FIM Scores Research Articles

Typology evolution of patients hospitalized after recent stroke in PRM department over 15 years: A retrospective observational study

Since 10 years, health care for stroke patients had increased considerably: increasing number of the stroke units, development of authorized neurological specialized PRM departments, and new therapies used (thrombolysis, thrombectomy). These evolutions could impact the typology of patients hospitalized in PRM units after recent stroke. This study aims to look at such a possible evolution in our department, and try to identify the potential factors of change. Retrospective study conducted on 7 years chosen over the last 15 years among hospitalized patients after recent stroke: demographic data, stroke's characteristics, treatments, length of stay and clinical characteristics. Statistic analysis on the evolution of these data was based on Chi 2 and Anova analysis. Six hundred and forty-two medical records were reviewed (225 women and 417 men, 432 ischemic stroke and 210 hemorrhagic, mean age 58 years [17–93, SD 13.2])). There was no difference regarding the characteristics of stroke (ischemic/hemorrhagic, unique/multiple, first/recurrence), entrance delay and length of stay. As expected the frequency of thrombolysis and thrombectomy increased ( P < 0.005). The number of category 3 SOFMER patients and cognitive disorders increased ( P < 0.005), contrasting with the increase of walking patients at entrance and discharge, as well as the functionality of the paretic upper limb ( P < 0.005) which probably explain the increase of entrance ( P = 0.003) and discharges FIM scores ( P = 0.009). A significant decreasing of usual complications as disabling spasticity and shoulder pain was observed ( P < 0.05). The findings showed significant changes in the typology of patients admitted after recent stroke in PRM department since 7 years, reflecting impact of health care for stroke patients.

Fitting with an electronic knee for a schizophrenic patient with bilateral amputation of lower limbs: What's the point?

The replacement of a mechanical knee with prosthetic class I foot fitting by an electronic knee with prosthetic class II foot was proposed to a 54-years-old schizophrenic patient, active, with right femoral and left tibial traumatic amputation. This fitting evolution was assessed both quantitatively and qualitatively. Compared evaluation of electronic knee with prosthetic class II foot versus mechanical polycentric knee with prosthetic class I foot (fitting unchanged moreover) in: – functional abilities and quality of life using standardized scores (Functional Ambulation Classification, Houghton, Functional Independence Measurement, B.A-BA, MOS-SF36), satisfaction VAS, walking perimeter, stair climbing abilities, crutches use; – walking and balance analysis using GAITRITE system, stabilometric platform, Get up and Go test. Functional abilities: walking perimeter was increased by approximately 2 km; walking outdoors was now performed with a single crutch; walking indoors without crutches was made possible on short perimeter, leaving both hands free for everyday or leisure tasks; walking downstairs was realized in a continuous sequence of steps. Quantified analysis of gait and balance: spatiotemporal parameters recorded on GAITRITE with 1 single crutch improved (speed, cadence, step length and support time), no improvement with 2 crutches. No improvement in static balance recorded on stabilometric platform. Get up and Go test improved (14.85 s vs. 19.77 s with mechanical knee). Standardized scores: improvement of Houghton's score (10/12 vs. 6/12), of FAC score (7/8 vs. 6/8), of B.A-BA (15/20 vs. 13.6/20). Slightly modified FIM score (123/126 vs. 120/126), yet there is an improvement of the SF36-MOS for physical scores (55.8/100 vs. 43.1/100) as well as mental scores (64.3/100 vs. 47.1/100). Global satisfaction improved (90/100 mm vs. 32/100 mm) using the VAS. This new fitting allowed an objective improvement of walk and quality of life. Compliance for the new femoral prosthesis is total although this schizophrenic patient was not spontaneously asking for prosthetic improvement initially. This is pleading for a systematic information of active patients, even non-demanding ones but regularly followed and evaluated, on fitting techniques evolution that might improve their daily lives.

Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy.

