Level Of Independence In Activities Research Articles

The effectiveness of robotic-assisted upper limb rehabilitation to improve upper limb function in patients with cervical spinal cord injuries: a systematic literature review.

Spinal Cord Injury (SCI) damages corticospinal tracts and descending motor pathways responsible for transmitting signals from the brain to the spinal cord, leading to temporary or permanent changes in sensation, motor function, strength, and body function below the site of injury. Cervical SCI (cSCI), which leads to tetraplegia, causes severe functional upper limb (UL) impairments that increase falls risk, limits independence, and leads to difficulties with activities of daily living (ADLs). Robotic therapy (RT) has been developed in recent decades as a new treatment approach for people with cervical spinal cord injuries (cSCI). The present review aimed to explore current available evidence and studies regarding the effectiveness of RT for individuals with cSCI in improving UL function, identify current research gaps and future research directions. This review was conducted by searching PubMed, CINAHL, Medline, Embase, and APA PsycInfo for relevant studies published from January 2010 to January 2022. Selected studies were analyzed with a focus on the patients' self-perception of limited UL function and level of independence in activities of daily living. In addition, the JBI Critical Appraisal checklist was used to assess study quality. A total of 7 articles involving 87 patients (74 males and 13 females) were included in the analysis, with four studies utilizing exoskeleton and three studies utilizing end-effector robotic devices, respectively. The quality of these studies varied between JBI Critical Appraisal scores of 4 to 8. Several studies lacked blinding and a control group which affected internal validity. Nevertheless, four out of seven studies demonstrated statistically significant improvements in outcome measurements on UL function and strength after RT. This review provided mixed evidence regarding the effectiveness of RT as a promising intervention approach to improve upper limb function in participants with cSCI. Although RT was shown to be safe, feasible, and reduces active therapist time, further research on the long-term effects of UL RT is still needed. Nevertheless, this review serves as a useful reference for researchers to further develop exoskeletons with practical and plausible applications toward geriatric orthopaedics.

Evaluation of a Remote-Controlled Drone System for Bedridden Patients Using Their Eyes Based on Clinical Experiment

With the aging of the population in Japan, the number of bedridden patients who need long-term care is increasing. The Japanese government has been promoting the creation of an environment that enables everyone, including bedridden patients, to enjoy travel, based on the principle of normalization. However, it is difficult for bedridden patients to enjoy the scenery of distant places and to talk with the local people because they need support from helpers to travel to distant places using travel agencies. Therefore, to enhance their quality of life (QOL), we developed a remote-controlled drone system, which involves using only the eyes. We believe that bedridden patients are able to operate the system’s drone in a distant place, to easily view the scenery of the distant place with a camera installed on the drone, and to talk with the local people. However, we have never evaluated whether actual bedridden patients can operate the drone in a distant place, to see the scenery, and to talk with the local people. In this paper, we presented clinical experimental results to verify the effectiveness of this drone system. Findings showed that, not only subjects with relatively high levels of independence in activities of daily living, but also bedridden subjects, could operate the drone at a distant place with only their eyes and communicate with others.

Relationship between Special Nursing Home Residents’ Level of Independence in Activities of Daily Living and Skeletal Muscle Mass Index

Relationship between Special Nursing Home Residents’ Level of Independence in Activities of Daily Living and Skeletal Muscle Mass Index

Geriatrik Bireylerde Günlük Yaşam Aktivitelerindeki Bağımsızlık Düzeyi ile Yaşam Doyumu Arasındakiİlişkinin İncelenmesi: Tanımlayıcı Araştırma

Geriatrik Bireylerde Günlük Yaşam Aktivitelerindeki Bağımsızlık Düzeyi ile Yaşam Doyumu Arasındakiİlişkinin İncelenmesi: Tanımlayıcı Araştırma

Clarification of Factors Determining Discharge Destination Among Elderly Patients After Stroke With Low Levels of Independence in Activities of Daily Living: A Retrospective Study

