Free-standing Rehabilitation Hospital Research Articles

Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant

ObjectiveTo describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital. DesignA retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency. SettingA freestanding rehabilitation hospital. Participants107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years. InterventionsAcute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services. Main Outcome MeasureFIM Change, FIM Efficiency, Discharge Disposition. ResultsParticipants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community. ConclusionAcute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.

Delirium following traumatic brain injury in adolescents: Symptomatology and prediction of ability to return to school or employment 1-year post-injury.

There is a limited evidence-base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, or the degree to which delirium impacts the ability of adolescents to return to school or work. To describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability 1 year post-injury was also examined. Exploratory secondary analysis of prospectively collected data. Free-standing rehabilitation hospital. Severely injured TBI Model Systems neurorehabilitation admissions (n = 243; median Glasgow Coma Scale = 7). The sample was divided into three age groups (adolescents, 16-21 years, n = 63; adults 22-49 years, n = 133; older adults ≥50 years, n = 47). Not applicable. We assessed patients using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria and the Delirium Rating Scale-Revised 98 (DRS-R-98). The employability item from the Disability Rating Scale was the primary 1-year outcome. Most items on the DRS-R-98 differentiated delirious from non-delirious adolescents. Only "delusions" differed among age groups. Among adolescents, delirium status 1 month post-TBI provided acceptable classification of employability prediction 1 year later (area under the curve [AUC]: 0.80, 95% confidence interval [CI]: 0.69-0.91, p < .001). Delirium symptom severity (AUC: 0.86, 95% CI: 0.68-1.03, SE: 0.09; p < .001) and days of post-traumatic amnesia (AUC: 0.85, 95% CI: 0.68-1.01, SE: 0.08; p < .001) provided excellent prediction of outcomes for TBI patients in delirium. Delirium symptomatology was similar among age groups and useful in differentiating the delirium status within the adolescent TBI group. Delirium and symptom severity at 1 month post-TBI were highly predictive of poor outcomes. Findings from this study support the utility of DRS-R-98 at 1 month post-injury to inform treatment and planning.

Naloxone-Prescribing Practices in a Freestanding Rehabilitation Hospital.

The study aims to determine whether Physical Medicine & Rehabilitation physicians offer naloxone per the Centers for Disease Control and Prevention Guidelines to patients at the highest risk of complications from opioid treatment and whether there is a difference between inpatient and outpatient naloxone prescribing. A retrospective chart review on 389 adults (outpatient n = 166; inpatient n = 223) from May 4 to May 31, 2022, at an academic rehabilitation hospital. Prescribed medications and comorbidities were evaluated to determine whether Centers for Disease Control and Prevention criteria for offering naloxone were met and whether naloxone was offered. One hundred twenty-nine opioid prescriptions were written for 102 outpatients; 61 qualified for naloxone (morphine milliequivalent range = 10-1080, mean = 158.08). On inpatient, 68 patients received 86 opioid prescriptions; 35 qualified for naloxone (morphine milliequivalent range = 3.75-246, mean = 62.36). Overall, there was a significantly lower rate of opioid prescriptions for inpatients (30.49%) than outpatients (61.45%) ( P < 0.0001), a nonsignificant lower rate of inpatient (51.47%) than outpatient (59.80%) "at-risk" prescriptions ( P = 0.351), and a weakly significant lower rate of naloxone prescribing for inpatient (2.86%) than outpatient visits (8.20%) ( P < 0.0519). At this rehabilitation hospital, there was a low rate of naloxone prescribing by inpatient and outpatient providers, with a higher rate occurring in the outpatient than inpatient setting. More research is needed to understand this prescribing trend to determine potential interventions.

Does What I Say Matter? Influence of Verbal Instruction on Bolus Size: Pilot Data