This study compared the effects of Nintendo Wii-Fit® balance-based video games and conventional balance training in children with mild cerebral palsy (CP). This randomized controlled trial involved 30 ambulatory pediatric patients (aged 5-18 years) with CP. Participants were randomized to either conventional balance training (control group) or to Wii-Fit balance-based video games training (Wii group). Both group received neuro-developmental treatment (NDT) during 24 sessions. In addition, while the control group received conventional balance training in each session, the Wii group played Nintendo Wii Fit games such as ski slalom, tightrope walk and soccer heading on balance board. Primary outcomes were Functional Reach Test (forward and sideways), Sit-to-Stand Test and Timed Get up and Go Test. Nintendo Wii Fit balance, age and game scores, 10 m walk test, 10-step climbing test and Wee-Functional Independence Measure (Wee FIM) were secondary outcomes. After the treatment, changes in balance scores and independence level in activities of daily living were significant (P < 0.05) in both groups. Statistically significant improvements were found in the Wii-based game group compared with the control group in all balance tests and total Wee FIM score (P < 0.05). Wii-fit balance-based video games are better at improving both static and performance-related balance parameters when combined with NDT treatment in children with mild CP.

Temperature management and nursing strategies for patients with acute ischemic stroke

Objective To investigate temperature management and nursing strategies for patients with acute ischemic stroke (AIS). Methods A total of 118 patients with AIS in Huai′an First People′s Hospital, Nanjing Medical University were enrolled in the study. They were randomly divided into two groups. Routine nursing was performed in control group (58 cases), and temperature management with nursing intervention was performed in research group (60 cases). Results The compliance rate of treatment and satisfaction degree of nursing in research group were significantly higher than those in control group (P<0.05). After nursing, temperature of research group was significantly lower than that of control group (P<0.05). FIM score and Barthel score of research group were significantly higher than those of control group (P<0.05). Conclusions Temperature management with nursing intervention for patients with AIS can improve treatment compliance and enhance nursing quality and quality of life. Key words: Acute ischemic stroke; Temperature management; Nursing strategies

Sex-Specific Predictors of Inpatient Rehabilitation Outcomes After Traumatic Brain Injury

ObjectiveTo identify sex-specific predictors of inpatient rehabilitation outcomes among patients with a traumatic brain injury (TBI) from a population-based perspective. DesignRetrospective cohort study. SettingInpatient rehabilitation. ParticipantsPatients in inpatient rehabilitation for a TBI within 1 year of acute care discharge between 2008/2009 and 2011/2012 (N=1730, 70% men, 30% women). InterventionsNone. Main Outcome MeasuresInpatient rehabilitation length of stay, total FIM score, and motor and cognitive FIM ratings at discharge. ResultsSex, as a covariate in multivariable linear regression models, was not a significant predictor of rehabilitation outcomes. Although many of the predictors examined were similar across men and women, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for men and women; mechanism of injury (P<.0001) was a significant predictor of functional outcome only among women, whereas comorbidities (P<.0001) was a significant predictor for men only. ConclusionsPredictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI.

Abstract TP149: Utilization of a Robotic Exoskeleton to Provide Increased Mass Practice for Gait Training and its Impact on Discharge Destination for Individuals With Acute Stroke

Introduction: Mass practice of task-specific activity, such as repeated stepping for gait retraining, is an integral part of acute stroke rehabilitation. New technologies including the use of a robotic exoskeleton (RE) have recently been introduced to the inpatient rehab facility (IRF). A RE can help skilled physical therapists (PT) provide repetitive stepping practice to patients who have had a stroke. Hypothesis: We hypothesize the use of a RE will enable PTs in an IRF to provide added stepping practice to their therapy program and influence discharge destination as compared to traditional treatment plans. Methods: Fifteen participants with acute stroke (&lt;6 months post, age 58±10; height 66±5in; 176±35lbs; LOS 29±7days) were recruited for RE gait training during inpatient rehabilitation in conjunction with traditional therapy. Participants ambulated in the RE over level surfaces with the assistance of a PT (minimum of 3 sessions in the RE). Participant inclusion requirements: medical clearance, upright standing tolerance (≥15 min), intact skin, and physically fit into the device. A matched sample of participants (n=15) was selected from a hospital database (matching criteria: length of stay, admission motor FIM, age, gender and affected side). The data was analyzed using independent sample and paired sample t-tests. Results: Participants in the RE group walked an average distance of 212 feet in traditional PT where gait training was provided and 551 feet in RE sessions (p=.033). Discharge destination for the RE group: 10 home; 3 subacute; 2 nursing facilty and for the matched sample: 13 home; 2 subacute. Motor FIM scores significantly increased from admission to discharge: RE group (p≤.001) and matched group (p≤.001). Motor FIM gain at discharge in the RE group significantly increased compared to the matched sample, 26.4±6.4 vs. 21.6±5.9, (p=0.044). Conclusions: This exploratory investigation demonstrated the RE provides increased dosing of gait training. Discharge destination was not notably impacted by method of gait training. Improvement of motor FIM scores in the RE group begins to demonstrate the impact of mass practice provided by the RE. Further research is needed to objectively explore the impact of RE on functional mobility and quality of life.

Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

ObjectiveTo examine contextual (facility and community) and individual factors associated with self-care and mobility outcomes among Medicare hip fracture patients receiving inpatient rehabilitation. DesignRetrospective cohort study of 3 linked data files: Inpatient Rehabilitation Facility–Patient Assessment Instrument, Provider of Services, and Area Health Resources. Multilevel modeling was used to examine the effects of contextual and individual factors on self-care and mobility outcomes. SettingInpatient rehabilitation facilities (IRFs). ParticipantsMedicare hip fracture patients (N=35,264; mean age, 81y) treated in IRFs (N=1072) in 2012. InterventionsNot applicable. Main Outcome MeasuresSelf-care (eating, grooming, bathing, upper and lower body dressing, toileting) and mobility (walk/wheelchair, stairs) at discharge. ResultsMean ± SD self-care and mobility scores at admission were 3.17±.87 and 1.24±.51, respectively; mean ± SD self-care and mobility scores at discharge were 5.03±1.09 and 3.31±1.54, respectively. Individual and contextual levels explained 44.4% and 21.6% of the variance in self-care at discharge, respectively, and 19.5% and 1.9% of the variance in mobility at discharge, respectively. At the individual level, age, race/ethnicity, cognitive and motor FIM scores at admission, and tier comorbidities explained variance in self-care and mobility; sex and length of stay explained variance only in self-care. At the contextual level, facilities' case mix (mean patient age, percent non-Hispanic white, mean self-care score at admission) and structural characteristics (rural location, freestanding, for-profit ownership) explained variance only in self-care; facilities' case mix (mean patient age, percent non-Hispanic white, percent living with social support, mean mobility score at admission) explained variance in mobility. Community variables were nonsignificant. ConclusionsIndividual and facility factors were significant predictors of discharge self-care and mobility among Medicare hip fracture patients in IRFs. The findings may improve quality of IRF services to hip fracture patients and inform risk adjustment methods.

Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial.

BackgroundThe effects of neuromuscular electrical stimulation (NMES) in critically ill patients after cardiothoracic surgery are unknown. The objectives were to investigate whether NMES prevents loss of muscle layer thickness (MLT) and strength and to observe the time variation of MLT and strength from preoperative day to hospital discharge.MethodsIn this randomized controlled trial, 54 critically ill patients were randomized into four strata based on the SAPS II score. Patients were blinded to the intervention. In the intervention group, quadriceps muscles were electrically stimulated bilaterally from the first postoperative day until ICU discharge for a maximum of 14 days. In the control group, the electrodes were applied, but no electricity was delivered. The primary outcomes were MLT measured by ultrasonography and muscle strength evaluated with the Medical Research Council (MRC) scale. The secondary functional outcomes were average mobility level, FIM score, Timed Up and Go Test and SF-12 health survey. Additional variables of interest were grip strength and the relation between fluid balance and MLT. Linear mixed models were used to assess the effect of NMES on MLT, MRC score and grip strength.ResultsNMES had no significant effect on MLT. Patients in the NMES group regained muscle strength 4.5 times faster than patients in the control group. During the first three postoperative days, there was a positive correlation between change in MLT and cumulative fluid balance (r = 0.43, P = 0.01). At hospital discharge, all patients regained preoperative levels of muscle strength, but not of MLT. Patients did not regain their preoperative levels of average mobility (P = 0.04) and FIM score (P = 0.02) at hospital discharge, independent of group allocation.ConclusionsNMES had no effect on MLT, but was associated with a higher rate in regaining muscle strength during the ICU stay. Regression of intramuscular edema during the ICU stay interfered with measurement of changes in MLT. At hospital discharge patients had regained preoperative levels of muscle strength, but still showed residual functional disability and decreased MLT compared to pre-ICU levels in both groups.Trial registrationClinicaltrials.gov identifier NCT02391103. Registered on 7 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1199-3) contains supplementary material, which is available to authorized users.

Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke

Purpose: To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients.Method: A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010–2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006–2014 period to evaluate effectiveness of fall-risk reduction measures.Results: The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and non-extreme FIM score (55–101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014.Conclusions: The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention.Implications for RehabilitationRecognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards.Assessing the fall risk is a team tasks and combines information from various sources.Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient.

Effectiveness of Manual Perturbation Exercises in Improving Balance, Function and Mobility in Stroke Patients: A Randomized Controlled Trial

Background and objective of study: Following stroke hemiplegic or hemiparetic patients presented with more postural sway, asymmetric weight distribution, impaired weight-shifting ability and decreased stability capability. There are many balance exercises and strategies to improve balance in stroke population to improve trunk control. There are limited evidences of giving manual perturbation based balance training in stroke patients to improve Balance, function and Mobility. Therefore, this study has been taken up to examine whether the manual perturbation balance training is effective in improving balance, function and mobility in stroke patients. Material and Method: Thirty patients were randomly allocated into two groups, Group (Conventional PT), Group B (Manual Perturbation Exercises and Conventional PT)- with 15 patients in each group. All the patients were evaluated with Berg Balance Scale; Functional Independence Measures and Time up and Go test on pre- treatment level. At the end of 4th week, effects of intervention were assessed by Berg Balance Scale, Time up and Go Test, and Functional Independence Measures. Results: When analysis was done between Group A and Group B, no significant difference found between BBS, TUG and FIM score in both Experimental and Control Group at pre interventional level. When comparison was done between both the groups from pre to post intervention level, the values of BBS, TUG, and FIM scores were improved at post interventional level (p=0.0001) in both groups. In the inter group comparison at post intervention level, values of BBS and TUG in the experimental Group were improved (p=0.0001), but not in FIM (p=0.240). Conclusion: Manual Perturbation exercises combined with Conventional Physiotherapy and Conventional Physiotherapy alone are beneficial in improving Balance, Function and Mobility in stroke patients. However, the subjects treated with manual perturbation along with conventional physiotherapy showed an additional benefit in Balance, and Mobility.

Relationship between Comorbid Cognitive Impairment and Functional Outcomes in Stroke Patients with Spatial Neglect

Objective: The aim of this study was to investigate relationships between cognitive impairment and functional outcomes in stroke patients with spatial neglect. Method: Twenty seven right hemisphere ischemic stroke patients who admitted to an inpatient rehabilitation unit were included. Patients were divided into two group based on KF-NAP scores: Neglect group (n=18) and non-neglect group (n=9). Neglect group (n=18) were subdivided into two groups by discharge FIM scores as poor outcome group (n=8, <70) and good outcome group (n=10, ≥70). Cognitive function assessments including attention (Attention & Calculation, Digit span test–Forward), memory (Digit span test–Backward, SVLT-Immediate recalls/Delayed recalls) and visual perception (LOTCA-Visual perception/Visuomotor organization), and stroke severity assessment including NIHSS, FMA, K-MMSE, and FIM were performed. Cognitive impairments and functional outcomes were compared between two groups. Results: There were significant differences in NIHSS, FMA (affected U/E, affected L/E), discharge FIM, FIM gain and LOTCA-visuomotor organization between Neglect group and nonneglect group (p<0.05). Among the patients with spatial neglect, there were significant differences in KF-NAP, K-MMSE and assessment scores of memory and visual perception between poor outcome group and good outcome group. Attention, memory and visual perception were significantly correlated with KF-NAP scores (p<0.05). Conclusion: Stroke patients with spatial neglect showed more severe impairment in cognitive, motor and general functional status, which resulted in delayed functional recovery. Spatial neglect patients with combined memory and visual perception impairment may show poor functional outcome. (Brain & NeuroRehabilitation 2016; 9: 37-47)

