Functional Independence Measure Scale Research Articles

FUNCTIONALITY OF UPPER GASTROINTESTINAL CANCER PATIENTS WHICH HAVE UNDERTAKEN SURGERY IN HOSPITAL PHASE.

ABSTRACTBackground: Cancer patients present various physiological, metabolic, social and emotional changes as a consequence of the disease’s own catabolism, and may be potentiated in the gastrointestinal tract cancer by their interference with food intake, digestion and absorption. Aim: To evaluate the functionality of upper gastrointestinal cancer patients which have undertaken surgery and analyze the factors associated with changes in strength and functionality during hospitalization time. Methods: Prospective analytical study in patients with cancer of the upper gastrointestinal tract which have undertaken surgery. Was evaluated the handgrip strength using a hand dynamometer and functionality through the functional independence measure and Functional Status Scale for Intensive Care Unit in the preoperative period, 2nd and 7th postoperative day. Results:Were included 12 patients, 75% men, and mean age was 58.17 years old. The most prevalent tumor site was stomach (66.7%). There was a progressive reduction from the pre-operative palmar grip strength to the 2nd and 7th postoperative day, respectively. There was a decrease in functional performance from the preoperative period to the 2nd and a gain from the 2nd to the 7th postoperative day (p<0.001). Conclusion: An important reduction in the handgrip strength and functionality was evidenced during the postoperative period in relation to the basal value in the pre-operative period.

Reducing redundant testing using the Functional Independence Measure and Early Functional Abilities scale during rehabilitation in patients with brain injury

ABSTRACTPrimary objective: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury.Methodology: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion.Results: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time.Conclusions and implications: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress.

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

ABSTRACTObjective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS could range from 0 to 100% disability risk.Results: The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups.Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.

Level of independence, functional capacity and respiratory muscle strength of patients with mucopolysaccharidosis type VI in the Northeast of Brazil

Abstract Objectives: to assess the functional independence, functional capacity and respiratory muscle strength (RMS) in individuals with mucopolysaccharidosis (MPS) type VI. Methods: in this cross-sectional study, the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure (FIM) scales were used to assess the functional independence. The functional capacity and the RMS were assessed by a 6-minute walk test (6MWT) and Manovacuometry, respectively. The associations between RMS and 6MWD were analyzed by using the adjusted simple linear regression models. And besides, the T-test was used to compare the differences among the groups. Results: twenty-four patients with MPS VI were included, the median age was 8 (ranged from 2-38 years old). The PEDI presented a functional performance below the expectations at the self-care and mobility domains of 33.3% when compared to groups of Brazilian children at the same age assessed with typical development. The decreased social function was found in only one single case. According to the FIM, of the 12 patients evaluated (age&gt; 7.5 years), 58.3% were classified as modified dependence and 41.7% as modified independence. The mean distance in the 6MWT was significantly lower than predicted, 263m in G1 (children, n= 7) and 336m in G2 (adolescents and adults, n=6), p&lt;0.001. The RMS was also lower than predicted in both groups, except for the RMS in G1. Conclusions: the functional capacity and the RMS were significantly reduced in individuals with MPS VI, with a decreased functional independence in one-third of the patients. However, a multidisciplinary follow-up in this population is essential to prevent, diagnose and treat early complications.

Functional outcomes of thoracic injuries in pediatric and adult occupants

ABSTRACTObjective: To develop a disability metric for motor vehicle crash (MVC) thoracic injuries and compare functional outcomes between pediatric and adult populations.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank (NTDB) for the top 95% most frequently occurring AIS 2, 3, 4, and 5 thoracic injuries in NASS-CDS 2000–2011. The NTDB contains a truncated form of the FIM score, including three items (self-feed, locomotion, and verbal expression), each graded from full functional dependence to full functional independence. Pediatric (ages 7–18 years), adult (19–45), middle-aged adult (46–65), and older adult (66+) MVC occupants were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each injury within each age group by dividing the number of patients who were disabled that sustained the specific injury by the number of patients who sustained the specific injury. To account for the impact of more severe co-injuries, a maximum Abbreviated Injury Scale (MAIS) adjusted DR (DRMAIS) was also calculated. DR and DRMAIS could range from 0 (0% disability risk) to 1 (100% disability risk).Results: The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, rib fracture, and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups.Conclusions: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can impact future age-specific modifications to AIS.

