Functional Independence Measure Subscales Research Articles

Functional Change from Five to Fifteen Years after Traumatic Brain Injury.

Few studies have assessed the long-term functional outcomes of traumatic brain injury (TBI) in large, well-characterized samples. Using the Traumatic Brain Injury Model Systems cohort, this study assessed the maintenance of independence between years 5 and 15 post-injury and risk factors for decline. The study sample included 1381 persons with TBI who received inpatient rehabilitation, survived to 15 years post-injury, and were available for data collection at 5 or 10 years and 15 years post-injury. The Functional Independence Measure (FIM) and Disability Rating Scale (DRS) were used to measure functional outcomes. The majority of participants had no changes during the 10-year time frame. For FIM, only 4.4% showed decline in Self-Care, 4.9% declined in Mobility, and 5.9% declined in Cognition. Overall, 10.4% showed decline in one or more FIM subscales. Decline was detected by DRS Level of Function (24% with >1-point change) and Employability (6% with >1-point change). Predictors of decline factors across all measures were age >25 years and, across most measures, having less than or equal to a high school education. Additional predictors of FIM decline included male sex (FIM Mobility and Self-Care) and longer rehabilitation length of stay (FIM Mobility and Cognition). In contrast to studies reporting change in the first 5 years post-TBI inpatient rehabilitation, a majority of those who survive to 15 years do not experience functional decline. Aging and cognitive reserve appear to be more important drivers of loss of function than original severity of the injury. Interventions to identify those at risk for decline may be needed to maintain or enhance functional status as persons age with a TBI.

Mobilization within 24 hours of new-onset stroke enhances the rate of home discharge at 6-months follow-up: a prospective cohort study

Background/Objective Previous research indicates a better improvement of functional independence measure (FIM) at discharge in acute-stroke patients who received physiatrist and registered therapist operating rehabilitation (PROr) within 24 hrs compared with those who received after 24 hrs was reported. The aim of this prospective cohort study was to determine whether PROr provided within 24 hrs for new-onset stroke patients affects home-discharge rate at 6 months later. Methods Acute new-onset stroke patients admitted to our hospital and received PROr (n = 227) and were conducted into 3 categories based on the time until starting PROr; within 24 hrs (very early mobilization; VEM; n = 47), 24-48 hrs (early mobilization; EM; n = 77) and >48 hrs (later mobilization; LM; n = 103). Home-discharge rates as well as changes in FIM, and rates of recurrence and mortality during the 6-month follow-up were assessed. Results A total of 139 patients [VEM (n = 32), EM (n = 43), LM (n = 64)] could be followed throughout the 6-month period. The home-discharge rate was ∼80% and significantly higher by ∼20% in VEM than EM. The gains in the motor subscale of FIM at 6 months were significantly higher in VEM than LM, while the mortality and recurrent rates were not significantly different among the categories. Conclusions Starting PROr within 24 hrs of new-onset stroke may help to increase home-discharge rates at 6-month follow-up, simultaneously with a higher FIM. Very early mobilization in our hospital did not increase the risks of recurrence or death.

The relationship between cognition and functional outcomes in rehabilitation: FIMCog vs. MoCA.

