Inpatient Multidisciplinary Rehabilitation Program Research Articles

Combined multidisciplinary in/outpatient rehabilitation delays definite nursing home admission in advanced Parkinson's disease patients.

Advanced Parkinson's disease (aPD) patients have a high risk on definite nursing home admission. We analyzed the effectiveness of an in-and outpatient multidisciplinary rehabilitation, focusing on activities of daily living (ADL) and delaying definite nursing home admission. This study included 24 aPD patients, who received a 6-week inpatient multidisciplinary rehabilitation program, including optimization of pharmacotherapy, which was followed by an individualized outpatient support program during 2 years (intervention group). A non-randomized matched control group (n = 19), received care as usual. Primary endpoints consisted of the Amsterdam Linear Disability Scale (ALDS) and percentage of patients being able to live independently at home after 2 years. Secondary endpoints included changes in medication (LEDD), motor performance (SCOPA-SPES), cognition (SCOPA-COG), hallucinations (NPI) and depression (BDI). Overall, 83% of patients were able to return home after the 6-week inpatient intervention, and 65% still lived at home at 2 years follow-up. Median ALDS scores after 2 years in the intervention group were significantly better, compared to the control group (p = 0.002). All secondary endpoints had improved significantly vs. baseline directly after the 6-week inpatient rehabilitation, which had disappeared at 2 years follow-up, with the exception of the daily dose of medication, which was significantly higher in the intervention group. This 2-year follow-up study showed that a combined multidisciplinary in/outpatient rehabilitation program for aPD patients, was able to stabilize ADL functions, and finally delayed definite nursing home admissions in 65% of treated patients. filenumber M10.091051; ABR code NL32699.042.10.

Early Admission to a Multidisciplinary Inpatient Rehabilitation Program Decreases the Duration of Opiate Weaning among Infants with Neonatal Abstinence Syndrome (NAS)

<h3>Research Objectives</h3> Medical rehabilitation for neonatal abstinence syndrome (NAS) combines medically supervised opiate weaning with intensive, individualized therapeutic supports. The purpose of this study is to investigate differences in length of stay in an NAS treatment program by: 1) early admission (by day 14 of life versus after); and 2) infant characteristics including prenatal narcotic exposure, prenatal care, birth complications, and demographics. <h3>Design</h3> Secondary analysis of data abstracted from electronic medical records. <h3>Setting</h3> An acute inpatient pediatric rehabilitation facility in the Northeast with a dedicated NAS program. <h3>Participants</h3> 62 infants were admitted for NAS treatment between July 2016 and April 2020. One case was excluded because of an atypical length of stay. The final analytic sample was N=61. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Inpatient rehabilitation length of stay in days. <h3>Results</h3> Infants with NAS in this sample spent an average of 17.9 days in the NICU, with a range of 5 to 39 days. 38% were admitted for NAS rehabilitation within two weeks of birth. These infants spent significantly less time in acute rehabilitation compared to infants admitted for NAS treatment after day 14 of life. Based on the results of a Poisson regression model, the predicted length of stay was 15.2 days (95% CI: 13.6-16.8) for infants in the early admission group and 19.9 days (95% CI: 18.5-21.4) for the later admission group, adjusting for differences in prenatal narcotic exposures, delivery type, birth complications, sex, and race. <h3>Conclusions</h3> Early admission for NAS reduces the length of time required to wean infants from opiates. We discuss the benefits of improving the referral process between NICU and NAS medical rehabilitation programs for this vulnerable population. <h3>Author(s) Disclosures</h3> None.

Low-Intensity Whole-Body Vibration: A Useful Adjuvant in Managing Obesity? A Pilot Study

The use of whole-body vibration (WBV) for therapeutic purposes is far from being standardized and an empirical foundation for reporting guidelines for human WBV studies has only very recently been published. Controversies about safety and therapeutic dosage still exist. The present study aimed to investigate the metabolic and mechanical effects of low-intensity WBV according to the ISO 2631 norm on subjects with obesity. Forty-one obese subjects (BMI ≥ 35 kg/m2) were recruited to participate in a 3-week multidisciplinary inpatient rehabilitation program including fitness training and WBV training. During WBV the posture was monitored with an optoelectronic system with six infrared cameras (Vicon, Vicon Motion System, Oxford, UK). The primary endpoints were: variation in body composition, factors of metabolic syndrome, functional activity (sit-to-stand and 6-min walking test), muscle strength, and quality of life. The secondary endpoints were: modification of irisin, testosterone, growth hormone, IGF1 levels. We observed significant changes in salivary irisin levels, Group 2 (p &lt; 0.01) as compared to the control group, while muscle strength, function, and other metabolic and hormonal factors did not change after a 3-week low-intensity WBV training with respect to the control group. Future studies are needed to further investigate the potential metabolic effect of low-intensity WBV in managing weight.