To determine factors influencing discharge destination of elderly patients after stroke with low levels of independence in activities of daily living (ADL). Cross-sectional study. A community-based public hospital in a rural area in Japan. A total of 67 patients with low daily function among 205 elderly patients with stroke screened for eligibility (N=67). Not applicable. Motor component of functional independence measure (M-FIM) at discharge and discharge destination-home or long-term care facility (LCF). Among the 205 eligible patients, 147 were discharged home and 58 were discharged to LCFs. Patients with an M-FIM score of ≤30 at discharge were defined as patients deemed difficult to discharge home because of low independence levels in ADL. Of the 147 patients discharged home, 24 (16.3%) had M-FIM scores of ≤30. Of the 58 patients discharged to LCFs, 43 (74.1%) had M-FIM scores of ≤30. Patients with an M-FIM score of ≤30 at discharge significantly tended to be discharged home if they obtained oral intake vs tube feeding as a nutritional method (P=.047) and higher cognitive component of FIM scores at discharge (P=.002). All six patients who lived alone among patients with an M-FIM score of ≤30 were discharged to LCFs. Two patients on tube feeding were discharged home. Nutritional method, cognitive function at discharge, and the prestroke living situation with or without household caregivers are important factors of discharge among elderly patients after stroke with low independence levels in ADL. However, only a small number of severely disabled patients were successfully discharged home.

The Impact of Robotic Therapy on the Self-Perception of Upper Limb Function in Cervical Spinal Cord Injury: A Pilot Randomized Controlled Trial.

Background: The aim of the present study was to evaluate the impact of robotic therapy in patients with cervical spinal cord injury (SCI), measured on the basis of the patients’ self-perception of limited upper limb function and level of independence in activities of daily living. Methods: Twenty-six patients with cervical SCI completed the treatment after being randomly assigned to the intervention or control group. The training consisted of 40 experimental sessions 1 h in duration, ideally occurring 5 days/week for 8 weeks. In addition to the conventional daily therapy (30 min), the control group received another 30 min of conventional therapy, whereas the intervention group received 30 min of robotic therapy. Patients were evaluated by means of the Capabilities of Upper Extremity Questionnaire (CUE) and Spinal Cord Independence Measure (SCIM) clinical scales. Results: The improvement in the feeding item of SCIM was significantly higher in the intervention group than in the control group after the treatment (2.00 (0.91) vs. 1.18 (0.89), p = 0.03). The correlation between the CUE and SCIM scales was higher at the ending than at baseline for both groups. Conclusions: Although both groups improved, the clinical relevance related to the changes observed for both assessments was slightly higher in the intervention group than in the control group.

Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living.

[Purpose] The relationship between quality of life and life-space mobility in community-dwelling older adults has recently been reported. The present study aimed to elucidate this relationship in home-based rehabilitation users with limited life-space mobility and loss of independence in activities of daily living. [Participants and Methods] The study population comprised 33 home-based rehabilitation users. The participants were expected to have a wide range of the level of independence in activities of daily living; therefore, they were categorized into three groups according to the Barthel Index score: independent (95–100 points), moderately disabled (90–65 points), and severely disabled (60–0 points) groups. We examined the relationships among the Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index scores and age. [Results] We detected a strong positive correlation between the Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the independent group; however, no significant correlations were observed in the moderately and severely disabled groups. [Conclusion] Our findings suggest a relationship between subjective well-being and life-space mobility in home-based rehabilitation users who are mostly independent in activities of daily living. However, owing to the small sample size and characteristics of the scales used in this study, further studies are warranted to verify these results.

Investigation of the Factors Affecting Quality of Life in Patients with Mild to Moderate Alzheimer's Disease in Terms of Patients and Caregivers.

Background and Objectives: As with other chronic diseases with limited medical treatment, the most important goal of Alzheimer’s disease (AD) treatment is to provide a better quality of life (QoL). The purpose of this study was to investigate the factors affecting the QoL of patients with mild to moderate AD in terms of patients and caregivers. Materials and Methods: Seventy-three home-dwelling patients with AD and their caregivers participated in this prospective, cross-sectional study. The patients were asked about their cognition, depression and a self-rating part of a QoL questionnaire. The caregivers were asked about their patients’ sociodemographic information, sleepiness, activities of daily living and a proxy rating part of a QoL questionnaire. Results: The self-rated QoL was higher than that provided by the proxy rating. Cognition (p = 0.02), sleepiness (p < 0.01) and depression (p = 0.03) were correlated with the self-rated QoL, while the patient’s independence level in activities of daily living was correlated with the proxy-rated QoL (p < 0.05). In regard to predicting QoL according to linear regression analysis, the following were statistically significant: depression was for total score, depression and cognition were for the self-rating and instrumental activities of daily living was for the proxy rating (p < 0.01). Conclusions: While individual factors such as psychology are an important determinant of QoL for patients with AD, objective conditions such as the independence of the patient in daily life are important for the caregiver. While evaluating the quality of life of AD patients, it is important to remember that patients and caregivers have different priorities, and the priorities of both should be taken into account when planning a treatment program.