To understand the relationship between scores on two standardized measures of cognition, the Montreal Cognitive Assessment (MoCA) and the cognitive subscale of the Functional Independence Measure (FIMCog), and whether these scores can predict functional outcomes in rehabilitation. Retrospective data analysis was conducted on all inpatients admitted to a general rehabilitation unit within a 6-month period (N = 477). The average age of patients was 74 years. The Functional Independence Measure (FIM) was completed for all patients on admission and discharge. The MoCA was administered to patients on clinical suspicion of cognitive impairment. The MoCA was completed with 116 patients. Cognitive status was assessed using FIMCog and MoCA. The motor subscale of FIM was used to assess functional status in calculating the motor Rehabilitation Functional Gain (mRFG) and motor Rehabilitation Functional Efficiency (mRFE) scores. Discharge destination was also used as an outcome measure. There was a moderate correlation between FIMCog and MoCA scores on admission (r = 0.49, P < 0.001). Higher FIMCog and MoCA scores were associated with higher mRFG and mRFE scores. There was an indication that patients with higher MoCA scores were more likely to be discharged to a private residence (adjusted odds ratio 1.11; 95% confidence interval: 0.99, 1.25, P = 0.072). Cut-off points of <25 on the MoCA (sensitivity 88.9%, specificity 48.9%), and <29 on the FIMCog (sensitivity 77.8%, specificity 53.3%) predicted those patients who were less likely to discharge to a private residence. FIMCog and MoCA scores on admission were moderately correlated, and strongly correlated with functional rehabilitation outcomes. The FIMCog and MoCA had moderately high utility in predicting discharge destination. Geriatr Gerontol Int 2020; 20: 336-342.

Using Functional Independence Measure Subscales to Predict Falls - Rapid Assessment.

Using Functional Independence Measure Subscales to Predict Falls - Rapid Assessment.

Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury.

Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI). This study examined functional status during the first 10 years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state). The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury. The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (≥ 28 days post-injury or never). Functional Independence Measure (FIM) at 1, 2, 5, and 10 years following TBI was used to measure functional outcomes. Measureable functional recovery occurred throughout the 10-year period, with more than two thirds of the sample achieving independence in mobility and self-care, and about one quarter achieving independent cognitive function by 10 years. Following commands prior to 28 days was associated with greater functional independence at all outcome time-points. Multi-trajectory modeling of recovery of three FIM subscales (self-care, mobility, cognition) revealed four distinct prognostic groups with different temporal patterns of change on these subscales. More than half the sample achieved near-maximal recovery by 1 year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort. Among a cohort of patients unable to follow commands at the time of inpatient rehabilitation, a substantial proportion achieved functional independence in self-care, mobility, and cognition. The proportion of participants achieving functional independence increased between 5 and 10 years post-injury. These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.

Using Functional Independence Measure Subscales to Predict Falls-Rapid Assessment.

Falls remain a major issue in inpatient rehabilitation. Decreased scores on the Functional Independence Measure (FIM), given to every patient, have been shown to predict falls risk. The aim of the study was to extend previous research using FIM to predict falls by using only subscales assessed earliest during admissions to indicate high risk of falls. Retrospective cohort study. Two consecutive samples of patients (n1 = 1,553, n2 = 12,301) admitted to a rehabilitation hospital over 9-month and 5-year periods, respectively, were used to evaluate the predictive utility of using only a small number of FIM subscales. Subscales were selected from those assessed earliest and were related to previously published research on falls risk factors. The metric was developed using a historical data set and was validated with a second, separate group of patients. Receiver operating characteristic curves were used to evaluate predictive utility. The combination of Toileting and Expression subscales yielded a comparable area under the curve to the full FIM, and both were greater than the existing method of falls risk assessment. Likelihood of falling was strongly linearly related to score on the Toileting/Expression metric. The sum of two FIM subscales can be used to predict which patients may fall during their stay in a rehabilitation hospital. The FIM scores are assessed early during a patient's stay, are required for all Medicare patients, and may be useful for simple, rapid, and accurate assignment of falls risk.

