Mean Barthel Index Research Articles

Evaluation of Neutrophil to Lymphocyte Ratio with Neurological Severity and Short-Term Outcome in Acute Ischemic Stroke

Introduction: Stroke represents a significant global health care challenge, ranking as the second most common cause of mortality and disability worldwide. Inflammatory process plays an important role in pathophysiology of acute ischemic stroke. These inflammatory responses increase the brain damage and cause neurological deterioration. Neutrophils and lymphocytes serve as pivotal mediators of inflammatory response. Aims and Objectives: This study aims to evaluate the association between the Neutrophils to lymphocyte ratio (NLR) with the initial severity of stroke and the short-term functional outcome using the NIHSS and BARTHEL index respectively. Materials and Methods: We conducted an observational cross-sectional study on 80 patients admitted at Father Muller Medical College Hospital, which is a tertiary care centre in Mangalore between May 2023 to April 2024. Diagnosis of stroke was based on clinical evaluation and Radiological imaging. Peripheral blood samples were collected for complete blood count within 24 hours of stroke onset. The NLR was determined by dividing the absolute neutrophil count (ANC) to the absolute lymphocyte count (ALC). This was then correlated with the NIHSS and the BARTHEL index. Results: This study included 80 patients, with the mean age of 65.1 years. Majority of the patients were in the age group 51-70years (55%). The mean NLR was found to be 13.39. The mean NIHSS and BARTHEL index was 11.08 and 63.69 respectively. The NLR showed significant correlation with the initial stroke severity and the short-term functional outcomes. For the purpose of correlation NLR was divided into three groups i.e. >3, 3-5 and >5. Patients with higher NLR (>5) were more likely to have a severe stroke and greater dependency. Conversely, those with lower NLR (<3) had a minor stroke and slight dependency. 80% of the patients with severe stroke had a NLR above 5, while 82% of the patients with minor stroke had a NLR below 3 (p value <0.001). This study also found a strong correlation between NIHSS and the BARTHEL index - patients with lower NIHSS and NLR were found to have a better short term function outcome. Conclusion: NLR was found to be significantly associated with the initial severity of stroke and the shortterm functional outcome. Because of its high specificity, low cost, routine use NLR can be used for the prediction of severity of stroke and patients can be prioritised for specialised treatment thus reducing the mortality rates.

Evaluation of Rehabilitation Outcomes in Patients with Chronic Neurological Health Conditions Using a Machine Learning Approach.

Background: Over one billion people worldwide suffer from neurological conditions that cause mobility impairments, often persisting despite rehabilitation. Chronic neurological disease (CND) patients who lack access to continuous rehabilitation face gradual functional decline. The International Classification of Functioning, Disability, and Health (ICF) provides a comprehensive framework for assessing these patients. Objective: This study aims to evaluate the outcomes of a non-hospitalized neuromotor rehabilitation project for CND patients in Italy using the Barthel Index (BI) as the primary outcome measure. The rehabilitation was administered through an Individual Rehabilitation Plan (IRP), tailored by a multidisciplinary team and coordinated by a physiatrist. The IRP involved an initial comprehensive assessment, individualized therapy administered five days a week, and continuous adjustments based on patient progress. The secondary objectives include assessing mental status and sensory and communication functions, and identifying predictive factors for BI improvement using an artificial neural network (ANN). Methods: A retrospective observational study of 128 CND patients undergoing a rehabilitation program between 2018 and 2023 was conducted. Variables included demographic data, clinical assessments (BI, SPMSQ, and SVaMAsc), and ICF codes. Data were analyzed using descriptive statistics, linear regressions, and ANN to identify predictors of BI improvement. Results: Significant improvements in the mean BI score were observed from admission (40.28 ± 29.08) to discharge (42.53 ± 30.02, p < 0.001). Patients with severe mobility issues showed the most difficulty in transfers and walking, as indicated by the ICF E codes. Females, especially older women, experienced more cognitive decline, affecting rehabilitation outcomes. ANN achieved 86.4% accuracy in predicting BI improvement, with key factors including ICF mobility codes and the number of past rehabilitation projects. Conclusions: The ICF mobility codes are strong predictors of BI improvement in CND patients. More rehabilitation sessions and targeted support, especially for elderly women and patients with lower initial BI scores, can enhance outcomes and reduce complications. Continuous rehabilitation is essential for maintaining progress in CND patients.