DUKUNGAN KELUARGA DENGAN TINGKAT KEMANDIRIAN LANSIA PASCA STROKE DI POLIKLINIK NEUROLOGI RSU.X

Post-stroke patients often experience obstacles in Activity Daily Living (ADL), efforts to increase the independence of elderly post-stroke activities require family participation. This study identifies the relationship between family support and the level of independence in Activity Daily Living (ADL) in post-stroke elderly. This study used descriptive correlative with a cross sectional approach. The population in this study were post-stroke patients who visited the Polyclinic of the General Hospital of Sufina Aziz. The research sample was using purposive sampling technique. The research sample consisted of 57 people. Data analysis used Rank Spearman Rho test.This study shows that family support for the level of independence in daily activities in the post-stroke elderly is in the moderate category (54.4%). The level of independence in daily living (ADL) activities in post-stroke elderly in the mild dependency category (73.7%). The results of this analysis meet the criteria of the hypothesis requirements, that there is a relationship between family support and the level of independence in daily living (ADL) activities in post-stroke elderly at RSU Sufina Aziz Medan with a p = 0.014 (p &lt;0.05). Therefore, nurses at the General Hospital Sufina Aziz Medan routinely provide counseling or health education to patients and families about the importance of providing support to the elderly after stroke in Activity Daily Living (ADL).

24-h movement behaviors among autistic adults: Differences by sex, age, and level of independence

BackgroundAutistic adults have low levels of physical activity [PA], high levels of sedentary behavior [SB], and insufficient sleep. Not known is the extent to which engagement in these movement behaviors vary by sex, age, and level of independence in activities of daily living (ADLs). ObjectiveTo characterize movement behaviors in a national sample of autistic adults by sex, age, and level of independence in ADLs. MethodsA national sample of autistic adults and caregivers of autistic adults self-reported PA, SB and sleep behaviors as well as demographic variables using an electronic survey. Levels of engagement in movement behaviors were described, and compared by sex, age (young-adult versus middle-age), and level of independence in ADLs. ResultsData were collected on 361 autistic adults (60.3% male, n = 217, mage = 30.82 years, SD = 10.24). Overall, 44% did not meet the PA guideline; PA guideline adherence was lowest among males and those who were dependent on others in ADLs. Overall, the SB guideline was not met by 43% of the sample at weekdays and 48% at weekends. SB guideline adherence was lowest among adults who were middle-aged, and those who were fully independent in ADLs. Overall, 35.2% did not meet the total sleep time (TST) guideline. Middle-aged autistic adults had the lowest adherence to the TST guideline. ConclusionsThese finding should prompt researchers to consider these demographic differences, and tailor research and programmatic efforts to account for the unique movement behavior profiles of different segments of this heterogenous population.

Activities of Daily Living and Categorization Skills of Elderly with Cognitive Deficit: A Preliminary Study.

Cognitive dysfunction affects the performance of Activities of Daily Living (ADL) and the quality of life of people with these deficits and their caregivers. To the knowledge of the authors, to date, there are few studies that focus on knowing the relationship between personal autonomy and deductive reasoning and/or categorization skills, which are necessary for the performance of the ADL. The aim of this study was to explore the relationships between ADL and categorization skills in older people. The study included 51 participants: 31 patients with cognitive impairment and 20 without cognitive impairment. Two tests were administered to assess cognitive functions: (1) the Montreal Cognitive Assessment (MoCA); and (2) the digital version of Riska Object Classification test (ROC-d). In addition, the Routine Tasks Inventory-2 (RTI-2) was applied to determine the level of independence in activities of daily living. People with cognitive impairment performed poorly in categorization tasks with unstructured information (p = 0.006). Also, the results found a high correlation between cognitive functioning and the performance of ADLs (Physical ADL: r = 0.798; p < 0.001; Instrumental ADL: r = 0.740; p < 0.001), a moderate correlation between Physical ADLs and categorization skills (unstructured ROC-d: r = 0.547; p < 0.001; structured ROC-d: r = 0.586; p < 0.001) and Instrumental ADLs and categorization skills in older people (unstructured ROC-d: r = 0.510; p < 0.001; structured ROC-d: r = 0.463; p < 0.001). The ROC-d allows the assessment of categorization skills to be quick and easy, facilitating the assessment process by OT, as well as the accuracy of the data obtained.