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study.

In the last decade robotic devices have been applied in rehabilitation to overcome walking disability in neurologic diseases with promising results. Robot assisted gait training (RAGT) using the Lokomat seems not only to improve gait parameters but also the perception of well-being. Data on the psychosocial patient-robot impact are limited, in particular in the real-world of RAGT, in the rehabilitation setting. During rehabilitation training, the Lokomat can be considered an “assistive device for movement”. This allowed the use of the Psychosocial Impact of Assistive Device Scale- PIADS to describe patient interaction with the Lokomat. The primary aim of this pilot study was to evaluate the psychosocial impact of the Lokomat in an in-patient rehabilitation setting using the PIADS; secondary aims were to assess whether the psychosocial impact of RAGT is different between pathological sub-groups and if the Lokomat influenced functional variables (Functional Independence Measure scale–FIM and parameters provided by the Lokomat itself). Thirty-nine consecutive patients (69% males, 54.0±18.0 years) eligible for Lokomat training, with etiologically heterogeneous walking disabilities (Parkinson’s Disease, n = 10; Spinal Cord Injury, n = 21; Ictus Event, n = 8) were enrolled. Patients were assessed with the FIM before and after rehabilitation with Lokomat, and the PIADS was administered after the rehabilitative period with Lokomat. Overall the PIADS score was positive (35.8±21.6), as well as the three sub-scales, pertaining to “ability”, “adaptability” and “self-esteem” (17.2±10.4, 8.9±5.5 and 10.1±6.6 respectively) with no between-group differences. All patients significantly improved in gait measure and motor FIM scale (difference after—before treatment values: 11.7±9.8 and 11.2±10.3 respectively), increased treadmill speed (0.4 ± 0.2m/s), reduced body weight support (-14.0±9.5%) and guidance force (-13.1 ± 10.7%). This pilot study indicates that Lokomat, in a real-world in-patient setting, may have a generalised approval, independent of disease, underlining the importance of the psycho-social framework for patients training with assistive robotic-devices.

Surgical Management of Myelomeningocele-Related Spinal Deformities.

To evaluate the optimal timing and type of surgical treatment of myelomeningocele (MMC)-related spinal deformities and long-term follow-up of surgical treatment. We reviewed and presented clinical pictures, treatment strategies and results of 20 patients with MMC-related spinal deformities treated at our center between 2010 and2017. The average patient age was 6.3 years. The average preoperative neurologic status according to a modified Japan Orthopedic Association (mJOA) scale was 7.3 points (Benzel's modification). Average functional status was 41 points according to a functional independent measure scale (FIM). The average angle of kyphosis was 83.7°, that of scoliosis was 36.7°, and that of lordosis was 67° (Cobb angles). The average duration of surgery was 234 minutes, and the average total blood loss was 175 mL. The average angle of kyphosis correction was 61°, that of scoliosis correction was 25°, and that of lordosis correction was 25° (Cobb angles). The average duration of hospitalization was 16.6 days, and the average follow-up was 34.5 months. The total number of complications was 13. Reoperation was required in 9 cases. Neurologic status according to the mJOA scale improved by 0.6 point on average. Functional status according to the FIM increased by 6.6 points on average. Early surgical correction of MMC-related spinal deformities improves body balance and quality of life. The dual growing rod technique is safe and effective in cases of moderate neuromuscular spinal deformities at an early age. Kyphectomy is a challenging procedure with high complication rates, especially skin problems, but there are no alternative procedures for cases of heavy rigid kyphosis.

