Early Predictor Of Functional Outcome Research Articles

Effects of trunk exercise with physioball to improve trunk balance among subjects with stroke: a systematic review and meta-analysis.

Poststroke subjects present with difficulties of reduced functional mobility and balance. Trunk impairment is common among stroke subjects which hinder the performance of upper and lower limb. In poststroke rehabilitation limbs are provided much attention than the trunk. Trunk function has been identified as an important early predictor of functional outcome after stroke. Physioball is commonly used among healthy subjects in performing trunk exercises. This systematic review with meta-analysis is conducted to investigate the effect of trunk exercises performed using physioball in improving trunk performance after stroke. Six authors identified relevant articles from the following databases: PubMed, Google Scholar, CINAHL (Cumulative Index and Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database). Articles evaluating the effect of physioball exercise for improving trunk stability among stroke subjects were included. Databases were screened from 2009 and up to 2019. Qualitative synthesis of evidence was prepared and meta-analysis was implemented to draw pooled effects of physioball exercise on improving trunk performance and balance among stroke subjects. Eight papers were included, totaling 273 participants. All the articles included in this review demonstrated moderate to good quality. Meta-analysis performed with seven papers demonstrated statistical significance of physioball in improving trunk performance during acute and subacute stages of stroke. Brunnel Balance Assessment outcomes demonstrated statistically significant improvement of balance among overall stroke survivors. Trunk exercise performed over a physioball is effective during the acute and subacute stage. This meta-analysis could not find its significant effect in improving trunk performance in the chronic stages.

Intrinsic Connectivity of the Globus Pallidus: An Uncharted Marker of Functional Prognosis in People With First-Episode Schizophrenia

There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may play a significant role in determining outcomes in schizophrenia. The globus pallidus (GP), a critical structure within this circuitry, unique in its role as a mediator of competing inputs through the striatum, has not been well characterized in schizophrenia. The following study examined functional interactions of the GP in individuals with first-episode schizophrenia (FES). To probe the large-scale intrinsic connectivity of the GP, resting-state fMRI scans were obtained from patients with FES and sex and age-matched healthy controls. Participants with FES were also evaluated after 6 months via the Strauss-Carpenter Outcomes Scale to assess overall functional trajectory. The GP was parcellated to generate seeds within its substructures, and connectivity maps were generated. Our FES cohort showed significantly lower functional connectivity between the left GP interna and a network of regions including the dorsolateral prefrontal cortex, caudate, and cerebellum at baseline. In addition, FES participants with lower overall scores of functioning at 6 months showed significantly decreased connectivity between the GP interna and the dorsal anterior cingulate and bilateral insula, all regions important for motivational salience. These results provide novel evidence for unique abnormalities in functional interactions of the GP with key prefrontal cortical regions in FES. Our findings also suggest that reduced prefrontal-pallidal connectivity may serve as a predictor of early functional outcome.

A patient\u2019s perception of their hospital stay influences the functional outcome and satisfaction of total knee arthroplasty

IntroductionTo assess whether patient satisfaction with their hospital stay influences the early outcome of total knee arthroplasty (TKA).MethodsDuring a 5-year period patients undergoing primary TKA at the study centre had prospective outcome data recorded (n = 2264). The Oxford knee score (OKS) and the short form (SF)-12 were recorded pre-operatively and 1 year post-operatively when satisfaction with their TKA was also assessed. Patient satisfaction with their hospital stay was also evaluated and their reasons for it were qualitatively documented.ResultsDecreasing level of satisfaction with their hospital stay was associated with a significantly worse post-operative OKS (p < 0.001) and SF-12 score (p < 0.001). Multivariable regression analysis confirmed that the patient’s perceived level of satisfaction with their hospital stay was an independent predictor of change in the OKS (p < 0.001) and SF-12 score (p < 0.006) after adjusting for confounding variables. Patient satisfaction with their TKA was significantly influenced by their hospital experience, decreasing from 96% in those with an excellent experience to 42% in those with a poor experience. Food, staff/care, and the hospital environment were the most frequent reasons of why patients rated their hospital experience as fair or poor.ConclusionA patient’s perception of their inpatient hospital experience after surgery is an important modifiable predictor of early functional outcome and satisfaction with TKA.

Trunk Impairment Scale -TIS precise tool for evaluating trunk motor deficit of stroke patients

Abstract Stroke causes impairment of brain function resulting in the disorder of motor control of the trunk. Assessment of the movement of a patient with hemiparesis poses many difficulties and limitations. A standard clinical neurological diagnosis does not provide an accurate assessment in terms of trunk deficit. This is the reason for the relatively small and insufficient monitoring of motor changes in patients. Post stroke assessment of the trunk is still insufficient despite the fact that disorders are a common problem in patients with stroke. Trunk function has been identified as an important early predictor of functional outcome after stroke. Trunk Impairment Scale-TIS is the only well-validated tool to examine a patient with hemiparesis taking into account qualitative and quantitative assessment of the trunk deficit. This scale consists of three subscales: static balance in sitting, dynamic balance sitting and coordination. TIS assesses existing compensation during motor tasks. The scale was translated into Polish and pre-adapted to clinical practice The scale supports clinical reasoning in terms of structure and function, body disorders and activity limitations of patients after stroke It appears that the introduction of scale in the clinical study for patients with stroke hemiplegia may not only affect the expansion of detailed documentation of motor deficits, but to support planning and carrying out appropriate (suitable) physiotherapy strategies.

