Independence In Activities Of Daily Research Articles

Employment outcomes of adults with cerebral palsy in Taiwan

Purpose: To examine the employment status and determinants of employability for adults with cerebral palsy (CP) in Taiwan. Method: A cross-sectional survey was conducted. Participants were recruited from five main branches of the Cerebral Palsy Association. Two hundred and seventy-nine persons over the age of 18 (M = 26.4, SD = 7.7) with a diagnosis of cerebral palsy participated in the current study. Results: Sixty-four of the 279 participants were employed with an employment rate of 22.9%. Of the 64 employed individuals, 67% worked in an integrated setting, 14% in supported employment, and 19% in sheltered employment. Hierarchical logistic regression analyses indicated that having an older age (odds ratio [OR] = 1.05; 95% confidence intervals [CI]: 1.01–1.10), a diagnosis of ataxia (OR = 3.44; 95% CI: 1.29–9.13), a higher educational attainment (OR = 1.86; 95% CI: 1.09–3.18), a higher mobility function in the community (OR = 1.48; 95% CI: 1.04–2.10), and a higher level of independence in daily activities (OR = 1.60; 95% CI: 1.23–2.09) were associated with an increased odds for employment. Conclusions: The employment rate for adults with CP in Taiwan is low. Age, CP diagnosis, educational attainment, and functional performance are important determinants related to employment outcomes for this group. Further research to validate effective medical and vocational rehabilitation interventions to improve the employability of people with CP in Taiwan is warranted.Implications for RehabilitationWith advances in medical care, the number of adults with CP continues to grow but information about their employment outcomes is often lacking.A low employment rate for adults with CP in Taiwan is found in the current study.Age, CP diagnosis, educational attainment, mobility in the community, and level of independence in daily activities are important determinants related to employment outcomes for this group.

Restoration of grasp following paralysis through brain-controlled stimulation of muscles

Patients with spinal cord injury lack the connections between brain and spinal cord circuits essential for voluntary movement. Clinical systems that achieve muscle contraction through functional electrical stimulation (FES) have proven to be effective in allowing patients with tetraplegia to regain control of hand movement and to achieve a greater measure of independence in activities of daily living 1,2. In typical systems, the patient uses residual proximal limb movements to trigger pre-programmed stimulation that causes the paralyzed muscles to contract, allowing use of one or two basic grasps. Instead, we have developed, in primates, an FES system that is controlled by recordings made from microelectrodes permanently implanted in the brain. We simulated some of the effects of the paralysis caused by C5-C6 spinal cord injury 3 by injecting a local anesthetic to block the median and ulnar nerves at the elbow. Then, using recordings from approximately 100 neurons in the motor cortex, we predicted the intended activity of several of the paralyzed muscles, and used these predictions to control the intensity of stimulation of the same muscles. This process essentially bypassed the spinal cord, restoring to the monkeys voluntary control of their paralyzed muscles. This achievement represents a major advance toward similar restoration of hand function in human patients through brain-controlled FES. We anticipate that in human patients, this neuroprosthesis would allow much more flexible and dexterous use of the hand than is possible with existing FES systems.

Post-operative guidelines following hip arthroscopy.

Rehabilitation following hip arthroscopy can vary significantly. Existing programs have been developed as a collaborative effort between physicians and rehabilitation specialists. The evolution of protocol advancement has relied upon feedback from patients, therapists and observable outcomes. Although reports of the first femoroacetabular impingement (FAI) surgeries were reported in the 1930's, it was not until recently that more structured, physiologically based guidelines have been developed and executed. Four phases have been developed in this guideline based on functional and healing milestones achieved which allow the patient to progress to the next level of activity. The goal of Phase I, the protective phase, is to progressively regain 75% of full range of motion (ROM) and normalize gait while respecting the healing process. The primary goal of Phase II is for the patient to gain function and independence in daily activities without discomfort. Rehabilitation goals include uncompensated step up/down on an 8 inch box, as well as, adequate pelvic control during low demand exercises. Phase III goals strive to accomplish pain free, non-compensated recreational activities and higher demand work functions. Manual muscle testing (MMT) grading of 5/5 should be achieved for all hip girdle musculature and an ability to dynamically control body weight in space. Phase IV requires the patient be independent with home and gym programs and be asymptomatic and pain free following workouts. Return to running may be commenced at the 12 week mark, but the proceeding requirements must be achieved. Athletes undergoing the procedure may have an accelerated timetable, based on the underlying pathology. Recognizing the patient's pre-operative health status and post-operative physical demands will direct both the program design and the program timetable.

