Independence In Self-care Research Articles

The assessment of disability in patients on an acute medical ward for elderly people.

The level of independence in self-care was monitored weekly in 212 patients admitted over 6 months to an acute medical ward for elderly people, and documented on discharge using a standard assessment, the Barthel Index. At discharge from the admitting ward, 39% of patients were independent (Barthel score of 20), 36% were mildly dependent (Barthel 15-19), 15% were moderately dependent (Barthel 10-14), 4% severely dependent (Barthel 5-9) and 6% very severely dependent (Barthel 0-4). Approximately 80% were able to transfer, walk, were continent of urine and could wash their top half, but one-third were unable to dress or use the toilet independently. Over half were unable to bath themselves or climb stairs unaided. It is feasible to assess disability in a busy acute service this way. Information can be provided both to community services on discharge of individual patients, and to managers responsible for planning services for elderly people.

Work and Family Issues After Injury: Do Female and Male Client Perspectives Differ?

Role demands weigh differently on men and women and the balance of role demands shifts when adult family members sustain injuries that compromise their physical capacity. Clients with orthopaedic and soft tissue injuries (N = 53) who were settling insurance claims or currently in litigation were assessed using the Life Roles Inventory (Values and Salience Scales), a Life Satisfaction Questionnaire (structured interview), and measurements of physical capacity, perceived exertion, and functional ability. Findings from this exploratory study suggest that although commitment to the major life roles does not change following injury, levels of participation and role value for working and home/family roles do change. The disruption of social networks is likely related to the working role for women in professional and skilled occupations. Financial concerns, strain in personal relationships, level of independence in self care, and pain on activity significantly affect performance and satisfaction.

Functional outcome of lower limb amputees with peripheral vascular disease

A series of 40 patients accepted for prosthetic rehabilitation after lower limb amputations for peripheral vascular disease were reviewed nine to 27 months later. Two have since died, one has not been traced, and 37 have been assessed. Fourteen were successful full-time limb users ('walkers'), 10 were partial users ('partial walkers') and 13 were wheelchair-dependent ('none walkers' or 'wheelchair users'). Of the walkers, 85% completed a 10-metre walk in under 30 seconds (mean 20s), whereas 90% of the partial walkers took over 30 seconds (mean 79s). The Barthel Activities of Daily Living (ADL) Index, a measure of independence in self-care, correlated closely with outcome status and walking speed. Other items that correlated well with outcome included grip strength, assessed using a simple hand-held dynanometer, and cardiovascular fitness, the measure being time taken for the pulse to return to resting baselme after exercise. This was less than two minutes in 85% of the walkers (mean 94s) and two minutes or more in 100% of the partial walkers (mean 240s). Age did not indicate whether prosthetic training would be successful, but in those who were walking it correlated closely with speed. The partial walkers had lower kitchen and domestic activity scores, which were due to lack of environmental modification for wheelchair use, it being assessed that their walking status conferred ability to do tasks whilst standing. These patients can easily be identified by measuring their walking speed and Barthel ADL Index.

Self-reported prevalence of disability after subarachnoid haemorrhage, with special emphasis on return to leisure and work.

The prevalences of motor and language impairments and of disabilities in activities of daily living (ADL), leisure and work were investigated in a consecutive series (n = 296) of long-term survivors of subarachnoid haemorrhage (SAH). Motor and language impairments were present in 17 and 20%, respectively. The majority reported independence in self-care (91%) and instrumental (80%) ADL, but among the self-care independent, 23% reported need of personal assistance. Leisure disability occurred in 48% and vocational disability in 40%. Hence, disabilities are more common after SAH than is indicated by occurrences of motor and language impairments. It is concluded that the discrepancy between the prevalences of impairments and of disabilities may be to a great extent caused by coping difficulties in relation to socio-demographic and geographic circumstances. The findings indicate a need for rehabilitative follow-up for virtually all SAH-patients.

Parental and Professional Estimates of Self-Care Independence of Children and Adolescents With IDDM

To report the results of a survey of 490 parents of children with insulin-dependent diabetes mellitus (IDDM) regarding the children's mastery of 38 diabetes-care skills. Parental responses are contrasted with those of a previous survey in which 229 diabetes professionals estimated ages at which typical children with IDDM master the same skills. Parents were recruited at five pediatric endocrinology clinics with a response rate of 88.9%. For 33 of 38 skills, professionals' median mastery age estimates exceeded, by greater than or equal to 1 yr, the median ages that parents reported skill mastery by their estimates, children. Despite the parent-professional disagreement about mastery-age their survey responses yielded substantial agreement about the order of mastery of specific skills. The data also revealed two profiles of comparative results. For many items, parents reported earlier skill mastery, but parental and professional estimates eventually converged during adolescence. These skills consisted of rote, motoric acts, or more complex tasks for which errors yield relatively certain aversive consequences. For other skills, more professional estimated skill mastery among adolescents than did parents. These skills required substantial organization and self-regulation by the adolescent, involved treatment components for which the aversive consequences of errors are deferred and uncertain, or they were skills infrequently required of most patients with IDDM. The parent-professional discordance revealed by this survey illustrates the importance of clear specification of treatment responsibilities, careful monitoring of self-care competence, and periodic reeducation of children with IDDM.