Abstract W P39: Internal Cerebral Vein Asymmetry on Follow-Up Brain CT after Intravenous Thrombolysis in Acute Anterior Circulation Ischemic Stroke is Associated With Poor Outcome

Background and aim: Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other and consistently seen on CTA. Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of ICA or MCA. Since systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. Methods: Consecutive AIS patients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/ neuroradiologists. Functional outcome was assessed by modified Rankin Scale (mRS) at 3-months, dichotomized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome. Results: Of 2238 patients with AIS, 226 (10.1%) anterior circulation AIS patients received intravenous thrombolysis. Median age 65yrs (range 19-92), 44% males and median National Institute of Health Stroke Scale (NIHSS) 16-points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) while 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was assessed in 103 (45.5%) patients. Admission NIHSS score (OR1.07;95%CI 1.079-1.201,p=0.046), change in NIHSS score during first 24 hours (OR 0.737; 95%CI 0.672-0.807,p&lt;0.0001) and ICV asymmetry on follow-up CTA (OR 20.3;95%CI 4.67-52.07,p &lt;0.0001) independently predicted poor outcome at 3-months. Conclusion: ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.

Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: A systematic review

Trunk control has been identified as an important early predictor of functional outcome after stroke but there is insufficient evidence that proximal stability of the trunk is a pre-requisite for sitting and standing balance, walking, and functional activities. We systematically reviewed the literature on trunk training exercises (TTE) in adult patients with stroke. To establish if TTE can improve trunk performance and sitting balance. CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, REHABDATA Database, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos were searched and reference lists screened to identify randomised controlled trials (RCTs) of trunk training exercises in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed trial quality. The primary outcomes were trunk performance and sitting balance. Due to the heterogeneity of included studies meta-analysis was not possible. A total of 11 studies with 317 participants were analysed. Trunk training exercises showed a moderate evidence to improve trunk performance and dynamic sitting balance. Trunk training exercises, performed with either stable or unstable surface, could be a good rehabilitation strategy and might help improving trunk performance and dynamic sitting balance after stroke.

Internal Cerebral Vein Asymmetry on Follow-up Brain Computed Tomography after Intravenous Thrombolysis in Acute Anterior Circulation Ischemic Stroke Is Associated with Poor Outcome

Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. Consecutive AIS patients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/neuroradiologists. Functional outcome was assessed by the modified Rankin Scale (mRS) at 3months, dichotomized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome. Of 2238 patients with AIS, 226 (10.1%) anterior circulation AIS patients received intravenous thrombolysis. The median age was 65years (range 19-92), 44% were men, and median National Institutes of Health Stroke Scale (NIHSS) score was 16 points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) patients, whereas 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was assessed in 103 (45.5%) patients. Admission NIHSS score (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.079-1.201, P=.046), change in NIHSS score during first 24hours (OR .737; 95% CI .672-.807, P<.0001), and ICV asymmetry on follow-up CTA (OR 20.3; 95% CI 4.67-52.07, P<.0001) independently predicted poor outcome at 3 months. ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.

Serum YKL-40 Levels Correlate with Infarct Volume, Stroke Severity, and Functional Outcome in Acute Ischemic Stroke Patients

Background and PurposeYKL-40 is associated with various neurological disorders. However, circulatory YKL-40 levels early after onset of acute ischemic stroke (AIS) have not been systematically assessed. We aimed to identify the temporal changes and clinical usefulness of measuring serum YKL-40 immediately following AIS.MethodsSerum YKL-40 and C-reactive protein (CRP) levels were monitored over time in AIS patients (n = 105) and compared with those of stroke-free controls (n = 34). Infarct volume and stroke severity (National Institutes of Health Stroke Scale; NIHSS) were measured within 48 hours of symptom onset, and functional outcome (modified Rankin Scale; mRS) was measured 3 months after AIS.ResultsWithin 12 hours of symptom onset, levels of YKL-40 (251 vs. 41 ng/mL) and CRP (1.50 vs. 0.96 µg/mL) were elevated in AIS patients compared to controls. The power of YKL-40 for discriminating AIS patients from controls was superior to that of CRP (area under the curve 0.84 vs. 0.64) and YKL-40 (r = 0.26, P<0.001) but not CRP levels were correlated with mRS. On day 2 of admission (D2), YKL-40 levels correlated with infarct volume and NIHSS. High YKL-40 levels predicted poor functional outcome (odds ratio 5.73, P = 0.03). YKL-40 levels peaked on D2 and declined on D3, whereas CRP levels were highest on D3.ConclusionsOur results demonstrate serial changes in serum YKL-40 levels immediately following AIS and provide the first evidence that it is a valid indicator of AIS extent and an early predictor of functional outcome.

