Satisfaction among Korean Older Adults with Physical Disabilities: The Results from the National Survey on Persons with Disabilities

Life satisfaction is an important indicator of quality of life. We examined the association between living arrangement and life satisfaction among older adults with physical disabilities and the mediating and moderating roles of social connectedness. We used data from the 2011 National Survey on Persons with Disabilities, South Korea, and analyzed a sub-sample of adults aged 65 and older with physical disabilities. We employed multivariate regression analyses to assess life satisfaction by living arrangement, taking into account social connectedness (social participation and quality of social relations) as well as background characteristics including the degree of independence in activities of daily living. Types of living arrangement included living with a spouse, living alone, and living with others. Among older adults with physical disabilities, individuals living alone and living with others reported poorer life satisfaction than those living with a spouse. The relationship between living arrangement and life satisfaction was explained away when quality of family and friend relations were added to the multivariate regression model. The influence of the quality of friend relations on life satisfaction was greater for those living alone, presenting the moderating role of living arrangement. Higher risks of life dissatisfaction among Korean older adults living alone with physical disabilities are of major concern. The results suggest that quality of social relations is an important modifiable factor for life satisfaction in this population. It would be crucial for policy makers and practitioners to recognize the needs for meaningful social connection by living arrangement among older adults with physical disabilities.

Stroke patients’ functions in personal activities of daily living in relation to sleep and socio‐demographic and clinical variables in the acute phase after first‐time stroke and at six months of follow‐up

To explore first-time stroke patients' degree of independence in activities of daily life in relation to sleep and other essential variables that might influence activities of daily life. Sleep has received little attention in rehabilitation of activities of daily life in stroke patients. This is a longitudinal survey and observational study design from the acute phase to six months poststroke. First-time stroke patients (n = 90) were recruited from two hospitals in eastern Norway in 2007 and 2008. Data were collected by survey interview, medical records and wrist actigraphy in the first two weeks at the hospital and at six months of follow-up. Actigraph measures patient activity and estimates sleep during the day and night. Linear regression showed that high dependence in personal activities of daily living was directly related to low estimated sleep time at night and higher estimated sleep during the day in the acute phase, controlling for socio-demographic and clinical variables. Furthermore, high estimated numbers of awakenings in the acute phase were related to lower activities of daily life functioning at six months of follow-up after controlling for socio-demographic and clinical variables. Stronger pain and a lower physical functioning showed direct relationships with lower independency level of in activities of daily life both in the acute phase and after six months. Sleep patterns in the acute phase may influence the patients' activities of daily life functioning up to six months poststroke. Furthermore, pain in the acute phase may influence the level of activities of daily life functioning in stroke patients. Nurses should pay attention to stroke patients' sleep quality and pain in the rehabilitation period after a stroke. Facilitating good sleep conditions and screening for pain should be an integral part of the rehabilitation programme.

Motor Retraining in Virtual Reality: A Feasibility Study for Upper-Extremity Rehabilitation in Individuals With Chronic Stroke

Background and Purpose. Individuals with stroke can improve upper-extremity function in the chronic phase, providing rehabilitation is intensive, attended, and of sufficient duration. Virtual reality has been used in motor retraining; however, off-the-shelf game consoles may not be appropriate for those with marked motor impairment and high finger or arm spasticity. The objective of this study was to investigate the feasibility and effects of training in individuals with chronic stroke who are either high-functioning or low-functioning, and also spastic. Case Descriptions. Four volunteers, 3 men and 1 woman, were recruited from a local aphasia support group. All individuals were chronic post stroke with right-side hemiplegia. Training took place at the Tele-Rehabilitation Institute at Rutgers University. The intervention was performed on the Rutgers Arm II, a prototype training table that senses supported arm movement and grasp strength and tilts to resist or assist reach. Participants played games that adapted automatically to each individual's motor abilities. The games were practiced over 6 weeks, 3 sessions every week, with sessions lasting up to 1 hour. The 4 participants were evaluated by a senior physical therapist before, immediately following, and 6 weeks after the intervention. No occupational or physical therapist was present during the training sessions. Outcomes. The primary outcomes were changes in the affected upper-extremity subset of the Fugl-Meyer test and self-reported changes in the participants' activities of daily living. Improvements in active range of motion and grasp strength were secondary outcomes. All individuals improved in Fugl-Meyer scores and retained these gains (participant 1, 45 to 50; participant 2, 16 to 22; participant 3, 12 to 20; participant 4, 42 to 51). Participants 2 and 3, who presented with severe motor impairment, began using their affected arms in daily activities subsequent to training. All participants improved in their shoulder, elbow, and finger flexion active range of motion. Remarkably, participants 2 and 3, who were unable to exert force in grasping or pinching pre-training, could now do so and retained these gains at 6 weeks following the intervention. Well-being and mood seemed to improve in all participants. Discussion and Conclusion. Results show that motor retraining in virtual reality is feasible, well-tolerated by participants, and benefitting them. The Rutgers Arm II system was able to train participants, who varied greatly in their degree of motor impairment, but without a clinician being present. The present study contributes to the body of knowledge on novel virtual rehabilitation interventions for the upper extremity. Key Words: Upper extremity, Virtual reality, Sustained grasp, Rutgers Arm, Stroke. BACKGROUND AND PURPOSE The direct and indirect costs associated with head injuries from stroke or trauma approach $200 billion a year in the United States alone.1'2 At the completion of standard-of-care motor retraining (6 to 9 months post stroke), individuals present with varying levels of upper-extremity (UE) functional recovery. Their recovery depends not only on the type and severity of the initial injury to the central nervous system, but also on the intensity and length of rehabilitation subsequently provided. Diminished upper-extremity function in the chronic phase post stroke negatively affects the individual's degree of independence in activities of daily living (ADLs), mental health, and social life. The person's motivation to improve and the important role knowledge of results feedback plays in motor relearning3 both point to the need to investigate virtual reality as an element of therapy. Virtual worlds4 have been shown to provide rich knowledge of results and to increase motivation if tailored to the individual's abilities.5'6 Virtual reality previously has been investigated as a way to conduct motor rehabilitation following a stroke. …