Understanding the impact of cognitive impairment and disease severity on activities of daily living in MS patients with different disability levels

ObjectivePhysical impairments seen in people with multiple sclerosis (PwMS) affect the level of independence in activities of daily living (ADL). However, physical problems are insufficient to explain some debilitating conditions experienced by PwMS in daily life, especially in activities that require high cognitive ability. The aim of this study was to investigate the impact of cognitive impairment and disease severity on ADL in MS patients with different disability levels. MethodsSeventy PwMS were enrolled and divided into three groups according to their disability status. Cognitive functions were assessed with the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and independence level in ADL was assessed with Functional Independence Measure (FIM). ResultsThere were significant differences between groups in FIM and FIM motor (FIMm) scores (p < 0.001), however no significant differences were found between groups in terms of FIM cognitive (FIMc) and LOTCA scores (p = 0.195 and p = 0.348 respectively). There was a moderate positive correlation between FIM and LOTCA total scores (p < 0.001) for overall sample. While there was a low correlation between LOTCA and FIMm (p = 0.008), high correlation was found between LOTCA and FIMc (p < 0.001). ConclusionAlthough most of the limitations in ADL can be explained by the severity of the disability in MS, the ability to perform ADL including cognitive skills was found to be similar for all disability levels. Cognitive problems should be taken into consideration as well as motor problems in the process of planning treatment programs for PwMS with any levels of disability.

Selection of discharge destination for patients with moderate-to-severe traumatic brain injury

ABSTRACT Objectives To investigate criteria acute care interdisciplinary providers use to select discharge destination for patients with traumatic brain injury (TBI). Design Cross-sectional, exploratory survey study. Methods Data were collected from interdisciplinary providers at a U.S. Level I trauma centre via electronic survey. We invited 199 providers to participate and 27 responded (13.5% response rate). Responses were received from physicians and physical, occupational, and speech therapists. Results Findings showed variability in standard criteria and clinical judgment criteria providers used to select discharge destination for patients with TBI receiving acute care. There was limited agreement on standard criteria used to select discharge destination. Findings showed some agreement between providers on clinical judgment criteria used to select home as discharge destination and to prevent discharge to home. Most common clinical judgment criteria included therapists’ recommendations on discharge location, patient’s level of independence in activities of daily living, planned family support and ventilator dependence. Agreement on clinical judgment criteria became more limited when stratifying by discipline, frequency of patient care and experience. Conclusions Findings on clinical judgment criteria providers use to select acute care discharge destination for patients with TBI are inconclusive.

Exploring the impact of carer stressors and psychological inflexibility on depression and anxiety in family carers of people with dementia

This study aimed to explore the impact of carer stressors (neuropsychiatric symptoms of dementia, level of independence in activities of daily living, hours of caring per week), demographic factors (carer age, relationship with the person with dementia, dementia type, dementia severity, number of years since diagnosis and cohabitation status) and psychological inflexibility on depression and anxiety in family carers of people with dementia. Eighty-nine family carers with a mean age of 69.13 years old completed self-reported and interview-based questionnaires. Participants were primarily female family members aged 65 years or older looking after a person with severe Alzheimer's disease. Two final regression models (Depression model R2 = 0.43; Anxiety model R2 = 0.43) demonstrated that psychological inflexibility (β = 0.52) and the number of hours devoted to caregiving (β = 0.23) had a significant impact on carer depression, while psychological inflexibility was the only significant independent predictor of carer anxiety (β = 0.55). The findings demonstrated psychological inflexibility to be a common factor explaining mental health problems in this population even after controlling for other variables known to have an impact. Acceptance and Commitment Therapy (ACT) may be beneficial for concomitantly treating depression and anxiety in this population. Considering that fifty-two per cent of participants responded that they devote more than 41 h to caregiving per week, a non-traditional face to face approach such as online ACT may have potential in future research. Future studies should also explore the suggested models in understudied subgroups of carers (e.g., carers of early-onset dementia, carers of people with early-stage dementia).