Impact of stroke on quality of life and functional independence

Background: Cerebrovascular accident is the prime cause for the functional disability and deteriorated quality of life (QOL) which affects person’s social and physical capabilities. Present stroke outcomes are restricted to evaluate global influence of event on patient’s well-being. Hence, it is mandatory to know the effect of stroke on functional independence and domain (DOM)-specific QOL in stroke survivors. Aims and Objectives: The objectives of this study are to assess DOM-specific QOL and functional independence in stroke survivors. Materials and Methods: A cross-sectional survey was conducted on 30 stroke survivors after approval from the Institutional Ethics Committee and their written voluntary consent. QOL was measured with the use of the World Health Organization Quality of Life Instruments (WHOQOLBREF) questionnaire, and functional independence was measured with the use of Functional Independence Measurement (FIM) scale. Results: Thirty patients (63.33% were men and 36.66% were women) were participated with the mean age of 61.47 ± 10.17 years for men and 64 ± 12.14 years for women. The QOL in DOM 1 (physical) was 10.6 ± 3.42, and in DOM 2 (psychological), it was 12.8 ± 6.09. DOM 3 (social relationship) was 14.06 ± 1.52 and DOM 4 (environmental) was 20.23 ± 5.71, i.e., DOM 1 and 2 were more affected. Further, motor component in functional independence was 41.83 ± 20.11, and in cognitive component, it was 34.76 ± 0.43, i.e., motor component was more affected than cognitive component in our patients. Conclusion: The stroke survivors had lower QOL and functionally dependent in the activity of daily living. Physical and psychological dimensions of QOL and motor component of FIM were more affected.

Neurocognitive functioning is associated with functional independence in newly diagnosed patients with temporal lobe glioma.

Cancer and treatment-related neurocognitive dysfunction has the potential to significantly disrupt the lives of survivors. While neurocognitive functioning is known to predict aspects of patient-reported quality of life in individuals with glioma, little is known regarding the association between neurocognitive functioning and clinician-rated functional independence. Newly diagnosed patients with glioma in the left (n = 73; 49% glioblastoma) or right (n = 30; 57% glioblastoma) temporal lobe completed comprehensive neuropsychological testing. Clinicians rated patient functional independence using the Functional Independence Measure (FIM) and Karnofsky Performance Status (KPS) scale. Correlational and regression analyses were conducted to determine relationships between neurocognitive functioning and functional independence. Tests of verbal learning, executive function, and language comprehension were moderately to strongly associated with clinician-rated functional independence, particularly for items pertaining to need for assistance with memory, problem-solving, and language functions. Stepwise linear regression showed that tests of verbal learning, executive functioning, and language comprehension predicted FIM ratings, together accounting for 40% of variance (P < .001). A test of executive functioning also predicted KPS scores and accounted for 19% of variance (P < .001). In patients with newly diagnosed temporal lobe glioma, neurocognitive functioning is associated with functional independence. Verbal learning, executive functioning, and language comprehension demonstrated the strongest associations across both measures of functional independence. These findings provide support for the ecological validity of neuropsychological assessment by demonstrating the real-world clinical significance of objectively assessed neurocognitive functioning in glioma patients.

Factors affecting outcome of acute cervical spine injury: A prospective study

Background:Injury to the spine and spinal cord is one of the common cause of disability and death. Several factors affect the outcome; but which are these factors (alone and in combination), are determining the outcomes are still unknown. The aim of the study was to evaluate the factors influencing the outcome following acute cervical spine injury.Materials and Methods:A prospective observational study at single-center with all patients with cervical spinal cord injury (SCI), attending our hospital within a week of injury during a period of October 2011 to July 2013 was included for analysis. Demographic factors such as age, gender, etiology of injury, preoperative American Spinal Injury Association (ASIA) grade, upper (C2-C4) versus lower (C5-C7) cervical level of injury, imageological factors on magnetic resonance imaging (MRI), and timing of intervention were studied. Change in neurological status by one or more ASIA grade from the date of admission to 6 months follow-up was taken as an improvement. Functional grading was assessed using the functional independence measure (FIM) scale at 6 months follow-up.Results:A total of 39 patients with an acute cervical spine injury, managed surgically were included in this study. Follow-up was available for 38 patients at 6 months. No improvement was noted in patients with ASIA Grade A. Maximum improvement was noted in ASIA Grade D group (83.3%). The improvement was more significant in lower cervical region injuries. Patient with cord contusion showed no improvement as opposed to those with just edema wherein; the improvement was seen in 62.5% patients. Percentage of improvement in cord edema ≤3 segments (75%) was significantly higher than edema with >3 segments (42.9%). Maximum improvement in FIM score was noted in ASIA Grade C and patients who had edema (especially ≤3 segments) in MRI cervical spine.Conclusions:Complete cervical SCI, upper-level cervical cord injury, patients showing MRI contusion, edema >3 segments group have worst improvement in neurological status at 6 months follow-up.