The Relationship of Active Aging Perspectives and Social Participation of Elderly Individuals with Their Mental States and Functional Independence

Objective: The aim of this study is to examine the active aging perspectives and social participation of older adults and to determine their relationship with their mental states and functional independence. Method: A total of 298 participants over the age of 60, with a mean age of 70.94±8.1 were included in the study. The degree of cognitive function of the individuals included in the study was evaluated with the Mini Mental State Examination (MMSE), the level of functional independence was evaluated with the Barthel Index. The social participation statuses of the older adult participants included in the study were analyzed with the social participation evaluation form created by the researchers. Results: Individuals with high social participation evaluation form mean scores had higher Mini Mental State Examination mean scores and Barthel Index mean scores (r1: 0.329, p

Prevalence of post-intensive care syndrome: Observations from a tertiary care hospital in Eastern India

ABSTRACT Background: Post-intensive care syndrome (PICS) refers to physical, cognitive and psychological symptoms that occur after a patient is discharged from the intensive care unit (ICU). Aims: The present study aimed to explore the prevalence of PICS among ICU survivors of a tertiary care setup in Eastern India. Methods: A single-centre prospective cohort study was conducted amongst patients admitted to the ICU. A predefined, structured interview in 1st month, 3rd month, 6th month after ICU admission was done. Baseline characteristics were noted. Physical and cognitive impairment, psychological distress and general health were assessed using the Barthel Index (BI), mini-mental state examination (MMSE) tool, Hospital Anxiety and Depression Scale (HADS) and EuroQoL Visual Analogue Scale. Results: Of the 150 patients included in the study, the mean Acute Physiology and Chronic Health Evaluation II score was 20.87. The leading cause of ICU admission was sepsis (40.7%), followed by acute exacerbation of chronic obstructive pulmonary disease and pneumonia (14%). The median stay in the ICU was 8 days. Mean BI significantly decreased from 79.20 at baseline to 60.17 and 64.33 in the 3rd and 6th months, respectively. The mean HADS-Depression score increased from 3.79 at baseline to 7.08 at 3rd and 5.92 at 6th month. Similarly, the mean HADS-Anxiety score increased from 4.37 at baseline to 7.44 at 3rd and 6.31 at 6th month. The mean MMSE score decreased from 24.61 at baseline to 22.26 at the 3rd and 6th months, respectively. Thus, PICS was recorded in 90% of cases in the 3rd month and 89.3% in the 6th month. Conclusion: The management of PICS involves a multidisciplinary approach, including physical rehabilitation, cognitive rehabilitation and psychological support.

Oral Health and the Association with Blood Parameters in Neurogeriatric Inpatients without Relevant Systemic Inflammation: An Observational Study.

As little evidence is available, we report the oral health of neurogeriatric inpatients and the association with hematological parameters representing systemic health. We performed a cross-sectional investigation of 30 patients undergoing neurogeriatric early rehabilitation and excluded systemic inflammation as a trigger for oral infection (C-reactive protein >5 mg/dL). Outcomes included oral health and hygiene status and routine laboratory parameters. Patients (mean age 79 ± 6 years, mean comorbidities 7 ± 3, and mean Barthel Index at hospital admission 31 ± 18) had impaired oral health (mean 18 ± 7 of their own teeth, elevated plaque indices (2.5 ± 0.4), and bleeding on probing (26 ± 17)), representing short- and long-term reduced oral hygiene. Twenty-four (80%) patients had periodontitis. Laboratory parameters for inflammation, nutrition, and anemia did not correlate with oral health parameters (p > 0.05). The number of teeth correlated moderately with total protein (Spearman's rank correlation coefficient (rs) = 0.524; p = 0.003). Plaque indices correlated weakly with number of teeth (rs = -0.460; p = 0.010) and periodontitis diagnosis (rs = 0.488; p = 0.006). Thus, highly vulnerable neurogeriatric inpatients had reduced oral health and hygiene independent of laboratory parameters, representing a high-risk population for oral health problems even without clinically proven systemic infection. This should be considered in future interprofessional therapy planning.

Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study.

To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3-10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48-5.75) and Frankel grades A-C (p < 0.001; OR, 4.91; 95% CI, 2.45-9.86) were independent risk factors for emergency surgery. Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3-10 metastases is required to avoid poor outcomes after emergency surgery.

Prognostic effect of systematic geriatric assessment on patients with acute heart failure.

Frailty and dependence are frequent in patients admitted for acute heart failure (AHF), but their prognostic significance is unknown, especially in young adults. We aimed to study in adults admitted for AHF, regardless of age, the effect of frailty and dependence on the incidence of mortality and a combined event of mortality, readmissions for AHF, and visits to the emergency room (ER) for AHF at 1 and 6months. We designed a prospective cohort study by including all the patients with AHF admitted in our Cardiology Department from July 2020 through May 2021. A multidimensional geriatric assessment was performed during the admission. We clinically followed up the patients 6months after discharge. We enrolled 202 patients. The mean age was 73±12.32years, and 100 (49.5%) of the patients were elderly (>75years). Just 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty (FRAIL≥3) was observed in 68 (33.7%) patients (mean FRAIL score: 1.88±1.48). Dependence (Barthel<100) was observed in 65 (32.2%) patients (mean Barthel index: 94.38±11.21). Frailty and dependence showed a significant association with both prognostic events at 1 and 6months. In the multivariable analysis, frailty was associated with higher mortality at 1month [hazard ratio (HR) 12.61, 95% confidence interval (CI) 1.57-101.47, P=0.017] but not at 6months (HR 2.25, 95% CI 0.61-8.26, P=0.224) or with the combined endpoint at neither 1month (HR 1.64, 95% CI 0.54-5.03, P=0.384) nor 6months (HR 1.35, 95% CI 0.75-2.46, P=0.320). Dependence was related to higher mortality at 1month (HR 13.04, 95% CI 1.62-104.75, P=0.016) and 6months (HR 7.18, 95% CI 1.99-25.86, P=0.003) and to higher incidence of the combined event at 1month (HR 5.93, 95% CI 1.63-21.50, P=0.007) and 6months (HR 2.62, 95% CI 1.49-4.61, P=0.001). In AHF patients, frailty and dependence implied a worse prognosis, rising mortality, readmissions, and ER visits for AHF.

Functional evaluation of physical performance, gait, balance and activities of daily living in older individuals with long COVID syndrome.

The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS). A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID-19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI). In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p < .05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p < .05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p > .05). It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL.

FC6: The Valladolid Multicenter Study: ¿Is there ageism in liaison psychiatry? Referrals of patients over 65 years to 7 Liaison Psychiatric Units (LPU) in Spain