The Timed Up and Go Test Is an Early Predictor of Functional Outcome After Hemiarthroplasty for Femoral Neck Fracture

The ability to predict the long-term physical function and prognosis of hip fracture patients during the early postoperative period is essential for surgeons and physical therapists as well as for patients and their families. The purpose of this study was to determine whether early functional assessment correlated with and/or predicted long-term function after surgery to treat a displaced femoral neck fracture. Sixty-two patients undergoing hemiarthroplasty for a displaced femoral neck fracture were evaluated prospectively; a minimum follow-up of two years was required. Validated functional assessments, including the Lower Extremity Measure and the Timed Up and Go test, were utilized, and scores were analyzed with respect to patient baseline data. The functional level of patients decreased significantly after the injury, with the mean Lower Extremity Measure score decreasing from 87.7 to 62.4 and the need for a walking aid increasing from 36% to 54% at two years postoperatively (p < 0.05 for both). The Timed Up and Go test scores at four days and three weeks postoperatively were significantly higher in patients who needed a walking aid at two years compared with independently walking patients (p < 0.05). Receiver operating characteristic curve analysis of the Timed Up and Go test scores revealed that the optimal threshold for predicting the need for a walking aid at two years was fifty-eight seconds at four days postoperatively and twenty-six seconds at three weeks. Also, the need for a walking aid at two years was ninetyfold higher when the Timed Up and Go test score at three weeks postoperatively exceeded the twenty-six seconds threshold. The Timed Up and Go test was an early clinical indicator of future physical function in patients with a hip fracture treated with hemiarthroplasty. Innovative clinical approaches to anticipate future function will contribute to increasing the efficiency of overall management of this growing set of patients.

Abstract 3286: Persistently Reduced Venous Drainage After Intravenous Thrombolysis is Associated With Poor outcome in Acute Anterior Circulation Ischemic Stroke

Background- Significant numbers of acute ischemic stroke (AIS) patients recover with timely-administered intravenous tissue plasminogen activator (IV-TPA). However, rates and extent of recovery remain variable. Considering scarce and costly resources, early identification of reliable predictors for functional outcomes is important for planning rehabilitation strategies. We hypothesized that venous drainage would be impaired on the side of cerebral hypoperfusion due to acute occlusion of internal carotid or middle cerebral artery. The 2 internal cerebral veins (ICV) drain the deep parts of hemispheres and run backward to form great cerebral vein. Since ICVs are consistently seen on CT angiography (CTA), parallel and run very close to each other, even minor asymmetry in their filling can be easily diagnosed. ICV asymmetry in pre-TPA CTA can change in patients achieving arterial recanalization, rendering it less useful for predicting the long-term outcomes. Thus, we aimed at evaluating whether the presence of ICV asymmetry on follow-up CTA can predict the final outcome. Methods- Data from consecutive AIS patients treated with IV-TPA, in a standardized protocol, from Jan2007 to March2010 were included in a prospective registry at our tertiary center. In this study, we excluded posterior circulation strokes. Significant proportion AIS patients undergo CTA on day 2 after IV-TPA to assess the status of arterial patency. ICV asymmetry was assessed by 2 independent stroke neurologists/ neuroradiologists, blinded to patient data or outcomes. Functional outcomes were assessed by modified Rankin Scale (mRS) at 3-months, dichotomized as good outcome (mRS 0-1) and poor outcome (mRS 2-6). Data were analyzed for the early predictors of function outcome. Results- Of the total of 2238 patients admitted during the study period, 226 (10.1%) with anterior circulation AIS treated with intravenous thrombolysis were included. Median age was 65yrs (range 19-92), 63% males and median National Institute of Health Stroke Scale (NIHSS) 16points (range 4-32). Hypertension was the commonest vascular risk factor in 144 (76%) while 63 (33%) patients suffered from atrial fibrillation (AF). Overall, 108 (47.8%) patients achieved poor functional outcome at 3-months. ICV asymmetry could be assessed only in 103 (45.5%) patients on their follow up CTA films. Admission NIHSS score (OR1.08;95%CI 1.001-1.157,p=0.048) and ICV asymmetry on follow-up CT scan (OR 23.9;95%CI 5.15-63.99,p &lt;0.0001) were associated with poor outcome at 3-months. Conclusion- Presence of the asymmetry of internal cerebral veins on the follow up CT angiography in acute ischemic stroke patients treated with IV-TPA can be used as an early predictor of poor functional outcome.

Brain imaging as a predictor of early functional outcome following traumatic brain injury in children, adolescents, and young adults.

A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury. CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels. Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P<.001). However, the deeper the lesion, the greater the functional gains (P=.05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to "catch up" with patients who had more superficial lesions. While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.