<h3>Research Objectives</h3> To evaluate the effects, if any, verbal instructions and delivery method may have on bolus size with self-administration of thin liquids. <h3>Design</h3> Prospective, randomized, repeated measure study. <h3>Setting</h3> Freestanding rehabilitation hospital. <h3>Participants</h3> Convenience sample of healthy adults with no history of dysphagia. <h3>Interventions</h3> Subjects were randomized into either the cup or straw group. Each subject consumed eight boluses of water under four different instructions: 1) Take a drink; 2) Take a comfortable sip; 3) Take a small sip: 4) Take a small sip like it is hot coffee. Order of instructions was randomized. Each subject had eight cups prepared (4 cups 60-ml water in 120-ml cup; 4 cups120-ml water in 240-ml cup). Subjects received new cup for each drink instruction. Ratio of liquid to cup size was the same between two cup sizes. <h3>Main Outcome Measures</h3> Bolus size extrapolated from weight of cup / water before and after each administration. <h3>Results</h3> Ten healthy subjects (5 men; 5 women), age range 22-58 years, mean age 39.3 years (SD=11.4 years) participated in the study. Overall, the differences between the mean volume consumed using various instructions were statistically significant (take a drink=28.80 ml; comfortable sip=14.35 ml; small sip=5.3 ml; small sip like it is hot coffee=3.01 ml; F=22.51, p≥.0001). Differences in mean volume consumed by cup size (i.e., 4-ounce cup vs. 8-ounce cup) were not statistically significant (p=.581). Differences in mean volume consumed by straw or cup presentation were not statistically significant (p=.914). <h3>Conclusions</h3> Results suggest verbal instruction has an influence upon bolus size with healthy adults with the semantic cue instruction (hot coffee) resulting in the lowest volume consumed. No differences were observed in amount consumed by cup size or straw vs. cup presentation. Reducing bolus size is a common clinical strategy to eliminate or reduce aspiration. It is important for the dysphagia rehabilitation team to understand the influence verbal instructions may have upon bolus size to facilitate a safe swallow. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interests to disclose.

Acceptability and Tolerance of Virtual Reality for Upper Extremity Rehabilitation after Stroke in Inpatient Rehabilitation.

<h3>Research Objectives</h3> To evaluate acceptability of 3-dimensional virtual reality (3dVR) technology for upper extremity weakness after stroke. <h3>Design</h3> Prospective, single center, pilot study. <h3>Setting</h3> Freestanding rehabilitation hospital. <h3>Participants</h3> Participants referred by occupational therapists. Inclusion criteria:18 years or older; ischemic or hemorrhagic stroke within 3 months; Fugl-Meyer of ≥14; follow commands; maintain upright sitting; and BIMS score of ≥7. Exclusion criteria included non-stroke related upper extremity weakness; history of seizures/epilepsy; history of orthopedic shoulder injury; Modified Ashworth scale >2 upper extremities; active cyber sickness symptoms; vestibular issues; contact isolation; legal blindness; and pregnancy. <h3>Interventions</h3> Clinical staff trained with 3dVR system implemented task specific protocol as part of standard care. Enrolled subjects received 6 thirty minutes 3dVR sessions adjunctive to standard therapy. 3dVR sessions were customized with modifications to ensure appropriate challenge. Post treatment, participants responded to questions regarding safety. After six sessions, participants reassessed with clinical outcome measures. <h3>Main Outcome Measures</h3> Acceptability assessed with 7-point Likert questionnaire; safety with Simulator Sickness Symptomology questionnaire; clinical outcomes using Care Tool, UE Fugl-Meyer, and Patient Specific Functional Scale (PSFS). <h3>Results</h3> : Eleven participants enrolled with six completing the protocol. Five subjects were discharged prior to completion of protocol, their partial data has been synthesized. Age range 53-82 years [Mean=65.6; SD±11.27], with sex distribution 36.36% male/ 63.64% female. Average onset time of stroke to enrollment 7.82 days. Participants who completed the protocol, average Fugl-Meyer change score was 11.67; PSFS increased by 3.81; Care Tool change 15.99. Single participant experienced dizziness with intervention, however overall patients tolerated 3dVR. <h3>Conclusions</h3> The pilot data revealed relatively good tolerance for 3dVR therapy with majority experiencing no adverse effects. Preliminary data shows promise; however, further research is needed with a larger sample size to confirm pilot data. <h3>Author(s) Disclosures</h3> The authors of this pilot study have no disclosures to declare.

Occupational injuries and patient lift usage among physical rehabilitation therapists

Physical therapists (PTs) and physical therapist assistants (PTAs) are at high risk for work-related musculoskeletal pain and discomfort. Determine the prevalence and exposure risk factors for work-related injuries (WRIs) among rehabilitation PTs and PTAs. A cross-sectional research survey was conducted among 170 PTs and 67 PTAs at 51 free-standing rehabilitation hospitals and rehabilitation units embedded in general hospitals in the Midwestern states of Iowa, Kansas, Missouri and Nebraska. The prevalence of WRIs and significant risk factors for developing WRIs were determined for PTs and PTAs. The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 29.5%. Multifaceted causes were identified including frequently bending/twisting, over-exerting force during patient handling activities, inadequate lifting devices, and lack of ongoing training for mechanical lifting device usage. Equipment usage barriers point to a critical need for technology creation, research, and education to advance worker safety while simultaneously enhancing patient outcomes.