Rehabilitation of Patients with Severe Disability after CO VID-19 in Rehabilitation Department. Multiple Case Study

The COVID-19 pandemic has significantly affected all aspects of life around the world including both the medical system as a whole and individual medical specialties. Understandably, medical rehabilitation was forced to adapt to the new disease, to develop adequate algorithms and technologies that can increase the level of independence and quality of life being disrupted as a result of coronavirus infection. Aim. To analyze, organize and present the results of in-patient rehabilitation of patients after severe forms of COVID-19 infection by reporting the real cases from the clinical practice. Material and methods. COVID-19 infection is a multi-systemic disease, which, in many cases requires for inpatient multidisciplinary rehabilitation program. Patients after severe forms of infection suffer different symptoms in variable combinations. According to main disabling signs we can classify all our patients in 3 groups: (1) general weakness or deconditioning, (2) respiratory disorders due to lung disease, and (3) patients with different neurological complications. Patients in all groups demonstrate serious psychological compliances which indefinitely have negative influence on rehabilitation process. The paper presents clinical cases specific to each of the groups. Results. All hospitalized patients showed good functional improvement through quite standard length of stay in the department All patients were discharged home with the opportunity to return to relatively normal daily activities. Conclusions. Patients after severe COVID-19 infection require professional multidisciplinary in-patient rehabilitation. All of them demonstrate good functional improvement and, after quite short period of hospitalization, can be discharged home.

Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson's Disease: A Retrospective and Observational Study.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor (resting tremor, rigidity, bradykinesia, postural instability, and gait disturbances) and nonmotor symptoms (cognitive, neuropsychiatric, and autonomic problems). In recent years, several studies demonstrated that neurorehabilitation therapy is an effective treatment in addition to pharmacological personalized interventions in persons with PD (PwPD). The main aim of this study was to explore the short-term changes in functional, cognitive, and geriatric domains after a multidimensional rehabilitation program in PwPD (as primary condition) in mild–moderate (M-Ms) to severe (Ss) stages. Our second aim was to compare the effects of multidimensional rehabilitation in M-Ms versus Ss of PD. Twenty-four PwPD in M-Ms to Ss [age (mean ± SD) = 76.25 ± 9.42 years; male/female = 10/14; Hoehn and Yahr (median; IQR) = 4.00; 1.75] were included in a retrospective, observational study. Motor, cognitive, functional, and neuropsychiatric aspects were collected in admission (T0) and in discharge (T1). PwPD were involved in a person-tailored (to individual's needs), inpatient, intensive (5–7 days per week), multidisciplinary (combining cognitive, physical, occupational, and speech therapies), comprehensive, and rehabilitative program. According to Movement Disorders Society Unified Parkinson's Disease Rating Scale III cutoff, PwPD were classified in M-Ms or Ss (M-Ms ≤59; Ss >59); 87.50% of our sample reported significant reduction of functional disability at Barthel Index (p < 0.001). A significant improvement in Token test (p = 0.021), semantic fluency (p = 0.036), Rey's Figure-Copy (p < 0.001), and Raven's Colored Progressive Matrices (p = 0.004) was observed. The pain intensity perception (p < 0.001) and the risk of developing pressure ulcers (p < 0.001) as assessed, respectively, by the Numeric Rating Scale and by the Norton Scale were improved. With regard to the second aim, in M-Ms group, we found a positive correlation between the number of neuromotor sessions and the change in functional disability and language comprehension; in the Ss group, on the other hand, despite a higher number of hospitalization days, the total number of completed sessions was positively associated with the change in visuoconstructional abilities. Our findings suggest that an intensive, inpatient, and multidisciplinary rehabilitation program may improve functional abilities, some strategic cognitive functions, and geriatric aspects in PwPD with mild–moderate motor impairment.