Comparative Study on the Trans-Province Transfer of the Multiple Trauma Patients after Sichuan Earthquake

Background: Trans-province transfer of the patients has been successfully carried out and has greatly relieved the burden of the hospitals in Sichuan Province after Sichuan earthquake. The aim of the study was to retrospectively analyze the efficacy and feasibility of the trans-province transfer of the multiple trauma patients after Sichuan earthquake. Methods: A retrospective and descriptive analysis was conducted based on the medical records of the multiple trauma patients (ISS ≥ 16) transferred to the Grade 3A hospitals outside Sichuan province. The patients were divided into two groups based on the distance to Sichuan province, i.e., Group A (the seismic patients transferred to Chongqing) and Group B (the seismic patients transferred to the other provinces/ municipalities). A comparison was done in aspects of distance of transfer, time from injury to transfer, vital signs, the infection rates (at transfer and on discharge), injury severity and prognostic indices (cure rate, disability rate and mortality). Results: The distance between Chengdu and the other places was at a wide range of 313 - 1653 km, whereas the time from injury to transfer showed no statistical difference between groups (P > 0.05). There were no significant differences between both groups with respects to patient demographics, injury mechanism, time from injury to transfer, vital signs, infection rate and injury severity. The prognostic indices showed no significant difference, except for FIM scores (P < 0.05). Conclusions: The results of the study indicate that the different distance of the transfer of the multiple trauma patients does not aggravate the severity or deteriorate the prognosis, which proves that the medical supportive transfer system is acceptable, effective and worthy of further implementation in China, which may be ascribed to the advanced transportation system and high level of therapeutic capacity of the hospitals. In the meantime, attention should be paid to psychological intervention and functional rehabilitation during the treatment of the transferred seismic patients.

Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study.

ObjectiveTo evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA).MethodsA total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2 on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).ResultsThe experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT.ConclusionIt is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.

Do Falls Experienced During Inpatient Stroke Rehabilitation Affect Length of Stay, Functional Status, and Discharge Destination?

ObjectiveTo compare length of stay, functional status, and discharge destination between individuals who fell during inpatient stroke rehabilitation and those who did not fall. DesignRetrospective cohort study. SettingRehabilitation hospital. ParticipantsIndividuals who fell during inpatient stroke rehabilitation (n=106; fallers group; mean age, 67.8±12.9y; mean time poststroke, 26.4±28.3d) were matched to individuals who did not fall (n=106; nonfallers group; mean age, 67.3±13.6y; mean time poststroke, 21.9±28.8d) on age and functional status (N=212). InterventionsNot applicable. Main Outcome MeasuresTotal length of stay, FIM assessed at discharge, and discharge destination. ResultsThe mean length of stay for fallers was 11 days longer than nonfallers (P=.0017). Nonfallers and fallers did not differ on discharge total FIM scores (P=.19), and both groups were discharged home after inpatient rehabilitation (nonfallers: 77%; fallers: 74%; P=.52). ConclusionsThis study suggests that falls experienced during inpatient stroke rehabilitation may have contributed to a longer length of stay; however, falls did not affect discharge functional status or discharge destination.