Dementia and functional decline in patients with Parkinson's disease.

Functional decline in Parkinson’s disease (PD), characterized by reduced ability to carry out activities of daily living, usually results from typical motor impairment and may be aggravated by concomitant cognitive impairment.ObjectiveTo compare the functional decline in Parkinson’s disease between patients with dementia and cognitively preserved patients.MethodsFrom an original sample composed of 50 patients with a clinical diagnosis of idiopathic PD seen in a consecutive series, 33 non-depressed patients were selected comprising 13 with dementia and 20 cognitively preserved individuals. All patients enrolled in this study were drawn from a public outpatient clinic, specialized in movement disorders. The clinical stage of PD was determined by the Hoehn & Yahr scale, and the functional capacity was verified using the Unified Parkinson’s Disease Rating Scale UPDRS ADL (subscale II: activities of daily living) and the Schwab & England scale. The two last scales measure the functional degree of independence in activities of daily living. The neuropsychological assessment was performed using The Cambridge Examination for Mental Disorders of the Elderly – CAMCOG, Cognitive Section and the Stroop Color Word Test.ResultsAs expected, in comparison with cognitively preserved patients, the group with dementia presented significantly lower scores throughout the neuropsychological evaluation. The patients with dementia were found to have a longer period of disease, a more advanced clinical staging according to the Hoehn & Yahr, and greater functional decline according both to the UPDRS ADL and Schwab & England, with statistically significant difference between the groups.ConclusionPatients with dementia were at a more advanced clinical stage of Parkinson’s disease and evidenced greater functional decline in comparison with patients without dementia.

Nondysphoric Depression Following Stroke

Nondysphoric Depression Following Stroke

Common drugs may influence motor recovery after stroke

Studies in laboratory animals indicate that certain centrally acting drugs (eg, the antihypertensives clonidine and prazosin, neuroleptics and other dopamine receptor antagonists, benzodiazepines, and the anticonvulsants phenytoin and phenobarbital) impair behavioral recovery after focal brain injury. Even single doses may have long-term harmful effects. To determine whether these medications have a similar negative impact in humans, we analyzed the recoveries of control patients who were enrolled in the Sygen in Acute Stroke Study, a multicenter study of the effects of GM1 ganglioside after ischemic stroke. Motor impairments were measured by the motor subscores of the Toronto Stroke Scale at baseline and 7, 14, 21, 28, 56, and 84 days after stroke. Using these data, we compared motor recovery between patients with initial motor deficits who received at least one of the drugs that interfere with recovery in laboratory studies ("detrimental" drug group, n = 37) and patients who did not receive these drugs ("neutral" drug group, n = 59). The groups were well balanced with regard to the frequency of comorbid conditions and other prognostic factors. For upper-extremity motor function, repeated-measures ANOVA showed a significant interaction between drug group and time after stroke [F(6,528) = 2.38; p = 0.03], with a significant (p < 0.001) difference between the groups beginning 7 days after the stroke. A similar trend was present for the lower extremity, but the overall difference between the groups was not significant [ANOVA F(6,498) = 1.22; p = 0.29]. Drug group did influence the degree of independence in activities of daily living as measured with the Barthel Index.(ABSTRACT TRUNCATED AT 250 WORDS)