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.

The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury.

Evidence of the effect of comorbid spinal cord injury (SCI) on cognitive outcomes in persons undergoing rehabilitation following newly diagnosed traumatic brain injury (TBI) is limited. We conducted a population-based study to investigate this effect. To compare cognitive outcomes in patients with TBI with and without a comorbid SCI. Adult patients diagnosed with TBI were identified and followed for 1 year through provincial health administrative data; those who entered inpatient rehabilitation were studied. A retrospective matched cohort study using the National Rehabilitation Reporting System data of all acute care and freestanding rehabilitation hospitals in Ontario, Canada. The exposure was a comorbid SCI in patients with diagnosed TBI. Exposed patients were matched to unexposed (TBI-only) on sex, age, injury severity, and income, in a ratio of one to two. Gain differences in the cognitive subscale of the Functional Independence Measure were compared between exposed and unexposed patients using multivariable mixed linear model, controlling for comorbidity propensity score, gains in motor function, and rehabilitation care indicators. Over the first year post injury, 12 750 (0.84%) of all TBI patients entered inpatient rehabilitation, of whom 1359 (10.66%) had a comorbid SCI. A total of 1195 exposed patients (65.4% male, mean age 50.9 ± 20.6 for male and 61.8 ± 21.8 for female patients) were matched to 2390 unexposed patients. Controlling for confounding, exposed patients had lower cognitive gain (beta -0.43; 95% CI -0.72, -0.15), for both male (beta -0.39; 95% CI -0.75, -0.03) and female (beta -0.51; 95% CI -0.97, -0.05) patients. The adverse effects of comorbid SCI were driven largely by lower gains in problem solving and comprehension. Adult patients with TBI and comorbid SCI showed a lower cognitive domain response to inpatient rehabilitation than patients with TBI alone. Identifying patients at risk for worse cognitive outcomes may facilitate the development of targeted strategies that improve cognitive outcomes.

The Vital Role of Inpatient Rehabilitation Facilities in a Large Health System

The current COVID-19 pandemic has put the global health-care system into an unprecedented crisis, leaving hospitals overwhelmed and desperate for additional capacity. As of April 20th, 2020, New York State had the most COVID-19 cases in the US. We here describe the process of transforming our freestanding rehabilitation hospital to help to create additional capacity for our parent system, the Montefiore Health System. This transformation required creating a capacity to handle an increased number of patients with higher medical complexity. The sequence of steps taken at Burke Rehabilitation Hospital to rise to the challenge is outlined in this article.

The Effect of Body Mass Index on Pulmonary Related Debility Rehabilitation.

Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF). To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital. Retrospective cohort study. Pulmonary unit in an acute freestanding rehabilitation hospital. All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period. The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge). The primary study outcome measure was the change in FIM per day by the patients' BMI category. For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05). This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation. III.

Adverse Event Profiles of High Dose Botulinum Toxin Injections for Spasticity.

Botulinum toxin injections are effective in relieving focal spasticity resulting from upper motor neuron injuries. Doses approved in the United States for onabotulinumtoxinA and incobotulinumtoxinA are up to 400 units, yet higher doses are often used. To determine differences in risk of adverse events when using higher (>600 units) as compared to lower doses within clinically applicable categories; the difference in adverse events between types of botulinum toxin-A, and any association of the injection of cervical muscles with increased risk for adverse events. Retrospective analysis of injections performed over a 3-year period at a freestanding rehabilitation hospital network. Persons with spasticity or dystonia undergoing ona- and/or incobotulinumtoxinA injections. Not applicable. Adverse events for injections were divided into the three dose ranges (≤400 units, 401-600 units, or > 600 units). 889 injections in 342 patients met inclusion criteria with 65% ≤400 units, 21% 401-600 units, and 14% >600 units. Adverse events were not significantly increased in doses of 401-600 units relative to ≤400 units (OR 0.97, 95% CI 0.31, 2.98). Doses of toxin over 600 units were associated with significantly increased relative risk of adverse events (OR 2.98, 95% CI 1.12, 8.13). There were no significant differences between adverse event rates for onabotulinumtoxinA or incobotulinumtoxinA (P >.99). Inclusion of cervical muscles in isolation did significantly increase the risk of adverse events (OR 4.21, 95% CI 1.15, 15.46). Risk for adverse events were not significantly increased in doses of ona- and/or incobotulinumtoxinA up to 600 units, suggesting that the current 400 units upper bound of approved dose may need to be reexamined. Doses above 600 units were found to increase the rate of adverse effects and clinical benefit versus risk should be taken into account. III.