Functional Outcome in Paraplegic Patients from Spinal Cord Injury

Background: Patients with Spinal Cord Injuries (SCI) are confronted with motor and sensory deficits as well as bladder, bowel and sexual dysfunction, which lead to a fundamental change of life. Because of the extensive medical, emotional and social consequences of the SCI, multidisciplinary management is essential. This study focuses on the functional outcome after a spinal cord injury.Methods: This was an observational study done during a period of 6 months from July 2007 to December 2007 among paraplegic spinal cord injured patients, admitted in the Neurosurgery Department and attended in the Department Physical Medicine and Rehabilitation, Chittagong Medical College, Chittagong. A total of 50 patients were selected for the study. Sampling technique was purposive and different scores and followup findings were collected and analyzed by Statistical Package for Social Science (SPSS-15) P value &lt; 0.05 was considered as significant.Results: Mean age of study population was 32.7 years with all patients were between 18 to 55 years age range. Male and female ratio was 9:1. Maximum respondents were day labourer 36.0%, followed by 34.0% other different types of occupation, 10.0% business man, 8.0% service holder, 8.0% housewife and 4.0% student. Fall from height was the major cause of spinal cord injury of the present study group followed by Road Traffic Accident (RTA). Out of all patients 50.0% had urinary incontinence, 44.0% hadbowel incontinence, 46.0% had spasticity, 34.0% had hypotension and 4.0% had bed sore. At pretreatment stage mean (±SD) FIM score of the patients was 92.5 and discharge 107.32. (p &lt;0.05). Spasticity of the patients was 2.6±1.55 at pretreatment stage and after six weeks of treatment mean (±SD) spasticity was reached at 1.96±1.07 (p &lt;0.05). Visual analog scale was used to measure the severity of the pain. At pretreatment stage mean (±SD) pain score of the patients was 5.7±1.07 after six weeks of treatment mean (±SD) pain score was reached at 2.2±0.88 (p &lt;0.05). At pretreatment stage mean (±SD) ASIA score of the patients was 3.0±0.81. After one week of treatment mean (±SD) ASIA score was reached at 3.12±0.72 and after six weeks at 3.38±0.69. ANOVA test was revealed statistical significant difference among groups in term of ASIA score of different treatment stages (F value=3.42, p value =0.035).Conclusion: For SCI rehabilitation program like physical therapy, occupational therapy, orthosis, gait retraining and management of complications make significant improvement in the term of FIM score, ASIA score, muscle weakness pain and spasticity which is proved by current study. So rehabilitation program is the only hope of spinal cord injury patients and physiatrist have important role to achieve the goals of functional outcome in paraplegic patient from spinal cord injury.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 52-56

Construct Validity of the SCI-QOL Trauma Item Bank

important difference (MCID) on at least one of 19 objective measures (e.g. Timed Up-and-Go). Results: Participants mean age was 61.7 (12.7) years, and were 45% female. Subjects attended 9.3(1.7) visits and traveled 11.3(6.6) miles to clinic. Mean CCI score was 5.8(2.4); mean FIM score was 13.4(5.1). Subjects took a mean 7.7(5.4) medications, were 7.9(10.1) years post. Frequency of achieving MDC/MCID was 69.7%. Variables associated with achieving MDC/MCID were CCI (OR 1.06 (1.01, 1.11), pZ0.02) and number of visits (OR 1.04 (1.01, 1.08), pZ0.02). Conclusions: A weekly student run clinic was associated with achieving MDC or MCID in patients with chronic stroke, MS or TBI.

Effect of a rehabilitation program using virtual reality for balance and functionality of chronic stroke patients

AbstractThis study aimed to investigate the effect of a rehabilitation program using virtual reality (VR) in addition to conventional therapy for improvement of balance (BERG scale) and functional independence (FIM scale) in chronic stroke patients. Ten individuals, mean age of 51.4 (± 6.7 years), participated of eight 60-minute sessions comprising kinesiotherapy (15min), Nintendo Wii (30min) and Learning transfer (15min) exercises. After training, nonparametric statistical analysis showed significant improvement in total FIM (p= .01) and BERG scores (p= .00), and in some of their subitems: FIM - dressing lower body (p= .01), transfer to bathtub/shower (p= .02) and locomotion: stairs (p= .03); BERG - reaching forward with outstretched arm (p= .01), retrieving object from the floor (p= .04), turning 360º (p= .01), placing alternate foot on step (p≤ .01), standing with one foot in front (p= .01), and one leg stand (p= .03). These findings suggest a positive influence of virtual reality exercises adjunct to conventional therapy on rehabilitation of balance and functionality post stroke, and indicate the feasibility of the proposed VR-based rehabilitation program.