Assessment of Intensive Inpatient Rehabilitation Program in Acquired Brain Injury Patients using UK FIM+FAM Scale: A Retrospective Study

Introduction: Acquired Brain Injury (ABI) can lead to a combination of physical, cognitive, and behavioural impairments and requires comprehensive and structured inpatient rehabilitation program. A multidisciplinary rehabilitation program can deal comprehensively with all these issues together rather than focussing on a single aspect like motor function. Number of people suffering from Traumatic Brain Injury (TBI) in India has been documented to be between 1.5 million to two million per year whereas out of this approximately one million die due to TBI. The rationale of the present study was to document the outcome of multidisciplinary inpatient rehabilitation program objectively using a standard functional outcome measure. Aim: To determine the change in functional outcomes of ABI patients being rehabilitated with a multidisciplinary inpatient neurorehabilitation program using UK version of Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). Materials and Methods: The retrospective observational study was conducted in Medanta Hospital, Gurugram, Haryana, India, from September 2017 to June 2018. Retrospective analysis of previously maintained data was done from June 2018 to November 2018. Data was collected from the Department of Neurorehabilitation. Demographic data was collected including age, sex, type of injury, time from injury to admission and duration of stay in the neurorehabilitation unit. Functional outcome measure used in the study was the UK FIM+FAM. Data was collected in paper forms and collated in Microsoft Excel and transferred to IBM® Statistical Package for the Social Sciences (SPSS)® version 22.0 (IBM Corp., Armonk, NY) for analysis. The UK FIM+FAM data was analysed as aggregate total scores and motor and cognitive subscales. Non parametric tests were used as UK FIM+FAM is an ordinal scale. The test used to measure the change in score was Wilcoxon Test. The p-value &lt;0.05 was considered statistically significant. Results: Total number of patients who were analysed in the study were 45. Motor subset of scores showed significant improvement from admission (50) to discharge (72) (p-value=0.001). Similarly, the cognitive subset of scores also showed a significant improvement from admission (58) to discharge (68, p value=0.002). Apart from motor and cognitive subscales of UK FIM+FAM, change in score in sub divisions of self-care and transfers showed the maximum change with p-value=0.001. Other sub divisions of locomotion, sphincter, communication, psychological and cognition also showed a significant difference of p-value &lt;0.05. Conclusion: A physiatrist led intensive interdisciplinary inpatient rehabilitation program for patients with ABI may significantly reduce residual disability and improve functional independence. Such a program is not only effective in high income countries but also in Low Middle Income Countries (LMIC).

Inpatient multidisciplinary rehabilitation program for postural and gait stability in Huntington´s disease – a pilot study

Inpatient multidisciplinary rehabilitation program for postural and gait stability in Huntington´s disease – a pilot study

Psychological and work-related outcomes after inpatient multidisciplinary rehabilitation of chronic low back pain: a prospective randomized controlled trial

BackgroundThis study investigated the long-term effects (12 months post-rehabilitation) of a standard inpatient multidisciplinary rehabilitation program for patients with chronic low back pain (CLBP), in which a control group (CG) received pain competence training and an intervention group (IG) received combined pain competence and depression prevention training.MethodsIn this prospective control group study with cluster-block randomization, a total of n = 583 patients were included into per protocol analyses. To examine the effects of rehabilitation on depressive symptoms, pain self-efficacy, and work ability, patients were stratified in repeated-measures analyses of variance by treatment condition (IG vs. CG), level of depressive symptoms (low vs. high), and time of assessment (pre, post, 6, and 12 months after rehabilitation). The impact of each treatment on pain-related days of sick leave (DSL; dichotomized into ≤ vs. > 2 weeks) was determined separately by conducting non-parametric analyses. Multiple imputations (n = 1225) confirmed the results. Effects were interpreted if clinical significance was given.ResultsOnly patients with high levels of depressive symptoms showed long-term improvements in depressive symptoms and self-efficacy. Long-term improvements in work ability index and mental work ability item were restricted to the IG. Furthermore, long-term effects on pain-related DSL were ascertained by per protocol and multiple imputation analyses only for the IG.ConclusionsPatients with high levels of depressive symptoms showed improvements in depressive symptoms and self-efficacy, supporting the psychological effectiveness of both interventions. However, the beneficial long-term effects of rehabilitation on work ability and pain-related DSL among the IG support implementation of combined pain competence and depression prevention training.Trial registrationDRKS00015465 (German Clinical Trial Register DRKS); date of registration: 03.09.2018.