Introduction and objective:Ageism is defined by the World Health Organization as stereotypes, prejudice, and discrimination towards others or oneself based on age. Ageism is thought to pose a risk to the physical and mental health of older adults, but little is known about how to measure it in LPUs. We propose that a form of ageism can be detected by comparing the referrals made by liaison psychiatry services among patients over age 65 at discharge with functional status and medical comorbidity. Our hypothesis is that the worse the functional index and medical comorbidity, the fewer referrals to psychiatric services and the more referrals to primary care physicians.Methods:This is an observational, cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each LPU. Data was collected over a period of one and a half months. Psychiatric evaluations were performed while the patients were in the wards. Sociodemographic, clinical, and care variables were collected. Functional status was measured with the Barthel and Lawton index and comorbidity with the Charlson index.Results:We obtained a sample of 165 patients with a mean age of 76,03 years old. The mean Barthel index was 87,18 previous admission and 61,15 at the time of our first visit. The mean Lawton index was 5,266667 and the Charlson index was 6,03. The different options for referral were primary care physician, psychiatric facilities, nursing homes, substance use centers, or exitus. Statistical analysis was performed using the nonparametric Kruskal-Wallis test to determine if there were significant differences (p &lt; 0,05) between the indices and referrals. Contrary to our hypothesis, statistical significance was observed only for the Lawton index, but with more referrals to psychiatric facilities among patients with the worst functional scores. No other statistical significance was observed.Conclusions:Functional status and medical comorbidity did not play a role in the referral of inpatients managed by LPUs. Further studies are needed to clarify whether there is any form of ageism in the referral of elderly inpatients attended by Psychiatric Liaison Units.

P54: The Valladolid Multicentre Study: Clinical Difference Between Age Groups in a Sample of Geriatiric Patiants Referred to 7 Liaison Psychiatrics

Introduction and Objectives:It is well known that geriatric patients are at increased risk of developing comorbid medical and psychiatric conditions, and a large proportion of them are admitted to psychiatric liaison units (LPUs). The aim of this study is to determine which clinical differences between age groups (65- 74 years and ≥75 years) are statistically significant to potentially warrant special attention when referring to an LPU.Methods:This is an observational, cross-sectional and comparative multicentre study. We collected data from 165 patients (≥65 years) admitted to 7 Spanish general hospitals and referred to each LPU from different departments. Data were collected over a period of one and a half months. Psychiatric examinations were performed during the patients' stay in the wards. The sample was divided into two age groups of patients and a comparative analysis was done.Results:We obtained a sample of 165 patients with a mean age of 76.03 years (42.10% &lt; 75 years, 57.83% ≥ 75 years). We analysed several variables between two age groups: the youngest (65- 74 years) and the oldest (≥75 years). In the younger group (mean age 69.87 years), the mean Barthel index before admission was 93.23 (52.1% with independent ambulation) and at the time of our first assessment was 54.62, before 82.71 of the older group (mean age 80.63). The mean Lawton index was 4.44 (6.35 for the older group) and the Charlson index was 6.38 (5.6 for the older group). 21.11% reported falls in the last 6 months, compared to 27.6% in the older group. The most common reason for referral was anxiety/depression symptoms in both groups (52.12% and 56.53%) and agitation (24.46% in the older group). After the LPU visit, the main diagnoses were adjustment disorder in both groups (25.3% and 25.53%) and delirium in the older group (23.4%). Antidepressants and benzodiazepines were the most common psychotropic drugs prescribed before the LPU visit, and benzodiazepines were the most common drugs discontinued after the LPU visit in both groups.Conclusions:Clinical differences were found between two age groups (65-74 years and ≥75 years) at LPU, which could allow professionals to improve their attention and interventions.

The effect of discharge training and telephone counseling service on patients’ functional status and caregiver burden after stroke: A randomized controlled trial

Objective: This study aimed to determine the effect of discharge training and telephone counseling service on patients’ functional status and caregiver burden after stroke. Methods: This study was conducted as a randomized controlled trial in 69 stroke patients and their caregivers. Discharge training and telephone counseling were given to the caregivers in the intervention group. Caregivers also received telephone counseling by calling researcher when needed. Information form for participants, Modified Rankin Scale, Barthel Index and The Zarit Caregiver Burden Scale were used for data collection. Pre-tests were applied to the intervention and control groups before discharge. Three months after discharge post-tests were performed for the two groups. Results: Three months after discharge, caregivers’ burden was significantly lower in the intervention group compared to the control group. The mean Modified Rankin Scale score of the patients in the intervention group was significantly lower than the control group three months after discharge. Although the mean Barthel Index score of the patients in the intervention group was statistically significant higher than before discharge, but the difference between the groups was not statistically significant. Conclusion: Discharge training and telephone counseling provided to the caregivers of stroke patients reduced the caregiver burden and had a positive effect on the improvement of the functional status of the patients.