Correlation between balance and the level of functional independence among elderly people

As the overall number of elderly people increases there is a corresponding rise in the number of older persons with disabilities. In order to examine whether there is any relationship between balance and activities of daily living, we evaluated balance and daily activities among elderly people living in the community. Cross-sectional study at Universidade Estadual Paulista (Unesp), Marília, São Paulo, Brazil. The study included 70 community-dwelling elderly people aged 65 and over. Balance was evaluated using the Berg Balance Scale (BBS) and physical independence in daily activities was evaluated using the Barthel Index (BI). The Spearman correlation coefficient was used to examine the relationship between the parameters evaluated. Significance was set at the level of 5% (P < 0.05). The population's mean age was 70.5 ± 5 years. The mean BBS score was 50.9 ± 4.1, whereas the mean BI score was 98.1 ± 2.8. Statistically significant relationships were found between the BBS and BI (r = 0.41; P = 0.0004); between age and BI (r = -0.24; P = 0.04); and between age and BBS (r = -0.57; P = 0.0001). The results showed that among elderly people, there are correlations between age, balance and independence level.

Application and Performance of Two Stroke Outcome Prediction Models in a Chinese Population

To apply and examine the performance of 2 acute stroke outcome prediction models, the Six Simple Variable Model (SSV model) and the One-Year Mortality Model (OYM model), in patients in China who had either a cerebral infarction or a cerebral hemorrhage. An observational study that used both retrospective and prospective study methods. A regional acute care facility in China. Two hundred and forty-eight consecutive patients who had an acute stroke who were admitted to the hospital between October 2007 and March 2009. Not applicable. Survival and daily activity independence 6 months after a stroke and 1-year mortality. The study sample had a mean age of 68.6 years (standard deviation, 11.1); 52.8% of the subjects were men, 66.5% had a cerebral infarction, and 33.5% had a cerebral hemorrhage. In the cohort, 107 patients (43.1%) achieved daily activity independence at 6-month follow-up, and 52 patients (21.0%) had died within 1 year. The area under the receiver operating characteristic curve (ROC) was 0.966 (0.935-0.998) for patients who had a cerebral infarction and 0.859 (0.766-0.952) for patients who had a cerebral hemorrhage in the prediction of 6-month survival and daily activity independence with use of the SSV model. The area under the ROC curve was 0.894 (0.846-0.965) for patients who had a cerebral infarction and 0.937 (0.904-0.988) for patients who had a cerebral hemorrhage in the prediction of 1-year mortality when the OYM model was used. Both the SSV and OYM prognostic models can be used for function and mortality outcome prediction for patients in China who have had a stroke. Variation existed in the precision of prediction between patients who had a cerebral infarction and those who had a cerebral hemorrhage. Other potential factors influencing functional recovery and mortality after stroke must be considered in outcome prediction.

Neurological Outcomes After Immediate Aortic Repair for Acute Type A Aortic Dissection Complicated by Coma

Management of acute type A aortic dissection (AADA) complicated by coma remains controversial. We analyzed our experience in managing AADA complicated by coma to determine the relationship of duration of preoperative coma to postoperative neurological recovery. Between September 2003 and October 2010, 181 patients with AADA were treated, including 27 presenting with coma (Glasgow Coma Scale <11) on arrival. Twenty-one patients were repaired immediately (immediate group); time from onset of symptoms to operating room was <5 hours. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative therapeutic hypothermia with magnesium treatment was performed. Six patients initially were managed medically, and 3 of them were followed by eventual repair because time from onset was >5 hours (delayed group). The preoperative National Institutes of Health Stroke Scale score was 31.4 ± 6.6 in the immediate group and 28.3 ± 9.5 in the delayed group. Hospital mortality was 14% in the immediate group and 67% in the delayed group. Full recovery of consciousness was achieved in 86% of patients in the immediate group and in 17% in the delayed group. In immediate group, the postoperative National Institutes of Health Stroke Scale score significantly improved to 6.4 ± 8.4, cumulative survival rate was 71.8% in 3 years, and independence in daily activities was achieved in 52% (11/21). Aortic repair, if performed immediately from the onset of symptoms, showed satisfactory recovery of consciousness and neurological function in patients with AADA complicated by coma. In this patient population, immediate aortic repair is warranted.