Effect of a specific inpatient multidisciplinary rehabilitation program on postural and gait stability in Huntington's disease – Pilot study

Postural and gait instability in Huntington's disease (HD) is an essential part of the motor symptomatology causing falls contributing to morbidity and mortality. Rehabilitation (Rhb) is considered beneficial in stability treatment. However, the number of studies is still limited. This is the first multidisciplinary inpatient study using a specific program aimed at postural and gait stability in HD. We aimed to evaluate the short-and long-term effects of an inpatient multidisciplinary rehabilitation program on postural and gait instability in HD. A sample of 16 HD subjects without severe cognitive deficit or depression were included, 13 subjects completed the full course. They underwent a 3-week specific inpatient rehabilitation focused on stability. The examination was at baseline, after the completion, 1 and 3 months after the rehabilitation. The testing included: gait stability examination (Dynamic Gait Index; DGI), posturography examination of postural stability Limits of Stability on a stable (PSS) and 20% unstable (PSU) platform and the motor function evaluation by Unified Huntington's Disease Rating Scale (UHDRS-TMS). There was a significant improvement in DGI immediately after the Rhb and a significant 3 months lasting improvement in PSS. There was no significant improvement in PSU and UHDRS-TMS. Specific Rhb methods improved postural and gait instability in early- and mid-stage HD patients. The improvement in PSS persisted 3 months. We found no improvement in PSU, which is probably a too difficult test for this degree of stability impairment. The improvement in DGI does not persist after 1 month. This study offers a verified specific Rhb protocol for stability training in HD.

Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1-Week Multidisciplinary Rehabilitation Program

BackgroundFunctional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies. ObjectiveTo assess outcomes of FMD patients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success. DesignRetrospective chart review. SettingUniversity-affiliated rehabilitation institute. PatientsThirty-two consecutive FMD patients admitted to the MoRe program from July 2014–July 2016. InterventionPatients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions. Main Outcome MeasurementsPrimary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program. ResultsTwenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes. ConclusionsThe majority of FMD patients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed. Level of EvidenceIII

A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial

BackgroundHip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of falling and associated activity restriction and thereby improves physical functioning.Methods/designThis multicentre cluster randomised controlled trial will be conducted among older patients with hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive behavioural therapy, including guided exposure to feared activities (that are avoided by the participants). Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at 3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention will be evaluated. Primary outcome measures are fear of falling and mobility.DiscussionTargeted treatment of fear of falling may improve recovery and physical and social functioning after hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the intervention is feasible.Trial registrationNetherlands Trial Register: NTR 5695.

Intensive rehabilitation model in Guillain-Barre syndrome: a case report

There is little information in the medical literature on the rehabilitation of patients with GuillainBarre Syndrome (GBS). There are clinical studies that demonstrate the effectiveness of a rehabilitation program using an interdisciplinary team, but without well-defined protocols and only performed on an outpatient basis. This case report aims to describe the evolution of a patient with GBS during the intensive multidisciplinary inpatient rehabilitation program, discussing the therapeutic possibilities for rehabilitation of the disease

Intensive rehabilitation model in Guillain-Barre syndrome: a case report

There is little information in the medical literature on the rehabilitation of patients with GuillainBarre Syndrome (GBS). There are clinical studies that demonstrate the effectiveness of a rehabilitation program using an interdisciplinary team, but without well-defined protocols and only performed on an outpatient basis. This case report aims to describe the evolution of a patient with GBS during the intensive multidisciplinary inpatient rehabilitation program, discussing the therapeutic possibilities for rehabilitation of the disease

Psychosocial Determinants of Longer Length of Stay on a Canadian Stroke Inpatient Rehabilitation Unit