Clinical Characteristics and Surgical Outcomes of Metastatic Spine Tumors in the Very Elderly: A Prospective Cohort Study in a Super-Aged Society.

The number of advanced-age patients with spinal metastases is rising. This study was performed to clarify the characteristics and surgical outcomes of spinal metastases in advanced-age patients. We prospectively analyzed 216 patients with spinal metastases from 2015 to 2020 and divided them into three age groups: <70 years (n = 119), 70-79 years (n = 73), and ≥80 years (n = 24). Although there were no significant intergroup differences in preoperative characteristics and surgery-related factors except for age, patients aged ≥80 years tended to have a worse performance status (PS), Barthel index, and EuroQol-5 dimension (EQ-5D) before and after surgery than the other two groups. Although the median PS, mean Barthel index and mean EQ-5D greatly improved postoperatively in each group, the median PS and mean Barthel index at 6 months and the mean EQ-5D at 1 month postoperatively were significantly poorer in the ≥80-year group than the 70-79-year group. The rates of postoperative complications and re-deterioration of the EQ-5D were significantly higher in the oldest group than in the other two groups. Although surgery for spinal metastases improved the PS, Barthel index, and EQ-5D regardless of age, clinicians should be aware of the poorer outcomes and higher complication rates in advanced-age patients.

Effects Of Core Strengthening And Proprioceptive Neuromuscular Facilitation Technique On The Barthel Index And Balance In Patients With Hemiplegic Stroke: A Quasi-Experimental Study.

To determine the effectiveness of core strengthening exercises and proprioceptive neuromuscular facilitation techniques on functional performance and balance among patients with hemiplegic stroke. The quasi-experimental study was conducted from March to August 2021 at Imran Idrees Hospital, Sialkot, Pakistan, and comprised stroke patients of either gender who were divided into proprioceptive neuromuscular facilitation group A and core strengthening group B. In both groups, the treatment was given for 6 weeks with 5 30-minute sessions per week. Functional performance and balance were measured using Barthel Index and Berg Balance Scale. Data were collected at baseline, 3 weeks and 6 weeks. Data was analysed using SPSS 22. Of the 48 patients, 24(50%) were in each of the 2 groups. There were 39 (81.25%) male and 9(18.75%) female subjects with an overall mean age of 45±4.919 years. Mean Barthel Index score in group A was 62.50±7.22 at baseline and 74.79±7.14 after 6 weeks. Mean Berg Balance Score was 25.04±2.15 at baseline and 41.66±6.04 after 6 weeks (p<0.05). In group B, Barthel Index score was 61.45±6.33 at baseline and 80.83±7.61 after 6 weeks. Mean Berg Balance score was 25.33±3.38 at baseline and 47.08±5.99 after 6 weeks (p<0.05). There was a significant difference in group B scores compared to group A (p<0.01). Core strengthening programme was more effective than the proprioceptive neuromuscular facilitation programme in terms of activity of daily living and balance in patients with stroke.

A CROSS-SECTIONAL STUDY OF RECOVERY PATTERN IN WATERSHED INFARCTS IN A TERTIARY CARE CENTRE.