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.

Cancer Rehabilitation: Do Functional Gains Relate to 60 Percent Rule Classification or to the Presence of Metastasis?

BackgroundLiterature supporting the benefits of inpatient rehabilitation for cancer patients is increasing. Many cancer patients, however, do not qualify for inclusion in the Centers for Medicare and Medicaid 60% rule and consequently may not receive services. The benefit of inpatient rehabilitation in this specific cancer group has not been investigated and is the focus of this study. ObjectiveTo investigate functional gains made during inpatient rehabilitation by patients impaired by cancer, and to compare the functional gains made during inpatient rehabilitation for patients impaired by cancer in relation to the presence or absence of metastatic disease and compliance or noncompliance with the Medicare 60% rule. SettingFreestanding university-affiliated rehabilitation hospital. ParticipantsA total of 176 adult patients admitted for inpatient rehabilitation due to cancer. MethodsRetrospective chart review of patients admitted for inpatient rehabilitation with deficits identified related to cancer. Main Outcome MeasuresDemographic data including cancer type, presence of metastasis, age, gender, marital status, ethnicity, length of stay (LOS), discharge destination, and transfer to acute care. Functional status including admission and discharge Functional Independence Measure Score (FIM), total, motor, and cognitive FIM gains, total, motor, and cognitive FIM efficiency for the study sample, for patients with and without a diagnosis compliant with the 60% rule and for patients with and without metastatic disease. ResultsIn all, 176 cases met inclusion criteria. An admission coded diagnosis that was compliant with the 60% rule was present in 97 cases (55.1%). In 153 cases, the presence or absence of metastatic disease was known. Metastatic disease was present in 69 cases (45%). All groups (total sample, metastatic versus nonmetastatic, compliant versus noncompliant) made significant functional gains. Patients with a diagnosis noncompliant with the 60% rule had higher admission total FIM (P = .001), discharge total FIM (P = .014), admission motor FIM (P = .005), admission cognitive FIM (P = .008), and discharge cognitive FIM (P < .001) scores than those with a compliant diagnosis. Patients with metastatic disease had higher admission total FIM (P = .026) and admission (P = .001) and discharge (P = .02) cognitive FIM scores than patients with nonmetastatic disease. There were no significant differences between groups regarding total, motor, or cognitive FIM gains or total motor or cognitive FIM efficiencies. Differences in age, length of stay, and admission motor and discharge FIM scores between groups were related to cancer types and source of impairment. ConclusionPatients with functional limitations resulting from cancer or its treatment made significant functional gains in inpatient rehabilitation. There were no significant differences in functional gains made by those with or without metastatic disease or those compliant versus noncompliant with the 60% rule. The presence of metastatic disease or a diagnosis not compliant with the 60% rule does not preclude cancer patients from making significant functional gains.

Impact of caring for children with medical complexity and high resource use on family quality of life.

This study examined the impact of caring for children with medical complexity (CMC) and high resource use on family quality of life (QoL). Families of CMC enrolled in a complex care program completed the PedsQL Family Impact module (PedsQL FIM) and Healthcare Satisfaction module (PedsQL HCS) at enrollment then 1 and 2 years after enrollment. Tertiary center resource utilization and staff care coordination time were collected for the two years. PedsQL FIM scores were low at enrollment and did not improve over time. Social Functioning, Worry, and Daily Activities were the lowest domains. PedsQL HCS scores were higher at enrollment, but also failed to improve over the two years. Changes in resource use were not associated with changes in PedsQL FIM or HCS scores. Staff care coordination time was highest for patients with ≥ 10 hospital days per year. CMC families' low QoL did not appear to be related to healthcare satisfaction or a shift from inpatient to outpatient resource use. Less staff support for families of CMC who spent more time at home may have contributed to their continued low QoL. Further study is required to identify causes of and strategies for improving the low QoL of families of CMC.