Objective: The relationship between availability of psychosocial resources and inpatient stroke rehabilitation length of stay (LOS) has been inadequately studied. The purpose of this prospective observational study was to identify psychosocial determinants that prolong LOS of patients in a stroke rehabilitation program. Methods: Patients admitted to a multidisciplinary inpatient stroke rehabilitation program in southern Ontario, Canada, were consecutively recruited from October 2008 to August 2010. Patients diagnosed as having had a cerebrovascular event resulting in neurological impairments that required intensive rehabilitation were eligible for the study. Independent variables included psychosocial (awaiting long-term care placement, poststroke depression, inadequate family support, limited access to community home care services), medical (comorbidity, medical complications), neurological (type and location of stroke, neurological deficits), and functional (Functional Independence Measure [FIM] score on admission and discharge, Modified Rankin Disability Scale score) factors. The main outcome measure was length of hospital stay (days). Results: A total of 117 patients were recruited. The mean and median LOS were 49.8 and 45 days respectively. Most patients (92.3%) were discharged home. On multivariate linear regression analysis, the significant determinants associated with longer LOS were awaiting long-term care placement (P<0.001), low admission FIM score (P=0.001), post-stroke depression (P=0.007), difficulties arising from inadequate family support (P=0.033), limited access to community home care services (P=0.035), and presence of medical complication(s) (P=0.039). These 6 factors, 4 of which were psychosocial, accounted for 48.8% of the total variance in LOS. Conclusion: Psychosocial factors were key determinants of longer LOS in addition to medical/neurological factors such as severity of stroke and medical complications. Health care systems must incorporate psychosocial information to a greater extent and recognize its fundamental role in rehabilitation outcomes.

Improvement rates in adolescent patients with chronic fatigue syndrome after receiving cognitive behavioural therapy

Werker et al. [7] claim that several randomised controlled trials have demonstrated that cognitive–behavioural therapy (CBT) resulted in improvement and ‘recovery’ in 60–70 % of adolescent patients with chronic fatigue syndrome when assessed at 6 months [3, 4, 6], with ‘comparable results at 2– 3-year follow-up’ [2, 5]. However, I believe further data from the cited research studies would have been helpful to put the results in their full context. The open-label FITNET trial [4, 5] did indeed report a 63 % ‘recovery’ rate at 6 months. However, the trial used a post hoc definition of ‘recovery’ which has been criticised for not being stringent enough [1, 8]. Furthermore, the follow-up paper concluded that receiving CBT ‘did not significantly influence recovery rates’ at long-term follow-up (LTFU), as there was no significant difference between CBT and the ‘usual care’ control group. In another cited study, Stulemeijer et al. compared CBT to a waiting list control. The proportion of patients who improved in fatigue and physical function was reported as 60 and 63 %, but when compared to the control group, the additional proportion of patients who improved after CBT was as follows: fatigue severity 39 %; physical functioning 39 %; full school attendance 29 %; and self-rated improvement 27 % [6]. Knoop et al. reported improvement rates of 60–74 %, but when compared to a waiting list control, the improvement rates for CBT at LTFU were 33 % for fatigue, and 24 % for physical functioning, with similar rates at immediate assessment [2]. The remaining cited study, by Lim and Lubitz, investigated an intensive multi disciplinary inpatient rehabilitation programme. Improvement rates were not presented in comparison to the control group, and 68 % of participants reported that they felt the psychological component of the programme was unhelpful or that they felt indifferent towards it [3].

OP0078-HPR A three week rehabilitation program had positive long term effects in patients with ankylosing spondylitis: Results from a randomised controlled trial

BackgroundThe Assessment of SpondyloArthritis International Society (ASAS) and European League against Rheumatism (EULAR) working group state that optimal management of ankylosing spondylitis (AS) comprises a combination of pharmacological and non-pharmacological...

A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: Randomized controlled trial

To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis. Observer-blinded, randomized controlled trial, with assessments made after 4 and 12 months. Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual. Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale (BASDAI), and function measured with the Bath Ankylosing Spondylitis Functional Index (BASFI). Secondary outcomes included well-being, spinal and hip mobility, and health-related quality of life measured with the Medical Outcome Study Short Form-36. Overall treatment effects were estimated with Mixed models repeated measures analyses. Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score (mean difference over the 1-year period -10.0, 95% confidence interval: -3.7 to -16.3), in well-being (-7.3, 95% confidence interval: -1.0 to -14.7), and in the Medical Outcome Study Short Form-36 variables social functioning, role physical, role mental and bodily pain (mean differences ranging from 5.8 (pain) to 10.7 (role physical)). A 3-week in-patient rehabilitation programme had positive overall effects on disease activity, pain, function and well-being, and should be considered an important complement to medical disease management in persons with ankylosing spondylitis.