Getting used to assistive devices: Ambivalent experiences by frail elderly persons

The aim was to learn how frail elderly people experienced becoming assistive device users and how assistive devices affected their independence in daily activities. Focus-group methodology was used, including people 80 and older with multiple health problems. Five group discussions were conducted with a total of 18 people including 14 women and four men. Each group met once, for 90–120 minutes, and all discussions were audiotaped. Two themes emerged: Confidence in knowledge and experience and getting used to assistive devices in daily activities. Confidence in knowledge and experience was formed by two categories of experiences from the prescription procedure: trust the expert and trust yourself, and to have confidence in having the right information about assistive devices. Getting used to assistive devices in daily activities was formed by five categories of ambivalent experiences when using assistive devices in daily activities: creates opportunities and limitations; provides security but also raises concerns; the need is seen as transient or permanent; the social environment both encourages and restricts; the physical environment both facilitates and complicates, with less extreme experiences in between. This study indicates that frail elderly people need specifically developed support in the process of becoming assistive device users.

P01-565 - Functional impairment prevalence in Brazilian frailty elderly

IntroductionHealth life expectation could be defined in many ways. The notion of health life can considered, for example, physical, mental or social well-being; disease consequences; functional impairment; successful aging. Functional independence in daily activities is a key aspect on frailty elderly quality of life. This independence is related with elderly social and leisure activities, which improves their physical and mental health and brings sense to their life.ObjectivesData obtained in other countries could not represent the national population; the objective was to describe a Brazilian frailty elderly sample.AimsDetermine functional impairment prevalence in Brazilian frailty elderly.Methods8769 frailty elderly were examined. Social data, tobacco and alcohol consumption were verified and the functional activities questionnaire was applied from May, 2009 to August, 2010.ResultsFemale elderly was predominant (68.1%). They were almost married (47.3%), followed by widow (37.9%), single (9%), divorced (5.9%). White people were predominant (69.9%); black (14.9%) and brown (15.2%) were presented at the same proportion. Only 13.1% were smokers and 4.3% drank alcohol. The majority (78.7%) were younger than 80 years-old. Functional impairment prevalence was 9.5% in the 60–69 years old group; 18.9% in 70–79 years old group; 36.8% in 80–89 years old group and 61.3% in 90–99 years old group.ConclusionsThe prevalence of functional impairment increased with aging and we presented data obtained in a Brazilian sample. These data can be used to compare functional impairment in different countries and to stimulate elderly independence during their aging.

The relationship between physical, functional capacity and quality of life (QoL) among elderly people with a chronic disease

The aim of this study was to evaluate the relationship between physical and functional capacity and quality of life (QoL) among elderly people who have a chronic disease. The study included 100 elderly individuals aged 65 years and older, who have a chronic disease. The study examined the marital and educational status, social security status, kind of chronic disease, number of chronic diseases and whether participants use assistive devices for walking. The Nottingham health profile (NHP) was used to evaluate QoL related to health; the physical mobility scale (PMS) was used to evaluate mobility in daily life and the functional independent measure (FIM) was used to evaluate functional independence in daily activities. In both female and male individuals, a statistically significant difference was found between the number of chronic diseases, kind of chronic disease, educational status, marital status, total FIM, PMS and NHP values (p<0.05). In males, there was a correlation between number of chronic illnesses and total NHP, FIM (p<0.05), but in females, there were no correlation between number of chronic illnesses and total NHP, FIM (p>0.05). There were no correlations between kind of chronic disease and PMS, NHP, FIM (p>0.05) in either of genders. It was found that there are differences among elderly female and male individuals with a chronic disease in terms of the number of chronic diseases, types of chronic disease, mobility level, functional status and QoL; and mobility level is related to functional capacity and QoL in females. It is thought that the rehabilitation programs to improve physical and functional capacity in elderly people and applications that increase participation in activities and reduce pain may improve QoL.