The minimal clinically-important difference of the Prosthesis Evaluation Questionnaire - Mobility Scale in subjects undergoing lower limb prosthetic rehabilitation training.

There is increasing interest in psychometrically sound outcome measures of mobility for people with lower limb amputation (LLA), in order to accurately monitor the impact of the prosthetic training during and after rehabilitation. To determine the minimum detectable change (MDC) and minimal clinically important difference (MCID) for the Prosthesis Evaluation Questionnaire-Mobility Scale (PEQ-MS) in people with LLA. Prospective single-group observational study. Two free-standing Rehabilitation Hospitals. Eighty-seven adult inpatients with LLA undergoing prosthetic rehabilitation. Patients completed the self-report PEQ-MS twice, immediately before and after prosthetic rehabilitation training. We administered a 7-point Global Rating of Change scale at the end of training as external anchor, to quantify the effect (improvement/deterioration) of the intervention. Test-retest reliability of the PEQ-MS (N.=24) was high (ICC2,1=0.90). The MDC at the 95% confidence level was 5.5 points. This value, together with those of the mean-change approach and receiver-operating characteristic-curve analysis (AUC>0.89), suggested the selection of a MCID for PEQ-MS of eight points of change, i.e. 16.7% of the maximum possible score (95% CI: 6.5-9.5). The PEQ-MS showed a high ability to detect change over time (responsiveness).The above MCID value - derived from a triangulation of distribution (MDC) and anchor-based methods - represents a minimal level of change (perceived as important by the patient) in mobility of people with LLA undergoing prosthetic rehabilitation training. The PEQ-MS is a widely used and analyzed outcome measure. The present study calculated - in a sample of people with LLA undergoing prosthetic training - both the MDC and MCID of the PEQ-MS, showing the high responsiveness of this tool. These values increase confidence in interpreting change in PEQ-MS values, and can help in clinical decision making.

The Effect of Environmental Changes on Hospital Employee Walking Duration

PURPOSE: Employee health is known to be associated with work-related physical exertion. The objectives of this study were to assess the effect on employee daily steps taken by transitioning a free-standing rehabilitation hospital to a larger facility and to compare step count differences across age, sex, and occupations. METHODS: Data from personal fitness devices linked to an employer-sponsored wellness program assessed the number of steps taken in two specific months (July and November) in the year prior to and in the year following the move to a rehabilitation facility three-times the size of the original. Participant data were only included for those enrolled in the program in these specific months pre- and post-move. Daily step counts accounted for activity both during and outside of work. RESULTS: Participants (n=70) had significantly less average daily steps for both July (9708 steps vs. 8008 p=0.02) and November (8839 vs. 7779 p=0.006) following the move to the new rehabilitation facility. Groups with significant step reduction included women compared to men (p=0.03), those aged 21-35 years (p=0.03), and the occupations of health care assistants (HCAs) and nursing (p=0.01), for both months. However, medical providers (physicians and nurse practitioners) had a trend towards increased step counts, regardless of age group or sex. CONCLUSION: Transitioning a rehabilitation facility to a larger building does not necessarily lead to increased employee work-related physical activity. In our study, the transition to a larger facility was associated with a reduction in employee daily steps taken with relation to age, gender, and occupation. These findings may reflect strategic planning within the new workspace, which optimizes efficiency specifically for nurses and HCAs, allowing occupational duties to be confined to a smaller area. This could lead to employees having less daily work-related physical exertion, although this will be investigated further in future studies.

Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: Changes in provider knowledge, self-efficacy and practice.

BackgroundThe Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians’ knowledge, self-efficacy, and practice related to implementing CO-OP.MethodsA single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares.ResultsSixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).

Gait Impairments in Patients Without Lower Limb Hypertonia Early Poststroke Are Related to Weakness of Paretic Knee Flexors

ObjectiveTo describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function. DesignCohort study. SettingMotion analysis laboratory in a tertiary-care free-standing rehabilitation hospital. ParticipantsConsecutive sample of 73 eligible inpatients (first-known stroke <2 months postonset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls (N=100). InterventionsNot applicable. Main Outcome MeasuresGait speed, stride and step lengths and cadences, stance time, single-support and double-support times, and associated symmetry measures in patients at self-selected normal speed and controls at very slow speed (51.1±32.6 cm/s and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion and extension strength in patients. ResultsExcept the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than nonparetic limb. Most temporospatial parameters moderately to strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004). ConclusionsGait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early poststroke.

