Total Functional Independence Measure Research Articles

Cognition in Patients With Burn Injury in the Inpatient Rehabilitation Population

ObjectiveTo analyze potential cognitive impairment in patients with burn injury in the inpatient rehabilitation population. DesignRehabilitation patients with burn injury were compared with the following impairment groups: spinal cord injury, amputation, polytrauma and multiple fractures, and hip replacement. Differences between the groups were calculated for each cognitive subscale item and total cognitive FIM. Patients with burn injury were compared with the other groups using a bivariate linear regression model. A multivariable linear regression model was used to determine whether differences in cognition existed after adjusting for covariates (eg, sociodemographic factors, facility factors, medical complications) based on previous studies. SettingInpatient rehabilitation facilities. ParticipantsData from Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury (N=5347) were compared with other rehabilitation populations (N=668,816). InterventionsNot applicable. Main Outcome MeasuresComparison of total cognitive FIM scores and subscales (memory, verbal comprehension, verbal expression, social interaction, problem solving) for patients with burn injury versus other rehabilitation populations. ResultsAdults with burn injuries had an average total cognitive FIM score ± SD of 26.8±7.0 compared with an average FIM score ± SD of 28.7±6.0 for the other groups combined (P<.001). The subscale with the greatest difference between those with burn injury and the other groups was memory (5.1±1.7 compared with 5.6±1.5, P<.001). These differences persisted after adjustment for covariates. ConclusionsAdults with burn injury have worse cognitive FIM scores than other rehabilitation populations. Future research is needed to determine the impact of this comorbidity on patient outcomes and potential interventions for these deficits.

Acu-TENS might alleviate the dysfunction following spinal cord injury

Spinal cord injury (SCI) influences approximately 1000 individuals per million in the general population, and almost 12,000 newcases of SCI occur every year in theUnited States, which is a heavy social and economic burden for the society and involved families. A series of therapies exist for functional recovery following SCI, including surgery, prescription drugs, physical therapy, and supportive treatment. Acupuncture, which is based on traditional Chinese medicine theory, has been widely used for pain relief or neurological dysfunction in China. A recent systematic review demonstrated that the acupuncture treatment was beneficial for the functional recovery based on the motor American Spinal Injury Association scores and total Functional Independence Measure scores. Both basic research and clinical study have demonstrated the effect of acupuncture on SCI. The combination of implanted electroacupuncture electric stimulation and bone marrow-derived mesenchymal stromal cells transplantation obviously promotes functional improvements for animals with SCI, indicating that this combination method has the potential to treat SCI in humans. Electroacupuncture treatment may increase the expression of neurotrophin-3, and promote the cell number and differentiation of endogenous oligodendrocyte precursor cells, along with the functional improvement of demyelinated

Improvement of functional independence of patients with acute schizophrenia through early occupational therapy: a pilot quasi-experimental controlled study

Objective: To clarify whether early occupational therapy for patients with acute schizophrenia improves their functional independence. Design: Quasi-experimental controlled study. Setting: A university hospital in Japan. Subjects: Forty-six out of 85 eligible patients with schizophrenia. Intervention: Participants were allocated into an intervention group or a control group according to the month of admission. Activities in one-on-one and mainly non-verbal occupational therapy were provided for the intervention group immediately after admission, and not for the control group. Main measures: Functional independence was measured using the Functional Independence Measure (FIM), at admission, at one month and at three months after admission. Psychiatric symptoms were also measured by the Brief Psychiatric Rating Scale. Results: Patients in both groups showed improved FIM total scores at one month and three months after admission. In the intervention group, the medians (interquartile ranges) were 89.0 (44.5) at admission, 113.0 (18.5) at one month, and 121.0 (6.5) at three months. In the control group, they were 88.0 (32.0), 107.0 (39.5), and 111.0 (17.0). At three months, the total FIM scores were significantly higher in the intervention group than in the control group (p = 0.016). In the FIM cognitive domain, the scores were significantly higher in the intervention group than in the control group at one month (p = 0.038) and, three months (p = 0.012). Both groups showed improvement in Brief Psychiatric Rating Scale total scores, while no significant differences were observed between the groups at any points. Conclusion: The results suggest that early occupational therapy may improve functional independence in patients with acute schizophrenia.