Hydration and independence in activities of daily living in people with multiple sclerosis: a pilot investigation

Purpose. Bladder dysfunction and disability may cause people with multiple sclerosis (pwMS) to limit fluid intake. However, hydration is rarely considered in the multiple sclerosis literature. We investigated the hydration status of people with pwMS and its association with independence in activities of daily living.Methods. Twenty-six (six men) pwMS over 18 years old and able to walk with or without an aid took part in the study. Hydration status was measured via urine osmolality, with adequate hydration defined as an osmolality ≤500 (mOsm kg−1). Independence in daily activities was measured using the Barthel index.Results. Mean urine osmolality was 470 ± 209 mOsm kg−1 and indicated 11 (42%%) participants were not adequately hydrated. Independence in daily activities could partly explain hydration status (R2 == 0.209, p < 0.05). Additionally there was a trend for men to be less well hydrated than women.Conclusions. The results indicate that some pwMS were not adequately hydrated and that this could be partly explained by disability. Implications of reducing and maintaining fluid levels on function and quality of life in relation to bladder dysfunction and disability in pwMS should be investigated.

Basic Research for Development of a Communication Support Device Using Air-Conducted Sound Localization

We have been engaged in the development of a new support device for subjects whose independent daily activities are limited due to severe progressive neuromuscular disease. In this study, we examined the possibility of developing a P300-type BCI (brain–computer interface) using orientation discrimination of stimulus sound with auditory lateralisation using a virtual sound source for air-conducted sound presented to the subject bitemporally. Sound stimulation with sound localization used in the study had a level difference of approximately 10 dB and time difference of approximately 0.6 ms, and was fixed at 60° to the left and to the right from the median. It was suggested that a virtual sound source with sound image fixed in left and right directions with added difference between the left and right ears can be used for development of a P300-type BCI by applying auditory stimulation. To further proceed to the development of a P300-type BCI system using auditory stimulation with comfort and convenience with the aim of reducing user burden in a clinical setting, we will reexamine the extraction algorithm for the target waveform, and examine the effects of the interval between stimulus presentation to make this a daily life supporting system to realise a faster and more efficient multiple command sending mechanism.

The effect of functional mobility and balance on health-related quality of life (HRQoL) among elderly people living at home and those living in nursing home

The present study examined the effect of functional mobility and balance on HRQoL among elderly people living at home and those living in nursing homes. The study included 122 elderly people aged 65 and over. With regard to the individuals whose socio-demographic data were collected in the scope of the study, balance and functional mobility levels were evaluated using the timed up and go test (TUG) and Berg balance scale (BBS); HRQoL was evaluated using the Nottingham health profile (NHP); physical independence in daily activities was evaluated using the Barthel index (BI); and basic mobility in daily life was evaluated using the Rivermead mobility index (RMI). Statistically significant differences were found between the TUG, BBS and NHP values of the elderly people living in a home environment and those living in nursing homes ( p < 0.05). However, no statistically significant difference could be found between the BI and RMI values ( p > 0.05). A statistically significant relationship was found between the NHP and TUG, RMI, BI and the use of assistive devices in daily life activities ( p < 0.05). It is thought that the inclusion of functional mobility and balance training in elderly care and rehabilitation programs would be useful for the elderly people to develop functional independence and in increasing their HRQoL.

Relationships between subjective well-being, mobility, and independence as a function of age bracket and gender among the elderly ENDEREÇO

The aim of this study was to investigate the associations of subjective well-being, independence in daily activities, and the measures of mobility and flexibility in the lower limbs of elderly outpatients, according to age groups and gender. 125 people over 60 of both genders were chosen and evaluated. The instruments used were: Functional Independence Measure (FIM) to evaluate their daily activities, Short Physical Performance Battery (SPPB) for their physical performance, and Subjective Well-Being (SWB) for satisfaction with life. The results revealed that women have poorer physical performance and less functional independence than men. The older subjects had lower scores in physical performance and were more dependent in daily life activities than the younger ones, however they were more satisfied with life. The results suggest that older individuals and women have greater functional limitation. Meanwhile the older seniors show greater satisfaction with life

Fractured neck of femur--internal fixation versus arthroplasty.