Gait asymmetry, ankle spasticity, and depression as independent predictors of falls in ambulatory stroke patients.

BackgroundFalls are the leading cause of injury in stroke patients. However, the cause of a fall is complicated, and several types of risk factors are involved. Therefore, a comprehensive model to predict falls with high sensitivity and specificity is needed.MethodsThis study was a prospective study of 112 inpatients in a rehabilitation ward with follow-up interviews in patients’ homes. Evaluations were performed 1 month after stroke and included the following factors: (1) status of cognition, depression, fear of fall and limb spasticity; (2) functional assessments [walking velocity and the Functional Independence Measure (FIM)]; and (3) objective, computerized gait and balance analyses. The outcome variable was the number of accidental falls during the 6-month follow-up period after baseline measurements.ResultsThe non-faller group exhibited significantly better walking velocity and FIM scale compared to the faller group (P < .001). The faller group exhibited higher levels of spasticity in the affected limbs, asymmetry of gait parameters in single support (P < .001), double support (P = .027), and step time (P = .003), and lower stability of center of gravity in the medial-lateral direction (P = .008). Psychological assessments revealed that the faller group exhibited more severe depression and lower confidence without falling. A multivariate logistic regression model identified three independent predictors of falls with high sensitivity (82.6%) and specificity (86.5%): the asymmetry ratio of single support [adjusted odds ratio, aOR = 2.2, 95% CI (1.2–3.8)], the level of spasticity in the gastrocnemius [aOR = 3.2 (1.4–7.3)], and the degree of depression [aOR = 1.4 (1.2–1.8)].ConclusionsThis study revealed depression, in additional to gait asymmetry and spasticity, as another independent factor for predicting falls. These results suggest that appropriate gait training, reduction of ankle spasticity, and aggressive management of depression may be critical to prevent falls in stroke patients.

0599 SLEEP APNEA SEVERITY IS ASSOCIATED WITH MOTOR RECOVERY AND PROCESSING SPEED IN ACUTE TBI REHABILITATION ADMISSIONS: A VA TBI MODEL SYSTEM STUDY

During a time of critical neural repair, significant proportions of persons with traumatic brain injury (TBI) undergoing neuro-rehabilitation have significant sleep disruption. Recent reports indicate up to 37% of consecutive TBI rehabilitation admissions have undiagnosed sleep apnea (SA) that may hinder neurologic repair due to hypoxemia and sleep disruption. To date, no study has examined outcomes associated with SA in early stages of TBI recovery. This is a consecutive prospective observational cohort study with IRB-approved research participants part of the TBI Model Systems lifetime study and who received PSG during inpatient neurorehabilitation. The Functional Independence Measure (FIM, Cognitive and Motor Subscales) and Disability Rating Scale were rated on admission and discharge by clinical teams. A subset recovered sufficiently and underwent neuropsychological testing including measures of memory (CVLT-2) and processing speed (Trail Making Test). Sample (n=68) was primarily male (96%), white (87%), married (35%), with ≥ 12 years of education. The median age was 31 years (interquartile range [IQR], 25,50). The most common TBI mechanism was motor-related (68%) with most having a severe injury (Median Emergency Department Glasgow Coma Scale =3, IQR, 3,11). Half of the sample (43%) had SA that was primarily mild (62%) and obstructive type. Individuals were divided into SA severity groups based on AHI of ≤4 (none), 5–14 (mild), and ≥ 15 (moderate to severe). One-way between subjects ANOVA revealed group differences for FIM Motor (F, (2,64) = 3.86, p=.026) and Total scores (F, (2,64) = 3.18, p=.048) on rehabilitation admission. Post-hoc (Tukey) comparisons revealed worse scores for participants with moderate-severe SA compared to those with mild. SA severity was significantly correlated with processing speed (r=0.4, p=0.007) but not verbal memory during early TBI recovery. Greater SA severity was significantly associated with lower motor functioning and slower processing speed during inpatient rehabilitation. Earlier detection of SA may improve rehabilitation outcomes following TBI. VA TBI Model Systems Program of Research, Subcontract from General Dynamics Information Technology (W91YTZ-13-C-0015), Defense and Veterans Brain Injury Center; Defense Health Agency (DHA); and Department of Veterans Affairs grants (1 I50 HX001233-01, W81XWH-13-2-0095).