Perioperative urinary retention, short‐term functional outcome and mortality rates of elderly hip fracture patients

Perioperative urinary retention (POUR) is common among hip fracture patients. The aim of the present study was to compare the prevalence, risk factors, functional outcomes and survival rates of patients with and without POUR. This was a retrospective chart review study that was carried out in an orthogeriatric hip fracture unit. A total of 639 consecutive hip fracture patients who had hip surgery followed by a standard rehabilitation course participated in the study. Post-void residual volume (PVRV), Functional Independence Measure (FIM) scores (total and motor FIM, FIM gain) and mortality rates (90 and 365 days, end of follow up) were measured. A total of 328 patients (51.3%) suffered from POUR. Diabetes (OR 1.55, 95% CI 1.04-2.31), urinary infection (OR 3.25, 95% CI 2.16-4.90) and delirium (OR 1.66. 95% CI 1.09-2.52) emerged as the best predictors for POUR. Functional gains were slightly better in patients without POUR (P = 0.037 and P = 0.023, for discharge motor and total FIM gain, respectively). There were no differences in FIM gains at discharge in male patients, whether with or without POUR. However, female patients without POUR showed significantly better motor and total FIM gains on discharge (P = 0.003 and P = 0.003, respectively), compared with females with POUR. In multiple linear regression analyses, POUR in female (but not male) patients was predictive for adverse motor FIM gain (beta = -0.089, P = 0.046). In Cox regression analysis, urinary retention was not associated with mortality rates. POUR is highly prevalent in elderly hip fracture patients. It adversely affects the functional outcome of female patients, but is not associated with increased mortality rates.

The Complementary Role of the Kinect Virtual Reality Game Training in a Patient With Metachromatic Leukodystrophy

Metachromatic leukodystrophy (MLD) is a lysosomal storage disease characterized by demyelination of the peripheral and central nerves. Patients with MLD can present with gait disturbances, progressive spastic quadriparesis, diffuse muscle atrophy, and areflexia attributable to central or peripheral nerve involvements. The rehabilitation of patients with MLD generally focuses on gait disturbances, balance impairments, and muscle weaknesses. Here, we present a case of MLD in which virtual reality (VR) training was used as an adjunctive therapy. We also discuss the complementary role of VR therapy, which was successfully integrated with a conventional rehabilitation program for a young patient with MLD who had impaired balance and gait. After completion of the integrated rehabilitation program, the patient demonstrated improvements in functional independency, mobility, walking speed, and balance. His total Functional Independence Measure score increased from 97 to 109, 6-minute walk test increased from 342 to 396 m, 10-minute walk test decreased from 11 to 7 seconds, and Berg Balance Scale score increased from 38 to 42 points. Moreover, 6 weeks after completion of the therapy, these improvements were sustained for the most part. Adding VR to a conventional rehabilitation program is an emerging trend in neurologic rehabilitation. Our patient with MLD demonstrated considerable improvements with a high level of enjoyment and satisfaction.

Prognosis for patients with traumatic cervical spinal cord injury combined with cervical radiculopathy.