Surgery is the treatment of choice for fractured neck of femur. For middle-aged patients (aged ca. 40 to 65), there is considerable debate over the indications for arthroplasty or internal fixation. The choice of surgical technique varies widely from one region to another. In this article, we discuss the main criteria that should be used in making this decision. We selectively reviewed the literature on the diagnosis and treatment of fractured neck of femur, including the current guideline of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU) and recent findings from the field of health services research. The treatment of middle-aged patients with dislocated fractures should be based on rational decision-making. The patient's level of activity before the accident should be judged in terms of his or her previous mobility, independence in daily activities, and mental status. Internal fixation is recommended if the fracture can be adequately repositioned, the bone is of good quality, and there is no evidence of osteoarthritis. Fractures that are more than 24 hours old should be treated with total hip arthroplasty. Hemiprostheses are appropriate for very old patients. Physically frail, bedridden, and/or demented patients should undergo internal fixation of the fracture. For non-displaced or impacted fractures, functional treatment (i.e., prophylactic securing of the fracture with screws or nails) is indicated. Rapid diagnosis and a short time in bed before surgery lower the rate of complications. Internal fixation with preservation of the femoral head should ideally be performed within the first 6 hours of trauma, and within the first 24 hours at most. Despite the increasing scarcity of resources, treatment should still be based on well-founded clinical guidelines. Minimally invasive surgery enables better function in the early postoperative phase and can thereby lower complication rates. An interdisciplinary concept for the postoperative care of elderly patients also has a major effect on the outcome.

Psychometric Properties of the Task Self-Efficacy Scale for Everyday Activities in Older Adults

Physical and cognitive factors contribute to independence in daily activities, but the confidence to perform an activity (self-efficacy) also contributes to it. The purpose of this study was to assess the psychometric properties of the Task Self-efficacy Scale (TSE) for confidence in performing daily activities, Validity and reliability were assessed in 278 older adults with scores on all items on the TSE for analysis. Factor analysis revealed two factors (self-care and mobility) explaining 72.42% of the variance in the items. Moderate to large correlations were found between the TSE for Self-Care and TSE for Mobility to exertion (.90 to .93, respectively) and fatigue (-.79 to -.84, respectively) associated with activities assessed in the TSE. The expected differences in TSE were found between those with and without mobility difficulties, fear of falls, and shortness of breath with activity. Cronbach's alpha was .96.

Rehabilitation Assists in Recovery After Complicated Intracerebral Hemorrhage Related to Deep Brain Stimulation

Bilateral subthalamic nuclei deep brain stimulation (DBS) has been shown to be effective in treating motor symptoms of Parkinson's disease. Numerous studies confirm the safety and efficacy of DBS. Complications of subthalamic nuclei DBS show a 1.2% risk of symptomatic intracerebral hemorrhage. There are few studies concerning the benefits of rehabilitation after occurrence of intracerebral hemorrhage related to DBS. We report a patient who underwent an inpatient rehabilitation program because of complicated intracerebral hemorrhage after a DBS procedure. We observed significant improvement in locomotion and independence of daily activities after the program. We also review the current literature reporting complications following DBS.

Functional Outcomes After Upper Extremity Surgery for Cerebral Palsy: Comparison of High and Low Manual Ability Classification System Levels

The heterogeneity of cerebral palsy makes interpretation and prediction of outcome after upper extremity surgery difficult. We hypothesized that the outcome of upper extremity surgery for cerebral palsy is related to the Manual Ability Classification System (MACS) level. We reviewed 27 patients with a mean age of 22 years, who underwent upper extremity surgery for spastic cerebral palsy at a mean follow-up of 29 months. Patients were classified into 5 MACS levels using a standardized questionnaire completed by their primary caregivers. Preoperatively and at most recent follow-up visits, patients were assessed using the House scale and patient-reported functional outcomes on a 5-point scale. We compared the outcomes of patients with high (I-II, independence in daily activities) and low (III-V, dependence in daily activities) MACS levels. The overall mean House scale improved from 2.9 to 4.6 postoperatively (p<.001), dressing ability from 3.7 to 4.2 (p=.005), hygiene from 4.2 to 4.9 (p=.005), and appearance from 2.4 to 4.2 (p<.001). A total of 13 patients had a high MACS level (7 had I and 6 had II) and 14 had a low MACS level (8 had III, 6 had IV, and none had V). The high-MACS group had a greater improvement according to the House scale (p=.009) and the low-MACS group had a larger improvement in hygiene status (p=.043). There were no differences in the amount of improvement in dressing ability (p=.169) and appearance (p=.765). Overall satisfaction with surgery was higher for the high-MACS group (p=.038). The high-MACS group had a greater improvement in rating according to the House scale and higher satisfaction than the low-MACS group after upper extremity surgery for cerebral palsy in our small number of patients. This study suggests that the MACS level can be used to predict upper extremity surgery outcomes for cerebral palsy. Prognostic II.