Development of the Italian version of the trunk impairment scale in subjects with acute and chronic stroke. Cross-cultural adaptation, reliability, validity and responsiveness

Purpose: To cross-culturally adapt and psychometrically analyse the Italian version of the Trunk Impairment Scale on acute (cohort 1) and chronic stroke patients (cohort 2).Methods: The Trunk Impairment Scale was culturally adapted in accordance with international standards. The psychometric testing included: internal consistency (Cronbach’s alpha), inter- and intra-rater reliability (intraclass correlation coefficient; standard error of measurement and minimal detectable change), construct validity by comparing Trunk Impairment Scale score with Barthel Index, motor subscale of Functional Independence Measure, and Trunk Control Test (Pearson’s correlation), and responsiveness (Effect Size, Effect Size with Guyatt approach, standardized response mean, and Receiver Operating Characteristics curves).Results: The Trunk Impairment Scale was administered to 125 and 116 acute and chronic stroke patients, respectively. Internal consistency was acceptable (α > 0.7), inter- and intra-rater reliability (ICC > 0.9, Minimal Detectable Change for total score < 1.6 in cohort 1 and < 1.1 in cohort 2) were excellent. The construct validity showed acceptable correlations (r > 0.4) with all scales but the motor Functional Independence Measure in cohort 2. Distribution-based methods showed large effects in cohort 1 and moderate to large effects in cohort 2. The Minimal Important Difference was 3.5 both from patient’s and therapist’s perspective in cohort 1 and 2.5 and 1.5 from patient’s and therapist’s perspective, respectively, in cohort 2.Conclusion: The Trunk Impairment Scale was successfully translated into Italian and proved to be reliable, valid, and responsive. Its use is recommended for clinical and research purposes.Implications for RehabilitationTrunk control is an essential part of balance and postural control, constituting an important prerequisite for daily activities and function.The TIS administered in subjects with subacute and chronic stroke was reliable, valid and responsive.The TIS is expected to help clinicians and researchers by identifying key functional processes related to disability in people with subacute and chronic stroke.

Effect of Chair Stand Exercise on Activity of Daily Living: A Randomized Controlled Trial in Hemodialysis Patients

Muscle atrophy and weakness impair activity of daily living (ADL). We examined whether chair stand exercise can improve ADL of hemodialysis patients. A randomized controlled trial. A single center study. Outpatients on hemodialysis older than 60 years (61-79years). Twelve weeks of intervention with chair stand exercise, 3 sessions/week versus the control exercise (stretch, 1 session/week). The primary outcome was the change in functional independence measure (FIM) score from baseline. The secondary outcomes were changes in thigh circumference, muscle strength of quadriceps, 6-minute walking distance, maximum duration of chair stand exercise, health-related quality of life, cognitive function serum albumin, and hemoglobin. Among the 27 patients who were randomized, 17 completed the study. The change in FIM from baseline was greater in the intervention group (1 [1-3] vs. 0 [0-0], median (minimum to maximum), P<.001) due to the significant improvement in the FIM subscales related to mobility (bed/chair/wheel chair) and locomotion (stair). Among the secondary outcomes, significant difference was noticed in the changes in thigh circumference and the physical component summary score of health-related quality of life by Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2). Chair stand exercise improved ADL in the hemodialysis patients aged older than 60years.

Responsiveness and concurrent validity of the revised capabilities of upper extremity-questionnaire (CUE-Q) in patients with acute tetraplegia.

This is a longitudinal convenience sample. The objective of this study was to evaluate the responsiveness of the revised Capabilities of Upper Extremity-Questionnaire (CUE-Q), in which the item responses were reduced from seven to five levels, relative to the upper extremity motor score (UEMS) and to the self-care subscale of Functional Independence Measure (FIMsc). A total of 46 subjects with acute traumatic tetraplegia, 19 motor complete, 27 motor incomplete, completed the revised CUE-Q, UEMS and FIMsc at admission and discharge from rehabilitation. Subjects were mostly male (n=42) and Caucasian (n=27). The mean age was 44±21 years. Predominant etiologies were falls (n=18) and motor vehicle accidents (n=17). During rehabilitation, mean CUE-Q scores increased from 49.8±30.8 to 73.7±36.3, UEMS increased from 19.6±11.9 to 26.3±13.4, and FIMsc increased from 9.8±5.1 to 21.5±9.7. At admission and discharge, CUE scores had excellent to good Spearman correlations (rs) with UEMS (rs=0.89, 0.70) and FIMsc (rs=0.73, 0.80), but change scores had little to moderate correlations (CUE-UEMS, rs=0.07; CUE-FIMsc, rs=0.51), suggesting that the CUE, UEMS and FIM measure related but different constructs. Effect size of the change score was 0.92 for CUE-Q, 0.87 for UEMS and 1.38 for FIMsc. This compares to an effect size of 0.73 for the original 7-level response CUE-Q. The simplified response set of the CUE-Q maintains the responsiveness of the original version, whereas it increases the ease of use for the patient.