ObjectiveTo delineate cervical radiculopathy that is found in combination with traumatic cervical spinal cord injury (SCI) and to determine whether attendant cervical radiculopathy affects the prognosis and functional outcome for SCI patients.MethodsA total of 66 patients diagnosed with traumatic cervical SCI were selected for neurological assessment (using the International Standards for the Neurological Classification of Spinal Cord Injury [ISNCSCI]) and functional evaluation (based on the Korean version Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]) at admission and upon discharge. All of the subjects received a preliminary electrophysiological assessment, according to which they were divided into two groups as follows: those with cervical radiculopathy (the SCI/Rad group) and those without (the SCI group).ResultsA total of 32 patients with cervical SCI (48.5%) had cervical radiculopathy. The initial ISNCSCI scores for sensory and motor, K-MBI, and total FIM did not significantly differ between the SCI group and the SCI/Rad group. However, at discharge, the ISNCSCI scores for motor, K-MBI, and FIM of the SCI/Rad group showed less improvement (5.44±8.08, 15.19±19.39 and 10.84±11.49, respectively) than those of the SCI group (10.76±9.86, 24.79±19.65 and 17.76±15.84, respectively) (p<0.05). In the SCI/Rad group, the number of involved levels of cervical radiculopathy was negatively correlated with the initial and follow-up motors score by ISNCSCI.ConclusionCervical radiculopathy is not rare in patients with traumatic cervical SCI, and it can impede neurological and functional improvement. Therefore, detection of combined cervical radiculopathy by electrophysiological assessment is essential for accurate prognosis of cervical SCI patients in the rehabilitation unit.

Relationship between urinary dysfunction and clinical factors in patients with traumatic brain injury

Objectives: Examination of relations between urinary dysfunction and Functional Independence Measurement (FIM) values and other clinical factors.Materials and methods: Twenty-nine patients with TBI were included in the study. Patients’ demographic values, lower urinary tract symptoms (LUTS) and urinary drainage methods were recorded. Functional assessment was performed using FIM. Urodynamic studies were carried out and maximum cystometric capacity (MCC), storage and voiding function, type of detrusor, urodynamic abnormality and post-void residual urine volume values were investigated.Results: Total FIM and FIM sphincter control sub-group scores were significantly lower in patients with storage dysfunction and urodynamic abnormality than patients without storage dysfunction and urodynamic abnormality (p < 0.05). In tetraparetic patients, frequency of storage dysfunction was significantly higher than hemiparetic patients (p < 0.05). Urodynamic abnormality was detected in five of nine patients with LUTS and in 12 of 20 patients without LUTS. There was no significant correlation between LUTS and urodynamic abnormality (p > 0.05).Conclusions: Storage dysfunction and urodynamic abnormality is associated with poorly functional outcomes in TBI patients. There is a direct correlation between motor deficit and urodynamic abnormality. All of the TBI patients with or without LUTS should be evaluated neuro-urologically; urodynamic evaluation and treatment should be arranged if needed.

The effect of protein and calorie intake on prealbumin, complications, length of stay, and function in the acute rehabilitation inpatient with stroke

Nutrition's impact on stroke rehabilitation outcomes is controversial. Existing studies utilize albumin without correcting for inflammation in nutritional assessments. Here, prealbumin was used and inflammation assessed to determine if nutrition impacts rehabilitation outcomes. Determine the effect of dietary intake on prealbumin level, number of complications, length of stay, and Functional Independence Measure (FIM) efficiency in rehabilitation stroke inpatients. Patients had admission and discharge prealbumin and C-reactive protein (CRP) levels drawn; and, weekly protein and calorie counts obtained. Patients were followed for number of complications, length of stay, and FIM efficiency. Mean protein and calorie intake was 57.6 ± 16.2 g/d and 1452.2 ± 435.8 kcal/d, respectively. 77.6% of patients had normal prealbumin on admission with 94.9% on discharge. Prealbumin increased significantly from admission to discharge (22.3 ± 6.2 mg/dL vs. 24.6 mg/dL ± 5.1 mg/dL, P = 0.007). Number of complications and length of stay were predicted by CRP in regression models. Total, motor, and cognitive FIM efficiencies were not universally affected by prealbumin levels, protein intake, or calorie intake. Nearly all hypoprealbuminemic stroke rehabilitation inpatients correct their levels eating a non-supplemented diet. Number of complications, length of stay, and functional outcomes in this patient are not affected by prealbumin levels, protein intake, or calorie intake.