Factors associated with successful home discharge after inpatient rehabilitation in frail older stroke patients

BackgroundStroke is a highly prevalent disease among older people and can have a major impact on daily functioning and quality of life. When community-dwelling older people are hospitalized due to stroke, discharge to an intermediate care facility for geriatric rehabilitation is indicated when return to the previous living situation is expected but not yet possible. However, a substantial proportion is still unable to return home after discharge and has to be admitted to a residential care setting. This study aims to identify which factors are associated with home discharge after inpatient rehabilitation among frail and multimorbid older stroke patients.MethodsThis study is a longitudinal cohort study among 92 community-dwelling stroke patients aged 65 years or over. All patients were admitted to one of eight participating intermediate care facilities for geriatric rehabilitation, under the expectation to return home after rehabilitation. We examined whether 16 potentially relevant factors (age; sex; household situation before admission; stroke history; cardiovascular disorders; diabetes mellitus; multimorbidity; cognitive disability; neglect; apraxia; dysphagia; urinary and bowel incontinence; emotional problems; sitting balance; daily activity level; and independence in activities of daily living) measured at admission were associated with discharge to the former living situation. Logistic regression analysis was used for statistical analysis.ResultsMean age of the patients was 79.0 years (SD 6.4) and 51.1% was female. A total of 71 patients (77.1%) were discharged to the former living situation within 6 months after the start of geriatric rehabilitation. Of the 16 factors analysed, only a higher level of independence in activities of daily living at admission was significantly associated with home discharge.ConclusionsOur study shows that the vast majority of previously identified factors predicting home discharge among stroke patients, could not predict home discharge among a group of frail and multimorbid older persons admitted to geriatric rehabilitation. Only a higher level of independence in activities of daily living at admission was significantly related to home discharge. Additional insight in other factors that might predict home discharge after geriatric rehabilitation among this specific group of frail older stroke patients, is needed. Trial registration: ISRCTN ISRCTN62286281. Registered 19-3-2010.

Designing and evaluating an intelligent augmented reality system for assisting older adults’ medication management

Intelligent Assistive Systems (IASs) provide personalised support to individuals to increase their autonomy and competence in performing activities. The personalisation of such technology represents a particular challenge, for the individuals abilities typically change over time. The aim of this research was to explore a theory-based, activity-centred framework for the development of IASs that both facilitate the active involvement of caregivers and target users and allow for adaptation to the individual over time.Medication management was focused on as a case study. Three older adults and two caregivers were involved in a co-design process of an IAS prototype system, the MED-AR, which uses projection-based augmented reality as the user interface technology. The theoretical framework for the design and evaluation of the MED-AR was activity theory. For the decision-making process of the MED-AR, formal argumentation theory was used. The major contributions of the study are (i) a formal framework for understanding the level of independence in activities and the way an IAS can tailor support to an individual and a situation, including caregivers; and (ii) a model for involving older adults and caregivers in a co-design process in the first phases of developing IASs.

Study on the Participation in Leisure Activities According to the Level of Independence in Activities of Daily Living among Inpatients with Stroke: Targeting Pre-elderly and Elderly Population

Study on the Participation in Leisure Activities According to the Level of Independence in Activities of Daily Living among Inpatients with Stroke: Targeting Pre-elderly and Elderly Population

Self-perceived and Actual Risk of Further Stroke in Patients with Recurrent Stroke or Recurrent Transient Ischemic Attack in Thailand