Background: Acute ischaemic stroke is one of the leading causes of morbidity along with cancers and cardiovascular diseases. Millions suffer from acute ischaemic stroke every year worldwide of which 5% suffer from watershed infarcts(1). The aetiopathogenesis and recovery from decits in watershed infarcts are different from territorial infarcts. The identication of specic features of recovery pattern and pathogenesis of infarcts may throw more light on these diseases as modern-day treatment of stroke is mainly concentrated on the treatment of territorial infarcts like endovascular procedures. This study may help to ll that gap. Aim: To study the recovery pattern in acute watershed infarcts. Methodology: 153 patients with acute watershed infarcts were studied. Detailed examination, NIHSS Score, mRS scale and Barthel index were assessed at the presentation and after 90 days of follow-up. Patients with Cognitive impairments were assessed and followed up after 90 days. Statistical analyses were done using SPSS 25.0 software for Windows. Chi-square and independent t-tests were applied to analyze categorical and numerical data, respectively. Results: A total of 153 patients out of the 2233 acute strokes were studied. The mean NIHSS score, mRS scale, and Barthel Index in patients of watershed infarcts are 10.9,3.1,62.9, and after 90 days are 7.9,2.3, and 74.5 respectively. The comparison was statistically signicant. Most patients had signicant motor improvement and cognitive improvement. The most common etiology was Internal Carotid artery thrombosis which also had the best prognosis. Conclusion: The pathogenesis and recovery in Watershed Infarcts are different from that of territorial infarcts. Prognosis and Recovery depend upon the etiology. Both Motor and Cognition recovery in watershed infarcts is signicantly higher

Negative impact of behavior restriction amidst a clustered COVID-19 infection on immobility syndrome in older patients negative for COVID-19: report from a chronic care hospital in Japan.

Previous studies have reported on associations between immobility syndrome and the COVID-19 pandemic. However, little is known about the aggravation of this syndrome in older patients negative for COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients was evaluated with the functional independence measure and Barthel index. Chronological changes in the functional independence measure and Barthel index scores were evaluated monthly, beginning one month before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p = 0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome in older patients who are negative for COVID-19.

Comparison of the Modified Barthel Index (MBI) Score Trends Among Workers With Stroke Receiving Robotic and Conventional Rehabilitation Therapy.

Stroke is one of the top causes of adult-acquired disabilities and the fifth most prominent cause of death worldwide. Working-age populations contribute about 40% of the stroke cases which occur annually in Malaysia. The modified Barthel Index (MBI) score has been used for self-care assessment to determine if stroke patients can meet their fundamental needs. The study was designed to compare the trend of MBI scores of workers who had a stroke and underwent robotic rehabilitation therapy to those who had conventional therapy. A cohort study was conducted among workers who had a stroke in northeastern Malaysia. They were assigned either to undergo robotic or conventional rehabilitation therapy. The robotic therapy is performed three times per day for four weeks. Meanwhile, conventional therapy involved walking exercises five days per week for two weeks. Data were collected for both therapies on the admission, at week 2 and week 4. The MBI, modified Rankin Scale (mRS) and Hospital Anxiety and Depression Scale (HADS) trends were examined one month after the therapies. The R (version 4.2.1) (R Core Team, Vienna,Austria) and RStudio (R Studio PBC, Boston, USA) were applied to perform the descriptive analyses on the respective platforms. Repeated measures of analysis of variance were performed to evaluate the outcomes trend and the effectiveness of the two therapies was also compared. A total of 54 stroke patients participated in this study of which 30 (55.6%) of them received robotic therapy. The age of the subjects ranged from 24 to 59 years and the majority (74.1%) were male. Stroke outcomes were evaluated using mRS, HADS, and MBI scores. Except for their age, the individuals' characteristics did not significantly differ between those undergoing conventional therapy and those receiving robotic therapy. After four weeks, it was found that the good mRS had increased, whereas the poor mRS had decreased. Comparing the therapy groups, the MBI scores improved significantly with time, although there were no significant differences between the therapy groups. However, the interaction term between the treatment group (p=0.031) and improvements over time was significant (p=0.001), indicating that robotic was more effective than conventional therapy in improving the MBI scores. For HADS score, there was a significant difference between the therapy groups (p=0.001), with those receiving robotic therapy having higher HADS score. Functional recovery occurs in acute stroke patients when the mean Barthel Index score rises from the baseline (on admission) to week 2 (during therapy)and subsequently on discharge (week 4). Based on these findings, it appears that there was not one therapy superior to the other; nevertheless, robotic therapy may be better tolerated and more effective in certain individuals.