Gender differences in functional outcome of elderly hip fracture patients

The purpose of the present study was to investigate whether gender might affect functional outcome of hip fractured patients undergoing in-hospital rehabilitation. This was a retrospective chart review study comprising of 759 consecutive elderly patients suffering traumatic hip fracture. All patients underwent a standard orthogeriatric care of surgical hip repair and post-acute rehabilitation care. Functional outcome (female vs male gender) was assessed by motor and total Functional Independence Measurement (FIM) scores on discharge. Data was analyzed by t-tests χ(2) -test and multiple linear regression analyses. A total of 574 (75.6%) out of all patients were females. There were no differences in admission FIM scores; however, male patients had a higher prevalence of comorbidities. FIM scores on discharge were higher in female patients (motor FIM, P=0.007; motor FIM gain, P=0.001; compared with males). A multiple linear regression analysis showed that female gender was independently associated with higher total FIM at discharge (β coefficient=0.056, P=0.008), higher motor FIM at discharge (β coefficient=0.071, P=0.007) and higher total FIM gain at discharge (β coefficient=0.11, P=0.008). The findings suggest that absolute discharge FIM scores of females are higher, compared with male patients. After adjusting for possible covariates, female gender still emerged as an independent predictor for higher FIM at discharge, suggesting that male gender should be considered as adversely affecting rehabilitation outcome of hip fracture male patients.

Predictors of functional outcome in Saudi Arabian patients with stroke after inpatient rehabilitation

To identify the possible factors influencing functional outcome of stroke patients after inpatient rehabilitation. One hundred and eighty patients with stroke consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke characteristics, impairment (National Institutes of Health Stroke Scale), disability level (Functional Independence Measure [FIM]), psycho-emotional state (Geriatric Depression Scale-15 [GDS-15]), cognitive function (Mini Mental State Evaluation [MMSE]), and preexisting medical conditions were recorded at admission. The main measure of functional outcome was the discharge FIM score. The univariate and multiple linear regression analyses were performed. The Mean admission total FIM score was 64.8 ± 22.4 and the mean discharge total FIM score was 84.0 ± 23.0, with this gain being highly significant (P < 0.001). Univariate analyses indicated that the significant factors influencing functional outcome of stroke patients at discharge from rehabilitation included age, total FIM score at admission, severity of stroke, recurrent stroke, cognitive impairment, and depression. However, in multiple linear regression analyses, age was not significant predictor. Age predicts the function outcome to lesser extent than other covariate. The admission total FIM score, cognitive condition, depression, and stroke severity are predictors of functional outcome of stroke patients after inpatient rehabilitation.

Longitudinal construct validity of the Health Utilities Indices Mark 2 and Mark 3 in hip fracture

The objective of this study is to evaluate the longitudinal construct validity of the Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) using a convergent/divergent validity approach in patients recovering from hip fracture, with the Functional Independence Measure (FIM) as the comparator. A total of 278 patients with a primary diagnosis of hip fracture were interviewed 3-5days after surgery and then at 1 and 6months using the HUI2, HUI3 and the FIM and a Likert-type rating of hip pain. A priori hypotheses were formulated. Convergent and divergent correlations between HUI2, HUI3 and FIM change scores for the baseline to 1-month and baseline to 6-month intervals were examined. Overall HUI2 detected continued gain in health-related quality of life between 1 and 6months after fracture, as the change increased from 0.20 to 0.29 units. The correlation between change in the overall HUI2 score and total FIM score was moderate (r=0.50) over the 6-month interval, but larger than the observed correlation over the 1-month interval (r=0.36). The correlation between change in overall HUI3 score and total FIM over the 1-month interval was small (r=0.32), and the correlation between change in overall HUI3 score and total FIM was moderate (r=0.37) over the 6-month interval. All hypotheses for the divergent correlations were supported. Weaker correlations were reported for change over 1month as compared to change over the 6months after fracture. Findings supported the longitudinal construct validity of the overall HUI2 and HUI3 for the assessment of recovery following hip fracture, particularly for change over the 6months following fracture.