Assessing the State of Chronic Spinal Cord Injury Using Diffusion Tensor Imaging

The aim of this study was to quantify the association between diffusion tensor imaging (DTI) parameters of the cervical spinal cord and neurological disability in patients with chronic traumatic spinal cord injury (SCI). A cervical spinal cord 3T magnetic resonance imaging (MRI) with DTI sequences was performed on 28 patients with chronic traumatic SCI and 40 healthy control subjects. DTI metrics, including fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD), were calculated within the normal-appearing spinal cord area at levels C2 or C3. Clinical assessment of the patients was performed according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the motor subscale of the Functional Independence Measure (FIM). The FA values of the patients with SCI were significantly lower than those of healthy control subjects (p<0.000001). In contrast, the ADC and RD values of these patients were significantly higher than those of control subjects (ADC p<0.0001, RD p<0.00001). In patients with SCI, the FA values were positively correlated with the motor (pr=0.56, p<0.01) and sensory (pr=0.66, p<0.001) scores of ISNCSCI and with the motor subscale of FIM (pr=0.51, p<0.01). DTI revealed spinal cord pathology, which was undetectable using conventional MRI. DTI changes in regions that were remote from the site of primary injury were most likely the result of secondary degeneration of white matter tracts. Decreased FA values were correlated with poorer motor and sensory function, as well as a lack of independence in daily living. DTI is a promising quantitative and objective tool that may be used in the clinical assessment of patients with SCI.

Measuring Indoor Life-Space Mobility at Home in Older Adults With Difficulty to Perform Outdoor Activities

Measurement of indoor physical activity at home in older adults who have difficulty performing outdoor activities is a key to documenting baseline physical activity levels to guide physical activity interventions aimed at reducing the rate of decline in mobility. The purpose of this study was to describe indoor life-space mobility at home (LSH) and examine the association between LSH and mobility-related physical functions in older adults who have difficulty performing outdoor activities. The participants were 20 community-dwelling older adults (mean age [SD], 76.6 [5.1] years) receiving home-care rehabilitation. Participants were assessed for LSH and physical function related to mobility. Assessments included isometric knee extensor strength, the Timed Up and Go (TUG) Test, functional status (a 13-item Motor subscale of Functional Independence Measure, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and outdoor life-space mobility (life-space assessment [LSA]). Life-space mobility at home documented how far and how often participants moved from a bedroom to 4 destinations (entrance, dining room, bathroom, and toilet) at home with or without assistance during the week prior to the assessment. Reliability of LSH was high (intraclass correlation coefficient [ICC] (1,1) = 0.80, ICC (1,2) = 0.89). Simple bivariate correlations showed a significant relationship between LSH and isometric knee extensor strength (rs = 0.59, P = .01) and TUG Test (rs = -0.74 P = .01). Life-space mobility at home showed moderate correlations with the Functional Independence Measure (rs = 0.58, P = .01) and Tokyo Metropolitan Institute of Gerontology Index of Competence (rs = 0.49, P = .03), but no significant correlation with the LSA (rs = 0.33, P = .17). Regarding intrarater reliability, the ICCs for measuring the LSH indicated high reproducibility. The results suggest that the LSA mainly reflects outdoor life-space mobility and activity rather than indoor life-space whereas the LSH reflects indoor life-space mobility and is considered an indicator of a major decline in indoor activities and physical abilities. The LSH concept can measure with high reliability and concurrent or discriminant validity, and it is a different concept from outdoor life-space mobility. Life-space mobility at home may be an important factor associated with physical functions related to mobility and functional status, and measuring LSH may be useful to assess current indoor life-space activity in older adults who have difficulty performing outdoor activities.