Recovering functional independence after a stroke through Modified Constraint-Induced Therapy.

Population ageing and changes in the epidemiological profile of neurological pathologies has resulted in an increase in patients with disabilities. Rehabilitation strategies such as Modified Constraint-Induced Movement Therapy (CIMTm) play a key role in treating patients with neurologic deficiencies and motor impairments. This intervention is intended to mitigate disability, promote maximum functional independence, and optimize social and economic participation of patients with upper extremity weakness. Our goal was to assess the recovery of functional independence in patients after a stroke using to CIMTm. Thirty-six subjects who had suffered stroke took part in a randomised clinical trial. The treatment was applied through either collective or individual modalities for three hours per day for a period of ten days. Participant's functional independence was assessed using the Functional Independence Measure (FIM) scale at the before and after of the intervention. An analysis of covariance carried out on the pre-test assessments indicates that the dependent variable presents significant differences (F1.31 = 42.78, p < 0.001, η2p = 0.72) in favour of the collective intervention modality. Both modalities of CIMTm intervention promote functional independence. However, the greatest improvements were observed in participants in the collective modality. Improvements in functional independence pursue a reduction in learned non-use behaviours through greater use of the paretic upper extremity in everyday activities.

Effects of Joints Weight Bearing Exercises Combine with Range of Motion Exercises on Affected Limbs in Patents with Stroke

Background: Weight bearing exercises have great role in joint nutrition, bone density and proprioception thus helping in neuro muscular control. Objective: Objective of study was to find the effects of weight bearing exercises on affected limbs on neuromuscular control in patients with recent stroke. Methodology: We selected 05 patients, 03 males and 02 females, with recent stroke on volunteer basis with informed consent. Inclusion criteria was recent stroke 10 to 15 days back, age between 25-35, both male and female, no previous history of fracture , no significant history of osteoporosis, hemiplegic right or left, intact vision and intact cognition. Selection of subjects was made by visiting to medicine and ICU wards of different hospitals including government and private hospitals of city. Patients were informed about the treatments protocol free of costs. Setting of study was outdoor physical therapy clinic. Duration of study was 02 months, 05 days in a week, 1 h daily. Interventions were weight bearing on affected limb with range of motion exercises. Standing time, 06 minutes’ walk test, functional independent measure and disability rating scale were outcome measurement tools. Study design was pre to post trial. Pre-intervention measure was measured 03 to 05 days before starting the interventions on all outcome measurements tools. Post intervention measure was measured after 02 months. Pre to post measurements were compared by using Wilcoxon signed rank test. Results: Pre interventional score on standing time test, 06 minutes’ walk test, functional independent measure and disability rating scale were 0, 0, 25 ± 05, 05 ± 01 respectively. Post interventional score on standing time test, 06 minutes’ walk test, functional independent measure and disability rating scale were 129 ± 09, 38 ± 05, 94 ± 09, 18 ± 02 respectively. Wilcoxon signed rank statistics (0.000) showed significant change. Conclusion: Study conclude that weight bearing exercises have significant role to improve standing time, walking distance, balance, motor skills and functional skills in patients with recent stroke.

