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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have observed that patients who suffer from hemiplegia after a cerebral stroke, tend to remove their clothes although it is not necessary to change them while they are in hospital. Not only does this activity make it difficult to manage the ward and carry out rehabilitation, but it also often becomes problematic for home care once the patient has been discharged from hospital. However, there have been no previous reports on this activity. In this study, we examined the characteristics pertaining to clothes removal in hemiplegic patients under home care. The subjects were chronic-stage, cerebral stroke hemiplegic patients hospitalized in the rehabilitation ward of this hospital since the first initial seizure. Once it was established that environmental factors, such as room temperature, were not the primary reason for the patients to try to remove their clothes, the patients were closely monitored and the circumstances under which they tried to remove their clothes (location, time and type of clothes removed) were recorded to examine the relationship among age, sex, side affected by paralysis, higher cortical function, motor paralysis and ADL. Thirty-five percent of the patients, mostly women, usually tried to remove their clothes and the tendency was for them to incompletely remove their tops without reason while they were confined to bed or sitting on the bed. This activity was also prevalent among patients with accompanying diminished intellectual function, left hemiplegia, and left unilateral spatial agnosia. The acquired level of ADL by FIM in the group in which this activity was observed was low, except regarding meals. Thus, it was inferred that in stroke hemiplegic patients being taken care of at home the removal of clothes was related to a diminished intellectual function or ADL, which suggested the importance of family guidance based on observations of the patient's behavior in the ward. Targeting a greater number of subjects, we would like to conduct further studies on home-care measures to deal with this activity.
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PMID:[Characteristics of hemiplegic outpatients with stroke who try to remove their clothes unnecessarily]. 1178 1

We undertook to develop a tool based on the FIM instrument to predict the number of nursing hours required to care for stroke patients in an acute inpatient rehabilitation program. The initial study to evaluate the feasibility of using the FIM instrument revealed that the total FIM score had a strong inverse relation to the level of care indicated by the Patient Care Index (PCI) at days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = -.76 to -.87). The results warranted continued investigation of the FIM instrument as a guide for nurse staffing decisions. Based on data from the initial study, five categories of FIM score ranges were designated that demonstrated the most accuracy of placing patients at the correct level of care. Special care considerations unique to institutional settings were identified and incorporated into the tool's final format, as were the calculations to determine the amount of assistance needed. The study reported here was undertaken to evaluate the level of care indicated by the adapted tool, compared with that of the PCI, in a sample of 67 stroke admissions. Spearman correlations revealed a moderate relationship (rs = .49 to .54) between the amount of care determined by the Patient Acuity and Staffing tool and through the PCI at the first, second, and third team meetings. We conclude that the system is an effective, efficient guide for scheduling nurse staffing on the stroke rehabilitation unit.
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PMID:A patient acuity and staffing tool for stroke rehabilitation inpatients based on the FIM instrument. 1203 91

The aim of this study was to evaluate the awareness of deficit profiles of stroke patients undergoing rehabilitation, and examine the impact of unawareness on rehabilitation functional outcomes. Sixty first-event stroke patients, 36 after right hemisphere damage and 24 after left hemispheric damage were included. The Awareness Interview was administered at admission to rehabilitation, and patients' responses were compared with standardized cognitive and neurological evaluations. The FIM motor scale and a safety rating were used to measure functional outcomes at discharge from rehabilitation and at 1-year follow up. The frequency of unawareness for motor and sensory deficits was low, whereas unawareness of cognitive deficits was much higher. Unawareness was not associated with a specific lesion site, however a significant association was found with cortical involvement, and with lesion size. In the right hemispheric damage group a significant negative correlation was found between total unawareness scores and discharge functional outcomes. Multiple regression revealed that unawareness at admission was a significant predictor of discharge FIM motor scores in the right hemispheric damage group, beyond the contribution of cognitive and demographic variables. Findings delineate the multifaceted nature of unawareness phenomenon, and highlight the significance of unawareness in post-stroke rehabilitation.
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PMID:Awareness of deficits in stroke rehabilitation. 1220 10

Two disability measures frequently used to assess the effects of interventions on stroke recovery are the Barthel Index (BI) and the motor component of the Functional Independence Measure (FIM Instrument). This study compared multiple measures of responsiveness of these instruments to stroke recovery between 1 and 3 months. Data on a 1- to 3-month change in the Instruments were obtained for 372 subjects who improved or maintained function on the modified Rankin Scale (MRS), using a subset of 459 eligible patients with confirmed stroke as defined by WHO criteria recruited from 12 participating hospitals in the Greater Kansas City area. Subjects were excluded because of death, early withdrawal from the study, missing MRS, or outcome data (57) decline on MRS (26), or inability to improve on MRS (4). Techniques used to assess responsiveness were: area under the ROC curve, Guyatt's effect size, paired t-statistics, standardized response mean, Kazis effect size, and mixed model adjusted t-statistic. The FIM Instrument and BI show little difference in responsiveness to change. The different responsiveness measures are generally consistent with this conclusion, with no measure clearly superior to the others. Large differences in the responsiveness measures were obtained within an instrument depending on the populations used (changers only or both changers and those who maintained function). Results also suggest responsiveness assessments are likely to be affected by time frame and phase of rehabilitation over which the responsiveness of a measure is determined.
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PMID:Comparison of the responsiveness of the Barthel Index and the motor component of the Functional Independence Measure in stroke: the impact of using different methods for measuring responsiveness. 1239 81