The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge- FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p < 0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p < 0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p < 0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p > 0.05). The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favourable short-term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

Self-Care and Total Knee Replacement

The purpose of this study was to examine the gains in self-care and transfer skills of persons after total knee replacement (TKR) and measure the effectiveness and efficiency of treatment. In this retrospective chart review, 47 patients met the selection criteria during a two-year period. Baseline and discharge Functional Independence Measure (FIM) subscales of self-care and transfers were compared using paired t-tests with post hoc analysis. Effectiveness and efficiency measures were calculated. FIM subscale scores improved 2.29 points on average. Statistically significant improvement was made in all eight subscales where baseline was less than independent level. Improvement in functional performance was made in self-care and transfers with discharge ratings at modified independent to independent.

Self-Care and Total Knee Replacement

The purpose of this study was to examine the gains in self-care and transfer skills of persons after total knee replacement (TKR) and measure the effectiveness and efficiency of treatment. In this retrospective chart review, 47 patients met the selection criteria during a two-year period. Baseline and discharge Functional Independence Measure (FIM) subscales of self-care and transfers were compared using paired t-tests with post hoc analysis. Effectiveness and efficiency measures were calculated. FIM subscale scores improved 2.29 points on average. Statistically significant improvement was made in all eight subscales where baseline was less than independent level. Improvement in functional performance was made in self-care and transfers with discharge ratings at modified independent to independent.

Functional Performance and Grip Strength After Total Hip Replacement

Objective. The progress of adults after total hip replacement (THR) was measured baseline to discharge using the Functional Independence Measure (FIM). Measures of effectiveness and efficiency were investigated. Additionally, although grip strength is frequently evaluated, its relationship to impact on functional gains after THR is unknown and was explored in this study. Method. A retrospective chart review was conducted on 41 patients' progress in acute rehabilitation following THR. Baseline and discharge FIM subscales of self-care, mobility, and locomotion were compared using paired t-tests with post hoc correction for type I error. Effectiveness and efficiency indicators on FIM subscale improvement were calculated. Grip strength was compared to expected values by age and gender using one-sample t-tests. Then, grip strength and FIM subscale scores were correlated using Pearson correlation. Results. FIM subscale scores each improved 2.1 points on average. Statistically significant improvement was made in 10 subscales of self-care, mobility, and locomotion. Grip strength was significantly less than expected norms in six of 14 subgroups after surgery; four of eight were female subgroups. There were no significant correlations between grip strength and any FIM subscale. Conclusion. Improvement in functional performance, as measured by FIM, was made on all FIM subscales. Grip strength after THR was moderately decreased from the norm. Results suggest that loss of grip strength alone may not adversely affect functional performance.

Functional Outcome after Inpatient Rehabilitation following Aneurysmal Subarachnoid Hemorrhage: A Prospective Analysis