Rehabilitation and Parkinson’s Disease 2013

Parkinson's disease (PD) is the second most common neurodegenerative disorder, and increasing age is a major risk factor for development of PD. As such, PD is expected to become increasingly prevalent in coming years as the aged population grows in number. PD is typically treated with pharmacological and sometimes surgical approaches, but these treatments do not adequately address many aspects of the disease. As such, rehabilitation may play a key role in the management of PD. The nine articles in this special issue illustrate the broad spectrum of important rehabilitation issues for people with PD. M. H. Nilsson et al. report relationships between health and housing in very old individuals with PD, examining the impact of environmental barriers and accessibility problems on daily life. A. Letanneux et al. focus on the psychosocial impact of speech impairment in PD, presenting a French version of the Dysarthria Impact Profile. K. B. Foreman et al. also address speech issues, examining the effects of concurrent performance of a speech task and a postural control task in individuals with PD. Postural control is also addressed by G. Vervoort et al., who present evidence of differences in specific aspects of postural control in people with PD who experience freezing of gait compared to those with PD who have no history of freezing of gait. S. T. Nemanich et al. also focus on gait in PD, examining utility of walking speeds for identifying fallers and determining predictors of preferred and fast pace walking speeds. A. Williams et al. examine the relationships between gait and upper extremity movements in PD, studying the effects of amplitude and cadence manipulations. B. K. Randhawa et al. also examine upper extremity performance as assessed by handwriting, demonstrating the acute changes in handwriting following a single intervention session using transcranial magnetic stimulation. L. A. King et al. examine two different exercise interventions, focusing on which outcome measures were most effective for measuring change following agility boot camp or treadmill training. Finally, G. Frazzitta et al. report the effects of a four-week multidisciplinary inpatient rehabilitation program on gait and balance function after completion of the intervention and one year later. The broad scope of work in this special issue is reflective of the far-reaching impact that rehabilitation may have on many aspects of PD, from the individual to the environmental level. Last but not least, the presented work will provide a multilevel understanding of PD motor problems which will feed into the clinical care and optimal rehabilitation for patients with this complex disease. Gammon M. Earhart Leland E. Dibble Terry Ellis Alice Nieuwboer

Variations in Functional Outcome Stratified by Discharge Disposition and Oncological Treatment Groups After Acute Inpatient Rehabilitation for Brain Tumor Patients

Objective: This study evaluated variations in functional outcome for patients participating in a multidisciplinary acute inpatient rehabilitation program specific for brain tumors at a free standing acute inpatient rehabilitation hospital. Methods: Data was collected retrospectively for 45 patients with brain tumors admitted for inpatient rehabilitation from January 1, 2008 to May 1, 2009. Primary outcome measure included Functional Independence Measure (FIM) score on admission and discharge based on discharge disposition and acute oncological treatment group. Data was collected regarding length of stay and general patient demographic information. Results: Patients receiving chemotherapy and radiation while participating in inpatient rehabilitation had the greatest statistically significant gains inFIM, FIM-D, � FIM-T, discharge FIM-T, discharge FIM-M, and FIM-E. Patients who discharged to home for continued aggressive treatment had greatest gains inFIM, FIM-D, � FIM-T, discharge FIM-T, � FIM-M, discharge FIM-M, and FIM-E. Correlation data was also established between several variables. Conclusions: Inpatient rehabilitation stay for brain tumor patients resulted in improvements of FIM score for all disposition and acute oncological treatment groups, though statistically significant differences were noted within groups. Greatest improvements were noted for patients receiving both chemotherapy and radiation therapy and patients who discharged to home for continued aggressive oncological treatment.

Hip fractures Inpatient rehabilitation designed for geriatric patients following hip fracture:a critique and the results of a recent metaanalysis

This recent metaanalysis included an evaluation of nine randomized controlled trials that studied the rehabilitation of geriatric patients who had suffered a hip fracture. Using pooling of the aggregate data from each study, functional improvements were significantly better for those patients who received a multidisciplinary inpa-tient rehabilitation program compared with those who received usual care, both at discharge and at longer term follow-up. There was less risk of nursing home admission and also of mortality in the rehabilitated patients compared with the usual care patients.