Background: The correct perception in patients of their future risk of recurrent stroke may lead to changes in behavior and to successful secondary prevention of stroke. The primary aim was to compare patients’ perceived risk with the actual risk of further stroke. Methods: This cross-sectional study was carried out in 2 tertiary hospitals in northeast Thailand. Self-perceived risk of further stroke was assessed by validated questionnaire and categorized as low, medium, or high. Actual risk was calculated using Stroke Prognosis Instrument II which classified patients into 3 risk groups: low, medium, and high. The level of agreement between perceived and actual risk was analyzed using the kappa statistic. Results: One hundred forty patients with recurrent stroke or recurrent transient ischemic attack were enrolled (age 65.6 ± 11.3 years, mean ± standard deviation). Most patients wrongly estimated their risk of further stroke: 43.6% of patients underestimated and nearly one fifth (17.1%) overestimated their risk; the kappa coefficient was .08. Patients with hypertension and diabetes were more likely to underestimate their risk of recurrent stroke. The only characteristic found to be significantly associated with perceived high risk was the level of independence in activities of daily living: patients with Barthel index less than or equal to 60 were more likely to perceive themselves as having high risk for recurrent stroke. Conclusions: Most patients underestimated their risk for further stroke. Implementation of a comprehensive care program to communicate to patients their future risk of stroke and to modify their risk factors is warranted in Thailand.

The effect of long-term, group-based physical, cognitive and social activities on physical performance in elderly, community-dwelling people with mild to moderate dementia.

Elderly people with dementia are known to be less physically active compared with elderly, healthy people, emphasizing the need for interventions in order to maintain a high level of independence in activities of daily living. The aim was to evaluate the effect of long-term, group-based rehabilitation including physical activity on physical performance in elderly, community-dwelling people with mild to moderate dementia. A quasi-experimental study of 18 elderly, community-dwelling people, diagnosed with mild to moderate dementia, participated in an ongoing rehabilitation programme based on integrated physical, cognitive and social activities. The outcome measure was physical performance: the 30-second sit-to-stand test, Guralnik balance test, 10-metre walking speed test, timed 6-metre walk test and a timed dual task walk test. The repeated measure ANOVA was used to analyse any overall differences between related means. No significant effect of time was found for the five outcome measures during the entire period. The variation in the estimate of most outcome scores was higher within subjects than between subjects during the period. Profile plots illustrated that three of the participants, who experienced severe cognitive deterioration, markedly declined in all physical performance tests. The expected, progressive deterioration in physical performance was delayed in a small group of home-dwelling people with mild to moderate dementia participating in long-term, group-based rehabilitation. Long-term, group-based rehabilitation may have the overall potential to delay deterioration in activities of daily living performance in home-dwelling people with mild to moderate dementia; however, more studies with larger samples are needed to confirm the findings of this study.

Efficacy of Virtual Reality in Upper Limb Rehabilitation in Patients with Spinal Cord Injury: A Pilot Randomized Controlled Trial.

Study DesignPilot randomized controlled trial.PurposeTo compare the efficacy between virtual reality intervention (using Nintendo Wii) along with conventional occupational therapy and conventional occupational therapy alone in improving upper limb function in patients with spinal cord injury (SCI).Overview of LiteratureThe use of virtual reality has gained importance in the rehabilitation sector over the last few years. Nintendo Wii has the potential to encourage upper limb function while engaging in an interesting activity, which is important in long-term interventions, such as the treatment of SCI.MethodsOverall, 22 patients with SCI participated in the study. They were randomly assigned to two groups. Group I received 30 minutes of virtual reality intervention (using Nintendo Wii) and 30 minutes of conventional therapy, whereas group II received conventional therapy only for 30 minutes. Both groups received therapy 3 days a week for 4 weeks. One hand of each patient was identified as the target hand based on the inclusion criteria. All patients were assessed at baseline, 2 weeks and 4 weeks (post-intervention), and 6 weeks (follow-up). The functional ability of the target hand was assessed using the Capabilities of Upper Extremity (CUE) questionnaire. Gross motor dexterity was assessed using the Box and Block Test (BBT). The level of independence in activities of daily living was assessed by the Spinal Cord Independence Measure-Self Report and quality of life by the World Health Organization Quality of Life-BREF.ResultsAfter 4 weeks of intervention, there was no significant difference in improved hand function between the groups. Mean scores were higher for group I than for group II, with a higher percent change (31.5% in CUE questionnaire and 51.7% in BBT) in group I.ConclusionsVirtual reality along with conventional therapy produces similar results in upper limb function as does conventional therapy alone.