Effects of music therapy accompanied by transcranial direct current stimulation on the recovery from aphasia following stroke: A single‑center retrospective cohort study

Aphasia is the difficulty in reproducing or understanding speech, and affects 21‑38% of patients with stroke immediately after onset. In addition, disregarding improvement in the first weeks after stroke, ~20% of patients present with chronic deficiencies 6 months later. Consequently, speech and language therapy appears to be the optimal choice of treatment for chronic aphasia. The present study aimed to systematically investigate the effects of experimental/traditional music therapy (MT) in combination with transcranial direct current stimulation (tDCS) on improving aphasia in patients following a stroke in regular stroke rehabilitation services. For this purpose, 98 eligible participants who had suffered a single cerebrovascular accident were divided into three groups as follows: Group A, no MT or tDCS (only standard treatment); group B, daily MT; group C, combined treatment with daily MT and tDCS at a 1:1.21:1.28 ratio for the three groups, respectively. Statistically significant differences between groups were found either in terms of the interval of the Aachen Aphasia Test [(T1‑T0) mean] (P&lt;0.05) or in terms of the mean cerebral blood flow in the damaged regions (P=0.042), the mean mini‑mental test (P&lt;0.05) and the mean Barthel index (P=0.004). On the whole, the present study demonstrates that following a stroke, recovery from aphasia can by promoted by a regular exercise, training and rehabilitation program, as well as an improved acoustic environment and tDCS.

130 CHARACTERISTICS AND OUTCOMES OF OLDER NURSING HOME RESIDENTS ATTENDING AN EMERGENCY DEPARTMENT

Abstract Background Older nursing home (NH) residents are among the most vulnerable members of society, often with multiple comorbidities and complex care needs. The Emergency Department (ED) is a common point of access to the acute hospital for NH residents. This study aims to review characteristics and outcomes of older NH residents presenting to ED over one year. Methods A prospective cohort study was carried out. NH residents aged 50 years and older attending ED of a university teaching hospital over one year (01/10/2019-30/09/2020) were included. Data on demographics, comorbidities, functional status, frailty and details of ED attendance were collected. Results There were a total of 515 ED attendances by 341 NH residents over one year. Mean age was 76.3 years (50-103 years; SD ± 10.9). 50.9% (n=262) were female. Mean Charlson Comorbidity Index (CCI) was 5 (0-12; SD ± 2.1). 46.6% (n=240) had a dementia diagnosis. A mean of 12.6 medications (0-31; SD ± 5.3) were prescribed in the NH. Mean Clinical Frailty Score (CFS) was 6.5 (3-9; SD ± 0.9). Mean Barthel Index (BI) was 8.9 (0-20; SD ± 6.0). 38.3% (n=197) of presentations occurred “in-hours”. Mean Manchester Triage Score (MTS) was 2.54 (1-5; SD ± 0.7) with 92.0% (n=474) scoring 1-3. Delirium was documented in 31.8% (n=164). Mean ED Length of Stay (LOS) was 13.7hours (0-80hours; SD ± 11.0). 14.6% (n=75) were discharged without follow-up. 61.2% (n=315) were admitted to hospital. Mean hospital (LOS) was 9.7days (0-191 days) and 8.7% (n=47) of those admitted died in hospital. 12 months after ED presentation, 40.4% (n=138) of the cohort had died. Conclusion NH residents are a frail group, with high levels of multimorbidity, polypharmacy and significant care needs. This complexity is reflected in the numbers requiring urgent review on attendance, rates of delirium, ED LOS and hospital admission rates. Dedicated NH liaison teams may enhance care and improve outcomes for this cohort.