Association Between Daily Activities Following Stroke Rehabilitation and Social Role Functioning Upon Return to the Community

Purpose: To examine the association between independence in daily activities at discharge from rehabilitation and the degree of resumption of social roles 6 months later in older adults with stroke. Method: A total of 111 adults participated (mean age 77 years). Daily activities were measured using portions of the Functional Measurement of Autonomy System (SMAF). Social roles, measured using the social roles section of the Assessment of Life Habits (LIFE-H), included responsibilities, interpersonal relationships, community life, and leisure domains. Regression analyses were performed to evaluate the association between daily activities and social roles in conjunction with several capability variables. Results: Independence in daily activities increased the variances of the total scores for the responsibilities and community life models social role domains by 7% to 8%. The total explained variances ranged from 47% to 52% with corresponding beta values for daily activities ranging from -0.37 to -0.41. The lack of association between independence in daily activities and both leisure and interpersonal relationships was striking. The lowest scores were in the leisure domain. Conclusion: The association between daily activities at discharge and social roles 6 months following rehabilitation varies depending on the social role domain. Leisure may not be sufficiently addressed during rehabilitation warranting a “second wave” of rehabilitation upon return to the community.

Association Between Daily Activities Following Stroke Rehabilitation and Social Role Functioning Upon Return to the Community

Purpose: To examine the association between independence in daily activities at discharge from rehabilitation and the degree of resumption of social roles 6 months later in older adults with stroke. Method: A total of 111 adults participated (mean age 77 years). Daily activities were measured using portions of the Functional Measurement of Autonomy System (SMAF). Social roles, measured using the social roles section of the Assessment of Life Habits (LIFE-H), included responsibilities, interpersonal relationships, community life, and leisure domains. Regression analyses were performed to evaluate the association between daily activities and social roles in conjunction with several capability variables. Results: Independence in daily activities increased the variances of the total scores for the responsibilities and community life models social role domains by 7% to 8%. The total explained variances ranged from 47% to 52% with corresponding beta values for daily activities ranging from -0.37 to -0.41. The lack of association between independence in daily activities and both leisure and interpersonal relationships was striking. The lowest scores were in the leisure domain. Conclusion: The association between daily activities at discharge and social roles 6 months following rehabilitation varies depending on the social role domain. Leisure may not be sufficiently addressed during rehabilitation warranting a “second wave” of rehabilitation upon return to the community.

Depression in adult males with lower extremity amputation and its bio-social correlates

Depression is often associated with many adverse health conditions and lower socio-economic status. Stressful conditions like presence of disability coupled with traditional negative societal attitude towards disability may result in higher level of depression in the individuals with disability than in general population and can cause other health problems as well. Therefore, the purposes of this study are to explore the association of depression with its biosocial correlates among individuals with lower extremity amputations (LEA) living in Kolkata, India. Eighty-five participants with traumatic LEA and 105 control participants with no amputation participated in this study. The depression levels of the participants were measured with Beck Depression Index (BDI). All participants were also measured with the following sets of health traits, using standard techniques－1) physical: body weight, stature, body mass index (BMI), blood pressure, total cholesterol, triglycerides, blood glucose, hemoglobin%, 2) functional: functional outcome or degree of independence in daily activities, and 3) social: economic condition, and social discomfort. No significant difference was found in mean BDI scores for individuals with LEA and control participants. Higher BDI scores were associated with chronic energy deficiency. None of the other physical health traits was associated with depression level. Higher depression was associated with poor socio-economic conditions like low economic condition, dependency on others for daily activity, occupational constraints due to disability and perceived problems in conjugal life. Therefore, economic development with a positive social attitude toward people with disability is essential for the mental wellbeing of the individuals with LEA.