Subarachnoid hemorrhage (SAH) secondary to ruptured aneurysm or arteriovenous malformation is a significant cause of morbidity and mortality in adults. Neurosurgical outcomes after SAH have been extensively studied. However, functional outcomes following SAH are less well understood. Forty-one consecutive patients were admitted for rehabilitation of SAH due to aneurysm or arteriovenous malformation rupture. Age- and gender-matched groups of patients admitted for rehabilitation of stroke and traumatic brain injury (TBI) were recruited for comparison. Data were prospectively collected and analyzed. Dependent variables included lengths of stay in acute care, lengths of stay in rehabilitation, Functional Independence Measure (FIM) total and subscale score changes (admission to discharge from rehabilitation), FIM total and subscale efficiencies (FIM change per week), and dispositions (home versus not home). The average length of stay for SAH patients in acute care services was 28.7 days, and the average length of stay on the rehabilitation unit was 36.6 days. FIM improvement total was 33.7 with a FIM efficiency of 8.9 per week. No statistically significant difference in the acute lengths of stay (LOS) was noted among the three groups. A statistical trend (p < 60.06) toward longer rehabilitation LOS was observed in SAH patients (36.6 days) when compared with TBI (27.2 days) and stroke (28.9 days) patients. Overall improvement among the three groups was similar from admission to discharge in total FIM scores, each of the FIM subscales, and total and subscale FIM changes per week.

Intermodal agreement of follow-up telephone functional assessment using the functional independence measure in patients with stroke

Objective: To examine the intermodal agreement of Functional Independence Measure (FIM) ratings when obtained by two commonly used approaches: telephone interview and inperson assessment of functional performance. Design: A random sample of 40 persons with hemiparesis was tested by two registered nurses trained in FIM definitions and telephone interview techniques. The two assessments occurred within 5 days of each other. The raters were blind to previous assessments. The administration of assessments was alternated to minimize bias and order effects. Setting: All subjects were assessed at home, between 3 and 10 months after discharge from rehabilitation. Patients: The criteria for inclusion were: (1) diagnosis of cerebral vascular accident (CVA); (2) completion of a minimum of 2 weeks in an acute rehabilitation program; (3) currently living at home; (4) living within a 30-mile radius of the hospital; and (5) cognitive and verbal skills adequate to complete a telephone interview. From a population of 103 patients, 40 subjects were randomly selected, 18 women and 22 men ranging in age from 37 to 90 years. Main Outcome Measures: The intermodal agreement between FIM ratings obtained by telephone interview and in-person assessment was examined using the interclass correlation (ICC). FIM item scores were analyzed for agreement using the Kappa coefficient. The stability of the responses was determined by computing the coefficient of variation and plotting the data to visually examine the relationship between the two methods of administration. Results: Data analysis revealed that there was no statistically significant difference ( p > .05) between the two methods of administration for total FIM score. The total FIM ICC was .97. ICC values for FIM subscales ranged from .85 to .98, except for social cognition. Kappa scores for noncognitive items ranged from .49 (bowel movement) to .93 (grooming). The coefficient of variation computed to examine cognitive and communication items with reduced variability indicated good stability across all items.

Inpatient Rehabilitation for Multiple Sclerosis

To study the outcome of inpatient rehabilitation in multiple sclerosis (MS), we con ducted retrospective chart review and follow-up telephone interviews (six to thirty-six months after discharge) with thirty-seven consecutive MS patients admitted for reha bilitation following functional decline related to disease activity, trauma, or surgery. Functional Independence Measure (FIM), Kurtzke Functional Systems (FS), and Expanded Disability Status Scale (EDSS) scores at admission, discharge, and follow up were analyzed. Of the thirty-seven patients, six had relapsing-remitting (RR), five relapsing progressive (RP), and twenty-six chronic progressive (CP) disease patterns. For all groups combined, significant improvements between admission and discharge were seen in FIM (p = .0001), FS (p = .0001), and EDSS (p = .0001) scores. Gains were partly maintained between discharge and follow-up. FS and FIM subscales were exam ined to ascertain which deficits were most amenable to rehabilitation therapies. Inpa tient rehabilitation is associated with significant functional improvement for MS patients.

Functional independence measure subscales versus neuropsychological assessment in the rehabilitation of stroke patients

Functional independence measure subscales versus neuropsychological assessment in the rehabilitation of stroke patients

Functional independence measure subscales versus neuropsychological assessment in the rehabilitation of stroke patients

Functional independence measure subscales versus neuropsychological assessment in the rehabilitation of stroke patients