Short-term functional outcome of ischemic stroke in the elderly: A comparative study of atrial fibrillation and non-atrial fibrillation patients

The purpose of this study was to evaluate whether atrial fibrillation affects the short-term functional outcome of elderly patients with ischemic stroke, undergoing post-acute in-hospital rehabilitation. We studied 919 consecutive patients admitted for ischemic stroke rehabilitation, out of whom 19.6% were diagnosed with atrial fibrillation. The Functional outcome of atrial fibrillation (AF) and non-atrial fibrillation (Non-AF) patients were assessed by the Functional Independence Measurement scale (FIM™) at admission and discharge. Data were analyzed by t-test, Chi-square test and by multiple linear regression analysis. Compared with Non-AF, patients with AF were slightly older (p<0.001), and had lower Mini-Mental State Examination (MMSE) scores (p=0.001). Discharge total FIM scores were significantly higher in Non-AF compared with AF patients (84.34±29.44 vs. 79.02±30.68, p=0.031). However, total and motor FIM gains at discharge were similar in the two groups. A multiple linear regression analysis showed that age (p<0.001), admission total and motor FIM (p<0.001) and MMSE score (p<0.001) emerged as the only independent predictors of total, motor and gain FIM scores at discharge. AF was not predictive, whatsoever, of adverse FIM scores (total, motor, gain) at discharge (β=−0.024, p=0.303; β=−0.019, p=−0.455 and β=−0.04, p=0.303, respectively). The finding suggests that Non-AF ischemic stroke elderly show higher total discharge FIM scores, compared with AF patients. However, both groups achieve similar FIM gains during rehabilitation period. AF should not be considered as adversely affecting the short-term rehabilitation process of such patients.

The impact of cranioplasty on neurological function

Objectives. To assess changes in neurological function after cranioplasty. Methods. Functional and neurocognitive assessments including activities of daily living assessment, functional independence measure (FIM) and the Cognitive assessment report (COGNISTAT) were conducted on all patients within 72 h before and 7 days after cranioplasty. A change in the total FIM score of 2 points was taken to be clinically significant. Results. Assessments were performed on 25 patients. The functional status was unchanged in eighteen patients (72%), four patients (16%) demonstrated a significant improvement and three patients (12%) deteriorated significantly. Those with deterioration after cranioplasty had some forms of complications including pneumocephalus or seizure. After excluding the three patients who had immediate medical or surgical complications after surgery, there was a mild overall improvement in the mean FIM score (2.1, 95% confidence interval 0.1–4.3, p = 0.049), mainly due to an improvement in their motor function. Conclusions. A small but significant number of patients appear to improve clinically following cranioplasty. The so-called syndrome of the trephined may be more common than had been previously appreciated.

Sustained-Release Fampridine (4-Aminopyridine) in Multiple Sclerosis: Efficacy and Impact on Motor Function

ObjectiveThe aim of this study was to determine the efficacy of sustained-release fampridine (4-aminopyridine) in veterans with multiple sclerosis (MS) with limited ambulatory ability, and its impact on motor function in an outpatient setting.DesignRetrospective.SettingTertiary referral center [Veterans Affairs (VA) Medical Center].ParticipantsVeterans; 20 MS patients were prescribed dalfampridine (10 mg twice daily) due to their difficulty with walking based on patient and caregiver report and clinician impression of change in the ability to ambulate based on prior 10-meter (10M) and 2-minute walk tests (2MWTs).InterventionNot applicable.Main Outcome MeasuresThe primary outcome measures were mean changes in walking speed (10M walk test), walking distance (2MWT), and Total Functional Independence Measure (TFIM). Improvement of >20 % in walking speed was indicated as a clinically meaningful change.ResultsTreatment with dalfampridine resulted in significant improvement in walking speed and endurance (p < 0.05). Walking speed increased by 33 % and walking endurance by 31 %, representing clinically meaningful improvement. This change was not influenced by change in muscle tone. This improvement in mobility was associated with a clinically significant change in motor function. Adverse effects, including insomnia, dizziness, and headache, were experienced by five patients who discontinued the medication after a minimum of 4 weeks.ConclusionTreatment with dalfampridine resulted in clinically relevant improvements in walking speed and endurance in MS patients with limited ambulation and helped improve their motor function.Electronic supplementary materialThe online version of this article (doi:10.1007/s40268-013-0020-x) contains supplementary material, which is available to authorized users.