Status of General Health, Functional Independence and Services in Persons with Locomotor Disability (A Study between Social Work Intervention and Non-intervention Group)

Several studies were made on health status and social work intervention but there is still a lag on studies focusing on functional independence in persons with disabilities. Hence this study was undertaken to compare status of general health, functional independence and social services between social work intervention and non-interventional group. 20 Clients who are attending services at NIEPMD under the category of locomotor disability were selected and allocated randomly into social work interventional and non-interventional groups. Both groups were distributed pamphlets and guidance about various services available in NIEPMD for persons with locomotor disabilities. The interventional group was in addition given regular counselling and information on, services and benefits available in NIEPMD and the importance of therapies in improving quality of life in persons with disabilities. After a month of intervention at NIEPMD, all the clients were assessed using General Health Questionnaire 28 and Functional Independence Measure Scale. There was significant difference in scores of functional independence measure between interventional and non-interventional groups and the scores of general health questionnaire-28 had no significant difference between both the groups.

Life Space Assessment in Stroke Patients.

ObjectiveTo evaluate the reliability of the practical life space in post-stroke patients using the Korean version of the Life-Space Assessment (K-LSA) questionnaire and to assess the relationships between the K-LSA and physical function, daily activity, quality of life, and post-stroke depression.MethodsThe LSA questionnaire was translated into Korean, and the translated version was authorized by the author of the LSA questionnaire. In a cross-sectional study, the performance of the K-LSA was evaluated in 34 stroke patients (20 males and 14 females; mean age 65.11±2.39 years) who were receiving physical and occupational therapy at the outpatient clinic in the rehabilitation medicine department of a university medical center at the time of evaluation. Performances were assessed twice by one examiner at a 2-week interval to test the reliability. The patients were evaluated using the Functional Ambulation Category (FAC) scale, Functional Independence Measure (FIM) scale, and mobility subscale of the FIM to assess their relationships with the K-LSA. They were also evaluated using the EuroQol 5 Dimensions questionnaire (EQ-5D) and Geriatric Depression Scale (GDS) to determine the relationship with quality of life and post-stroke depression.ResultsTest-retest reliability at the first (62.20±32.14) and second (63.15±32.22) assessment was 0.993 (p<0.01). The K-LSA showed significant correlations with the FAC (r=0.848, p<0.01), FIM (r=0.765, p<0.01), mobility category of the FIM (r=0.764, p<0.01), GDS (r=-0.657, p<0.01), and EQ-5D (r=0.506, p<0.01).ConclusionThis study suggests that the practical life space of post-stroke patients, assessed by the K-LSA, has a significant correlation with patients' functional mobility, independence in daily activity, quality of life, and depression.

Improved level of function in an individual with Carcinoma of the pyriform sinus undergoing radiotherapy: A case report study

A 72-year-old female with a history of cough and difficulty in swallowing was admitted in KLE Cancer Hospital and was diagnosed with carcinoma of the pyriform sinus, where she was undergoing radiotherapy and was referred for physiotherapy. On examination, she had chest secretion, cough, breathlessness, and generalized body weakness that led to functional limitations. Pre- and postfunctional assessment was done with the help of Functional independence measure (FIMS) scale. A 10-day physiotherapy intervention was given and post intervention evaluation showed an increased functional level.

Pre- and Postintervention Factor Structure of Functional Independence Measure in Patients with Spinal Cord Injury.

Objective To evaluate the factor structure of Functional Independence Measure (FIM®) scale amongst people with spinal cord injury (SCI). Methods This was a retrospective, register-based cohort study on 155 rehabilitants with SCI. FIM was assessed at the beginning and at the end of multidisciplinary inpatient rehabilitation. The internal consistency of the FIM was assessed with Cronbach's alpha and exploratory factor analysis was employed to approximate the construct structure of FIM. Results The internal consistency demonstrated high Cronbach's alpha of 0.95 to 0.96. For both pre- and postintervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items (“walking or using a wheelchair” and “expression”), the structures of the identified three factors remained the same from the beginning to the end of rehabilitation. The loadings of all items were sufficient, exceeding 0.3. Both pre- and postintervention chi-square tests showed significant p values < 0.0001. The “motor” domain was divided into two factors with this 2-factor structure enduring through the intervention period. Conclusions Amongst rehabilitants with SCI, FIM failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that fluctuated only little depending on the timing of measurement. Additionally, when measured separately, also motor score was 2-dimensional, not 1-dimensional. Using a total or subscale FIM, scores seem to be unjustified in the studied population.