The Effect of Body Mass Index on Rehabilitation of Patients with Amputation

ABSTRACT Introduction This retrospective cohort study was designed to investigate the association between body mass index (BMI) and the functional progress of 327 consecutive patients with amputation admitted to the amputee unit of a freestanding acute care rehabilitation hospital between January 2000 and April 2006. Methods Data were analyzed during the period of January 2000 to April 2006 from all previously amputated patients admitted and discharged from an acute freestanding rehabilitation hospital. Data were retrieved from the medical record including diagnosis, height, and weight measured before amputation, functional independence measurements (FIMs) scored on admission and discharge, and the length of rehabilitation hospitalization. Results After adjusting for age, sex, and length of stay, the FIM gain per day was the highest among those in the obese class I, followed by those in obese class III and the underweight group. Conclusions In patients undergoing rehabilitation after amputation, FIM gain per day is not significantly associated with BMI. Thus, obese patients can expect to have functional gains that are similar to patients with normal BMI after amputation.

Translating evidence into action: An intervention for increasing vitamin D supplementation in a deficient rehabilitation population

Introduction/Background Inadequate vitamin D is highly prevalent, affecting approximately 42-77% of the general United States population. Vitamin D deficiency (VDD) increases the risk of osteoporosis, falls, and fractures. Acute inpatient rehabilitation patients have several risk factors for VDD, and the adverse effects of VDD may hinder long-term functional gain. Material and method Prospective cohort study, evaluating patients admitted before and after a screening intervention as part of a quality improvement initiative at an academic, freestanding acute inpatient rehabilitation hospital. This study included a convenience sample of patients admitted two months pre-intervention (n = 128), and patients admitted two months post-intervention (n = 129). Providers obtained a routine serum vitamin D level on admission (universal screening), then utilized a standard supplementation protocol. Vitamin D insufficiency (VDI) was defined as a 25-hydroxyvitamin D (25(OH)D) level of 20–29.9 ng/mL, and VDD as Results Pre-intervention, 10.2% of patients were screened for VDD, with 23.1% found to be VDI and 46.2% VDD. Post-intervention, 89.9% of patients were screened, with 31.9% found to be VDI and 47.4% VDD. Pre-intervention, 88.9% of all screened patients were on vitamin D supplementation at discharge versus 75.0% post-intervention. In both uni- and multivariate analyses, we found increased risk of VDD was significantly associated with African American race (OR 7.3, 95% CI, 1.56–34.2, P = 0.12) and age younger than 65 (OR 13.6, 95% CI, 2.5–73.8, P = 0.002). Diagnoses in the “other neurologic” category were associated with decreased risk of VDD (OR 0.01, 95% CI, 0.001–0.193, P = 0.002). Conclusion Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may be a good practice to improve quality of care.

A Tale of Two Cities: Evolution of Academic Physiatry in Boston and Baltimore: Part 1: The Boston Marathon

A Tale of Two Cities: Evolution of Academic Physiatry in Boston and Baltimore: Part 1: The Boston Marathon

Mobility Device Quality Affects Participation Outcomes for People With Disabilities: A Structural Equation Modeling Analysis

ObjectiveTo test the effect that indicators of mobility device quality have on participation outcomes in community-dwelling adults with spinal cord injury, traumatic brain injury, and stroke by using structural equation modeling. DesignSurvey, cross-sectional study, and model testing. SettingClinical research space at 2 academic medical centers and 1 free-standing rehabilitation hospital. ParticipantsCommunity-dwelling adults (N=250; mean age, 48±14.3y) with spinal cord injury, traumatic brain injury, and stroke. InterventionsNot applicable. Main Outcomes MeasuresThe Mobility Device Impact Scale, Patient-Reported Outcomes Measurement Information System Social Function (version 2.0) scale, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities, and the 2 Community Participation Indicators' enfranchisement scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected. ResultsRespondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating effect on participation outcomes, with 3 device quality variables (repairability, ease of maintenance, device reliability) accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than did ambulation aid users. ConclusionsMobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable.

Use of Accelerometers to Assess Upper-Extremity Motor Performance Following Stroke: A Pilot Study

Abstract Date Presented 4/9/2016 The poster will discuss the results of a pilot study conducted in a free-standing rehabilitation hospital investigating the relationship between hemiplegic arm use after stroke measured in the clinic versus measurement of arm use in the home setting by wrist accelerometers. Primary Author and Speaker: Rahsaan Holley Additional Authors and Speakers: Neepa Shah, Evan Chan, Peter Lum