Functional Status Impairment Is Associated With Unplanned Readmissions

ObjectiveTo determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. DesignRetrospective cohort study. SettingAcademic hospital-based CIIRP. ParticipantsConsecutive patients (N=1515) admitted to a CIIRP between January 2009 and June 2012. InterventionsPatients' functional status, the primary exposure variable, was assessed using tertiles of the total FIM score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domains. A propensity score, consisting of 25 relevant clinical and demographic variables, was used to adjust for confounding in the analysis. Main Outcome MeasuresReadmission to acute care was categorized as (1) readmission before planned discharge from the CIIRP, (2) readmission within 30 days of discharge from the CIIRP, and (3) total readmissions from both groups, with total readmissions being the a priori primary outcome. ResultsAmong the 1515 patients, there were 347 total readmissions. Total readmissions were significantly associated with FIM scores, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the highest tertile (AOR=2.6; 95% CI, 1.9–3.7; P<.001 and AOR=1.7; 95% CI, 1.2–2.4; P=.002, respectively). There were similar findings for secondary analyses of readmission before planned discharge from the CIIRP (AOR=3.5; 95% CI, 2.2–5.8; P<.001 and AOR=2.1; 95% CI, 1.3–3.5l P=.002, respectively), and a weaker association for readmissions after discharge from the CIIRP (AOR=1.6; 95% CI, 1.0–2.4; P=.047 and AOR=1.3; 95% CI, 0.8–1.9; P=.28, respectively). The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score. ConclusionsFunctional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.

Medical Comorbidities in Disorders of Consciousness Patients and Their Association With Functional Outcomes

ObjectiveTo identify, for patients in states of seriously impaired consciousness, comorbid conditions present during inpatient rehabilitation and their association with function at 1 year. DesignAbstracted data from a prospective cross-sectional observational study with data collection occurring January 1996 through December 2007. SettingFour inpatient rehabilitation facilities in metropolitan areas. ParticipantsThe study sample of 68 participants is abstracted from a database of 157 patients remaining in states of seriously impaired consciousness for at least 28 days. InterventionsNot applicable. Main Outcome MeasureOne-year cognitive, motor, and total FIM score. ResultsThe most common medical complications during inpatient rehabilitation for the study sample are active seizures (46%), spasticity (57%), urinary tract infections (47%), and hydrocephalus with and without shunt (38%). Presence of ≥3 medical complications during inpatient rehabilitation, controlling for injury severity, is significantly (P<.05) associated with poorer total FIM and FIM motor scores 1 year after injury. The presence of hydrocephalus with and without shunt (r=−.20, −.21, −.18; P ≤.15), active seizures (r=−.31, −.22, −.42), spasticity (r=−.38, −.28, −.40), and urinary tract infections (r=−.25, −.24, −.26) were significantly (P<.10) associated with total FIM, FIM cognitive, and FIM motor scores, respectively. ConclusionsReported findings indicate that persons in states of seriously impaired consciousness with higher numbers of medical complications during inpatient rehabilitation are more likely to have lower functional levels 1-year postinjury. The findings indicate that persons with ≥3 medical complications during inpatient rehabilitation are at a higher risk for poorer functional outcomes at 1 year. It is, therefore, prudent to evaluate these patients for indications of these complications during inpatient rehabilitation.