Treatment of unilateral spatial neglect after stroke using transcranial direct current stimulation (ELETRON trial): study protocol for a randomized controlled trial.

BackgroundUnilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects that are presented in the spatial hemisphere that is contralateral to the lesioned hemisphere of the brain. USN has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Noninvasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been used in people who have been affected by USN after stroke. The effects of such treatment could provide new insights for health professionals and policy-makers. The aim of this study will be to evaluate the effectiveness and safety of tDCS for USN after stroke.MethodsA prospective randomized controlled trial with two parallel groups will be conducted, which will aim to recruit 60 patients with USN after ischemic or hemorrhagic stroke. Participants will be randomly placed into the following four treatment groups: (1) anodal tDCS over the right parietal lobe (n = 15), (2) cathodal tDCS over the left parietal lobe (n = 15), (3) a sham group of anodal tDCS over the right parietal lobe (n = 15), and (4) a sham group of cathodal tDCS over the left parietal lobe (n = 15). Blinded assessors will conduct two baseline assessments and one post-intervention assessment. The primary outcome measure will be the level of USN as assessed by the conventional Behavioral Inattention Tasks and the Catherine Bergego Scale. Secondary measures will include neurological capacity (based on the Scandinavian Stroke Scale), functional capacity (based on the Functional Independence Measure and Modified Rankin Scale), autonomy (based on the Barthel Index), and quality of life (based on the EuroQol-5D). Group allocation will be concealed, and all analyses will be based on an intention-to-treat principle.DiscussionThis study will explore the effects of more than 15 sessions of tDCS on the level of USN, functional capacity, autonomy, and quality of life in patients with USN after stroke. This proposed study has the potential to identify a new, evidence-based intervention that can enhance perception and independent living in patients with USN after stroke.Trial registrationREBEC - RBR-78jvzx, registered on 13 March 2016.

Assessment of virtual teacher feedback for the recovery of the upper limb after a stroke. Study protocol for a randomized controlled trial.

Enhanced feedback provided by virtual reality has been shown to promote motor learning both in healthy subjects and patients with motor impairments following lesions of the central nervous system. The aim of this study is to evaluate the effect of displaying a virtual teacher as visual feedback to promote the recovery of upper limb motor function after a stroke. The protocol reports the design of a single blind randomized controlled trial (RCT), blinded to outcome assessment. Two different treatments based on virtual reality will be compared: in the “Teacher” group, the patients receive treatment with continuous displaying of a virtual teacher, while in the “No-Teacher” group, the same exercises will be proposed without visualization of a virtual teacher. The Fugl-Meyer upper extremity scale will be considered as the primary outcome, while the Functional Independence Measure scale, Reaching Performance Scale and Modified Ashworth Scale will be considered as secondary outcomes. Moreover, kinematic parameters such as mean duration (seconds), mean linear velocity (cm/s) and smoothness (i.e. number of sub-movements) will be registered when performing standardised tasks. All tests will be performed before and after treatments. Both treatments will last four weeks with a daily session lasting one hour, five days a week (20 overall sessions). This study is designed to systematically assess the influence of using enhanced visual feedback for the recovery of upper limb motor function after a stroke. These findings will help to determine whether the use of a virtual teacher as enhanced visual feedback is effective for promoting better recovery of upper limb motor function over four weeks of post-stroke treatment. Current Controlled Trials registration number: NCT02234531 (registered on 29 August 2014, ClinicalTrials. gov) Kiper P., Zucconi C., Agostini M., Baba A., Dipalma F., Berlingieri C., Longhi C., Tonin P., Turolla A. Assessment of virtual teacher feedback for the recovery of the upper limb after a stroke. Study protocol for a randomized controlled trial. Med Rehabil 2016; 20(3): 13-20. DOI: 10.5604/01.3001.0009.5010