231 NURSING HOME RESIDENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH FALLS

Abstract Background Nursing Home Residents (NHR) are the most-frail group of older persons, with many comorbidities that increase their risk of falling. Falls are a frequent reason for ED attendance by NHR’s as it is for all older persons, but little is reported on their characteristics and outcomes specifically. Methods A prospective cohort study of all NH presentations with falls to the ED of a university teaching hospital over a one-year period. Detailed operational and clinical phenotype characteristics, and outcomes were recorded in all instances. Results There were 519 ED presentations by 344 NHR over one year. Almost half of all presentations (48.2%, 250/519), were as result of a fall, by 172 residents. The majority were female (137/250, 55%), with an average age of 77.8 years (±10.8). Many, 84.3% (145/172), had a prior fall in the past six-months. Almost half had a diagnosis of dementia (124/250, 49.6%). A third mobilised with a Zimmer-frame (83/250), and 10.8% (27/250) wheelchair. 33.2% (83/250) had visual impairment. The mean Barthel Index was 9.55 (±5.12) indicating high-dependency. NHRs fallers frequently attended ED outside routine working hours, with 36.8% (92/250) and 27.6% (69/250) presenting after 5pm (Monday to Friday), or at the weekend respectively. 54.8% of patients were admitted (137/250), and only 25.6% of patients had review by a GP prior to ED-referral (64/250). The average Length Of Stay (aLOS) for admitted NHR fallers was 10.4 (±9.1) days. Injurious falls were noted in only 10.4% (26/250) presentations. aLOS for those admitted with documented injuries (14/26, 54%) was 5.0 days (±7.0, n=14). Conclusion NH residents have complex clinical needs and falls is a frequent reason for attending ED. Better access to “out of hours” clinical support within the NH, and better integrated falls prevention programmes/ care pathways between NHs and primary/secondary services are necessary to enhance care and optimise falls prevention.

Correlation of Motor and Functional Recovery with Neuroimaging in Ischaemic Stroke: An Observational Study

Introduction: Stroke is a leading cause of long-term disability worldwide. Neuroimaging plays a critical role in diagnosing and planning the treatment of stroke. Early prognostic markers help in predicting the prognosis after stroke. Aim: To correlate the motor recovery and functional outcome with Computed Tomography (CT) brain findings using Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) in patients with ischaemic stroke. Materials and Methods: This observational cross-sectional study was conducted in Department of Physical Medicine and Rehabilitation at Vardhman Mahavir Medical College and Safdarjung Hospital (tertiary care centre), from October 2016 to March 2018. A total of 45 patients diagnosed with Middle Cerebral Artery (MCA) territory Ischaemic Stroke were included. Motor and functional assessment were done using Fugl-Meyer Assessment (FMA), and Barthel Index (BI). FMA and BI were correlated with the radiological assessment using ASPECTS on Non Contrast Computed Tomography (NCCT) of head. Results: The mean age of the study population was 60.98±8.61 years. The mean BI score was 70.34± 25.2, and FMA score was 61.56±32.8. The mean ASPECTS was 7.5, with 26 patients having ASPECTS 8-10 and 19 with ASPECTS 0-7. Patients with higher ASPECTS (8-10) had moderate to no dependence in Activities of Daily Living (ADL) and mild to no motor impairment respectively (p-value&lt;0.0001). Patients having lower ASPECTS (0-7) had severe dependency in ADL and motor impairment (p-value&lt;0.0001). Conclusion: Alberta stroke programme early computed tomography score has a significant correlation with motor and functional recovery and is a strong predictor of outcome after ischaemic stroke. The higher the score on ASPECTS, the better will be the motor and functional outcome. The computed tomography findings of brain will help in stroke rehabilitation by enabling to set realistic goals at an early (acute) stage poststroke.