Comparison of the Kurtkze Expanded Disability Status Scale and the Functional Independence Measure: measures of multiple sclerosis-related disability

Background: Multiple sclerosis (MS) is a disease which has a variable clinical presentation followed by a variable clinical course. Therefore, accuracy of clinical rating scales to measure disability at initial clinical presentation and during follow-up visits is essential to accurately capture the variability inherent in this disease. This is particularly vital when attempting to identify the efficacy of interventions. Objective: This observational study in veterans with MS compared the Kurtkze Expanded Disability Status Scale (EDSS) and the Total Functional Independence Measure (TFIM) scale as measures of MS-related disability. Methods: We retrospectively reviewed the electronic charts of 76 veterans with MS who are regularly followed in our VA MS clinic. Local Institutional Review Board approval was obtained for the protocol. Data were analyzed using SAS (SAS System for Windows, version 9.2, SAS Institute Inc., Cary, NC, USA). Chi-square and Fisher exact tests were used to assess categorical variables. Kruskal–Wallis tests evaluated the relationships between MS types [relapsing–remitting MS (RR), secondary progressive MS (SP), primary progressive MS (PP) and clinical isolated syndrome (CIS)] and the initial TFIM, EDSS and Impairment Index (II) scores. Results: The EDSS score accurately measured MS-related impairment at initial evaluation and follow-up relative to an II. However, the EDSS score did not change over time, compared to the TFIM suggesting reduced sensitivity of the EDSS for detecting change in MS-related disability over time. Conclusions: This suggests TFIM scale is a more sensitive measure of MS-related disability than EDSS for use in future MS clinical trials.Implications for RehabilitationThis study highlights that given the paucity of scales to which EDSS has been compared, TFIM is a valuable adjunct to EDSS in measuring MS-related disability.TFIM is able to accurately measure the severity of MS-related disability and help provide for services patients with MS-related disability would need.TFIM is an easy to administer and a sensitive scale to measure the change in MS-related disability following interventions.

Functional Outcomes of Adult Patients With West Nile Virus Admitted to a Rehabilitation Hospital

The clinical manifestation of West Nile Virus (WNV) varies in individuals from mild flu-like symptoms to acute flaccid paralysis. Advanced age is the most significant risk factor for developing severe neurological disease and for death. The broad range of neurologic symptoms associated with WNV infection leads to varied body structure and function limitations and participation restrictions that may require rehabilitation. The purpose of this study is to describe the functional impairments upon admission and the functional outcomes at discharge of 48 adult patients admitted with WNV to a rehabilitation facility in the Midwest from 2002 to 2009. A retrospective chart review was completed on 48 patients (29 male, 19 female) with mean age 67.8 (SD = 16.6, range = 24-91) years and median age 72.5 years, admitted to inpatient rehabilitation with a diagnosis of WNV after January 1, 2002, and discharged prior to December 31, 2009. General information (sex, age, social history, employment, and living environment), past medical history, and information specific to the current hospitalization (medical conditions, functional status and activity level on admission and discharge as measured by the Functional Independence Measure [FIM], lengths of stay [LOSs] in the acute care and rehabilitation hospital, physical therapy care, discharge destination, and follow-up care provisions) were gathered. The standardized response mean (SRM) was calculated for total, motor, and cognitive FIM scores to provide insight into the effect size and the responsiveness of the FIM for the patients with WNV in this study. All patients were admitted to the rehabilitation hospital from acute care hospitals following LOSs ranging from 1 to 62 days. The rehabilitation hospital LOS ranged from 2 to 304 days. These patients had significant comorbidities including hypertension (43.75%), diabetes mellitus (41.67%), acute respiratory failure (37.5%), ventilator dependency/tracheostomy (33.33%), and pneumonia (29.17%). Their admission FIM scores ranged from 13 to 116 (mean = 45.8 ± 28.2) and discharge FIM scores ranged from 18 to 121 (mean = 75.1 ± 34.2). The change in FIM during inpatient rehabilitation was statistically significant (P < .001). The calculated SRM for the total (1.06) and motor (1.12) FIM indicate a large effect size, whereas the SRM for the cognitive FIM (0.79) indicates a moderate effect. The majority of patients were discharged home or to a nursing facility (46%), skilled or extended care (38%) with a need for continued rehabilitation services. The manifestation of the WNV and functional outcomes after comprehensive rehabilitation vary from patient to patient. Higher numbers of comorbid conditions lead to more complex presentation and challenge rehabilitation professionals to design individualized plans of care to enable these patients to achieve the highest functional outcomes. Most patients require follow-up physical therapy care after discharge from rehabilitation.