Survey of Diabetes Professionals Regarding Developmental Changes in Diabetes Self-Care

There are no empirically obtained data defining appropriate developmental expectations for the acquisition of self-care independence by children with insulin-dependent diabetes mellitus. This study surveyed diabetes professionals about their estimates of ages at which children typically master 38 diabetes skills. The 229 survey respondents represented a broad range of professions and clinical settings and had extensive experience as diabetes professionals. Mean mastery age estimates were less than 14 yr for the 38 skills assessed. Responses to each item were variable among respondents, with a mean SD of 2.1 yr in estimated mastery ages for all items. Estimated mastery ages were below the age ranges recommended by the American Diabetes Association for 14 of 20 comparable skills. Physicians generally expected the diabetes skills to be mastered at later ages than did nurses or other health-care professionals. There were no other consistent response patterns related to respondent characteristics, i.e., years of clinical experience, employment setting, current patient load, or method of survey distribution.

Factors Associated with Independent Meal Preparation, Self-Care and Mobility in CVA Clients

This study compared factors associated with and predictive of performance by stroke clients on two tests, namely a Meal Preparation Scale and the Barthel Index (a measure of independence in self-care and mobility). There is some overlap between factors associated with independent meal preparation and those associated with independence in self-care and mobility. However, motor function in the upper extremity is significantly (.05) more highly correlated with performance of self-care and mobility (r = .47) than with meal preparation (r = .28). Similarly, motor function in the lower extremity is significantly (.05) more highly correlated with performance in self-care and mobility (r = .47) than with meal preparation (r = .07). On the other hand, motor planning is significantly (.05) more highly correlated with meal preparation (r = .51) than with self-care and mobility (r = .28). Motor function in the upper extremity and visual-spatial perception on admission are predictors of future performance in both self-care mobility and meal preparation; but neither function can be predicted accurately using variables measured in this study.

Unexpected Cardiac Arrest during Spinal Anesthesia

Fourteen cases of sudden cardiac arrest in healthy patients who received spinal anesthesia were discovered in a preliminary review of 900 closed insurance claims for major anesthetic mishaps. All patients were resuscitated from the intraoperative cardiac arrest, but six suffered such severe neurologic injury that they died in hospital. Of the eight survivors, only one exhibited sufficient neurologic recovery to allow independence in daily self-care. In view of the unexpected nature of the cardiac arrests, as well as the ultimate severity of injury, these cases were analyzed in detail to determine whether there were recurring patterns of management that may have contributed to the occurrence or outcome of these anesthetic mishaps. Two patterns were identified. The first was the intraoperative use of sufficient sedation to produce a comfortable-appearing, sleep-like state in which there was no spontaneous verbalization. Cyanosis frequently heralded the onset of cardiac arrest in patients exhibiting this degree of sedation, suggesting that unappreciated respiratory insufficiency may have played an important role. The second pattern appeared to be an inadequate appreciation of the interaction between sympathetic blockade during high spinal anesthesia and the mechanisms of cardiopulmonary resuscitation. Prompt augmentation of central venous filing through the use of a potent alpha-agonist and positional change might have improved organ perfusion, shortened the duration of cardiac arrest, and lessened the degree of neurologic damage.

Optokinetic nystagmus and upper extremity dressing independence after stroke.

Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.

Rehabilitation of Ventilator-Dependent Subjects with Lung Diseases: The Concept and Initial Experience

Sixteen ventilator-dependent patients were enrolled in an in-patient pulmonary rehabilitation (PR) program in a university medical center with the goals of achieving independent self-care, mobility and discharge home. Ten patients had chronic obstructive pulmonary disease and six had restrictive respiratory disorders. PR by a multi-disciplinary team consisted of five phases: 1) stabilization; 2) evaluation; 3) rehabilitation planning including motivation by allowing speech and mobility; 4) rehabilitation training encouraging independent performance of activities of daily living (ADL); and 5) discharge planning with training of patients and families in home respiratory care techniques. A key aspect of the program is improving independence early in the program through the use of mobile ventilators. Periods of weaning from ventilatory support for two or more hours per day were of great importance in improving patient mobility and independence in ADL. Twelve patients were discharged home; except for two individuals who were severely limited by neuromuscular disease, all patients were largely independent in ADL in the home. This preliminary report demonstrates the feasibility of training ventilator-dependent persons to be independent and to participate in their own care in the home.