Abstract WMP86: Novel, High-tech Walking Recovery Program Improves Motor Recovery

Introduction: Although there are a number of research studies investigating walking recovery after stroke, most focus on one intervention or piece of equipment in order to achieve a controlled experimental environment. Such studies have yet to produce a comprehensive clinical practice guideline (CPG) for gait training. To fill this void, we implemented a clinical program for walking recovery, iWalk™, using a variety of advanced technologies, and an evidence-based CPG to assist in making assessment and intervention decisions. This study compares outcomes of patients treated using a traditional therapy program to those treated with the iWalk program. Hypothesis: The systematic application of a novel, evidence-based CPG for walking recovery will result in superior motor performance when compared to traditional therapy in patients post stroke. Methods: This study included all stroke survivors admitted to a rehab facility during a 24 month period, with the cohort split into two groups. The control group received traditional rehabilitation (n=152) and the experimental group received the iWalk protocol (n=165). Since full implementation of the protocol could not be assigned a specific date, a buffer group (n=50) between the two groups was excluded from this analysis. Results: Functional Independence Measure: An interaction between age and treatment program was detected (p&lt;0.001). Motor FIM scores showed greater improvement for younger patients in iWalk than in the traditional therapy program. Length of Stay: When examining LOS as an outcome, an interaction between treatment group and total FIM score was detected (p=0.073). Patients who were lower functioning on admission were more likely to be discharged home if they were in the iWalk program. Examining LOS as a predictor, the difference in timed-up-and-go scores between the treatment groups reveals that iWalk seems to be better for a LOS around 3 weeks, but is not significant (p&gt;0.05). Conclusions: This study demonstrates outcome differences that favor iWalk. Additionally, there may be a LOS range which optimizes motor recovery. It is unclear whether a patient’s LOS is a reflection of the improvement of clinical variables or practical reasons. Further work is necessary on this topic.

Interés del uso clínico del tensor de difusión en la planificación del tratamiento rehabilitador en pacientes tras el primer ictus

ObjectiveTo compare the predictive value of the MR diffusion tensor (DT) imaging modality in a sample of stroke patients. Material and methodA prospective study was conducted on 7 inpatient subjects of both genders who were undergoing intensive rehabilitation after a first ischemic stroke. The protocol included: 1) motor skills evaluation by Motor Index, Trunk Control Test; 2) Walking capacity: functional assessment categories and functional capacity: Barthel Index and Functional Independence Measure (FIM); 3) Tractography study: mean and standard deviation for fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in internal capsule, corona radiata and right and left pontine tract; 4) Statistical analysis: projection of the data into a two-dimensional scatterplot matrix; verification of every possible link with a simple regression model (linear or logistic). Results with P-value <0.2 are included. ResultsThe relations with two pairs of variables that are significant are: 1) upper extremity motor skill and FA values in the pontine tract; 2) lower extremity motor skill and FA values at the corona radiate; 3) motor and cognitive FIM with ADC at the corona radiate; 4) motor and cognitive FIM with FA in the pontine tract; 5) Cognitive FIM and FA at the corona radiate; 6) FIM total and FA at the internal capsule and pontine tract and, 7) total FIM and ADC in the pontine tract. The results represent the preliminary findings of the use of DT in a small sample of stroke patients in a neurorehabilitation unit. We consider DT to be useful in the evolutive prediction of stroke.