Musculoskeletal components of decrepitude

Two groups of elderly females were studied to assess the importance of manual ability as a component of independent self-care. A survey instrument was designed which consisted of timing empiric tasks chosen to approximate skills needed to conduct daily activities. Comparison of the mean times for almost every task reveals differences of such magnitude that the populations sampled are totally different by the criteria of manual ability. Many hypotheses are consistent with this observation. Regardless of which hypothesis will prove most likely, the result will be germane to geriatric medicine.

Physical recovery after severe closed head trauma in children and adolescents

Three hundred forty-four patients under 18 years of age with severe closed head injuries, comatose over 24 hours, were followed prospectively for a minimum of one year. Motor vehicles were involved in 82% of the injuries. Seventy-three percent of the patients regained independence in ambulation and self-care, 10% remained partially dependent in self-care and achieved only limited ambulation, 9% regained consciousness but were totally dependent, and 8% remained comatose. A favorable prognosis for recovery of motor function can be made if the duration of coma is less than three months. Complications of prolonged hypertension, ventricular enlargement, and seizures significantly decrease the probability of achieving physical independence. Although mortality following severe head injury is decreasing, neurologic sequelae in the survivors are statistically unchanged since 1970. Improved neurosurgical management in recent years has not increased the percentage of severely disabled survivors.

What is the function of a hospital for geriatric and chronic diseases?

The functioning of a hospital for chronic diseases was examined in terms of the type of patient referred, the course in the hospital and the eventual outcome, in a prospective study of a year's admissions to one department of Harzfeld Hospital in Israel. Of the 191 patients admitted, 55 percent were assessed as possible candidates for rehabilitation, and two-thirds were discharged. Among those admitted primarily for nursing reasons, the mortality was 76 percent. The average stay was 68 days for the 47 percent who were discharged and 95 days for the 45 percent who died; 8.4 percent remained as long-stay patients. Mobility improved in 37 percent and deteriorated in 8 percent; independence in self-care increased from 13 percent on admission to 51 percent on discharge. Thirty percent of the discharges occurred in the first month, and further 30 percent in the second month; 85 percent of these patients returned to their own homes. The hospital stay exceeded 6 months in 18 percent, of whom 7 percent died and 3 percent were later discharged. The possibility of release from the hospital was influenced by the degree of disability rather than the social circumstances. The best change for improvement was among the patients who required only partial help on admission. The most important tasks of the hospital were: intensive and sometimes prolonged rehabilitation; basic nursing care; medical reevaluation and sometimes referral for surgical salvage operations; attention to acute and subacute medical problems, some of which occurred as complications, including accidents; and the concentration of physiotherapy and occupational therapy where most needed. Achievement of these aims was based on fostering a cooperative spirit between patients and staff, adjusting to the problem of re-integrating the long-stay patient, and coordinating specialist services from other hospitals when needed.

Independence in Self‐Care For Traumatic Quadriplegics

Australian Occupational Therapy JournalVolume 18, Issue 1 p. 40-43 Independence in Self-Care For Traumatic Quadriplegics S. K. SHAH O.T.D. (Bom.), O.T.R. (U.S.A.), S. K. SHAH O.T.D. (Bom.), O.T.R. (U.S.A.) Lecturer in Occupational Therapy, Western Australian Institute of TechnologySearch for more papers by this author S. K. SHAH O.T.D. (Bom.), O.T.R. (U.S.A.), S. K. SHAH O.T.D. (Bom.), O.T.R. (U.S.A.) Lecturer in Occupational Therapy, Western Australian Institute of TechnologySearch for more papers by this author First published: January‐March 1971 https://doi.org/10.1111/j.1440-1630.1971.tb00441.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume18, Issue1January‐March 1971Pages 40-43 RelatedInformation

The team approach to hemiplegia.

The cerebrovascular accident patient has much potential, which is best implemented by a team therapeutic approach. A physician must evaluate the patient and determine functional goals. The physical, occupational and speech therapists, social worker and rehabilitation nurse join the physician in helping the patient achieve the goals of independent self-care and ambulation, reentry into comfortable group relationships, and resumption of community roles.