This is the third annual report describing patients discharged from subacute rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation (UDSmr). The analysis included 39,562 complete records of first admission cases discharged alive from 180 facilities in 1999. Sixty-five percent of the patients were women, and most patients (91%) were white. Sixty-two percent of the patients were 75 yr of age or older. Before the impairment onset, 55% lived with at least one other person. The average total FIM (motor and cognitive) score change for all patients was 21.1 points, and when stratified by rehabilitation impairment group, average scores ranged from 18.3 for patients with pulmonary conditions to 25.3 for patients with a joint replacement. The percentage of patients discharged to a community-based setting ranged from 67% for patients with stroke to 94% for patients with a joint replacement. These data show that patients receiving care in subacute rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.
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PMID:The Uniform Data System for Medical Rehabilitation report: patients discharged from subacute rehabilitation programs in 1999. 1296 Sep 12

The purpose of this retrospective study was to compare functional dysphagia outcomes following inpatient rehabilitation for patients with brain tumors with that of patients following a stroke. Group 1 (n = 24) consisted of consecutive admissions to the brain injury program with the diagnosis of brain tumor and dysphagia. Group 2 (n = 24) consisted of matched, consecutive admissions, with the diagnosis of acute stroke and dysphagia. Group 2 was matched for age, site of lesion, and initial composite cognitive FIM score. The main outcome measures for this study included the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, length of stay, hospital charges, and medical complications. Results showed that swallowing gains made by both groups as evaluated by the admission and discharge ASHA NOMS levels were considered to be statistically significant. The differences for length of stay, total hospital charges, and speech charges between the two groups were not considered to be statistically significant. Three patients in the brain tumor group (12.5%) demonstrated dysphagia complications of either dehydration or pneumonia during their treatment course as compared to 0% in the stroke group. This study confirms that functional dysphagia gains can be achieved for patients with brain tumors undergoing inpatient rehabilitation and that they should be afforded the same type and intensity of rehabilitation for their swallowing that is provided to patients following a stroke.
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PMID:Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation. 1450 86

The effect of age on functional outcome after stroke remains uncertain. Many studies have found that younger patients do better than older patients, whereas others have found minimal or no effect of age on rehabilitation outcomes. We examined the effect of advancing age on FIM trade mark gain, length of stay, length of stay efficiency, and home discharge in 979 stroke rehabilitation patients at a long-term acute care rehabilitation hospital. We found a strong relationship of increasing age to poorer outcome in all measures for patients with admission FIM (AFIM) score <40, a variable relationship in those with AFIM 40-80, and no relationship of age to the outcome measures in patients with AFIM >80.
Top Stroke Rehabil 2004
PMID:Age and functional outcome after stroke. 1511 64

Transparency with regard to measuring devices is one of the fundamental requirements for progress in science. The ability to derive comparable measures from different measuring devices is the cornerstone of transparency. To this end, progress in measuring and understanding rehabilitation outcomes requires that there is a method of measuring outcomes that is independent of the particular collection of items that is used to assess the outcomes. The purpose of this study is to develop a equivalence between the PECS Motor Skills and Cognition and Communication LifeScales with the FIM Motor Skills and Cognitive items. However, only the results of the Motor Skills Scale are reported here in the interest of brevity. This equating is based on approximately 500 simultaneous evaluations using bout the PECS and FIM scales on admission and discharge. The patients in this study were consecutive admissions to a free-standing rehabilitation hospital in early 1998. Patients from five diagnostic groups were included in this study, Brain Injury, Spinal Cord Injury, Stroke, Neuromuscular, and Musculoskeletal. The results indicate that it is possible to construct a common equal interval translation between the PECS and FIM for the two scales. Measures on the common metric can be based to either scale and are independent of the number of items completed. This use of these anchored scales will allow institutions using either the PECS and FIM to make direct comparisons of clinical outcomes with other institutions, independent of the particular outcome tool used to evaluate patients.
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PMID:Equating rehabilitation outcome scales: developing common metrics. 1524 71

We investigated whether L-threodops (L-DOPS), a norepinephrine precursor, improves rehabilitation outcome in patients with initial hemiparetic supratentorial ischemic stroke (2 months post stroke). Five patients who agreed to be treated with L-DOPS received 45-minute physical therapy (PT) and occupational therapy (OT) for 2 months, 3 days a week, with an oral dose of 200 mg L-DOPS 2 hours before each session, followed by PT and OT without L-DOPS for 2 months (DOPS group). Eight patients who disagreed received PT and OT for 4 months (control). Each group demonstrated comparable age, sex, complications, Mini-Mental State Examination, and the baseline Functional Independence Measure (FIM, DOPS/control = 36/42), Fugl-Meyer (F-M) motor scale (30/27), and ambulation endurance (10/9 meters). DOPS group had significantly greater gain than control (p < 0.05, Mann-Whitney U test) in FIM score at 4 (51/45) and 6 months (57/49), ambulation at 4 (66/16) and 6 months (82/24), and F-M score at 4 months (40/29). There were no side effects that required discontinuation of the drug. These results suggest that L-DOPS treatment paired with PT and OT may be effective in improving functional outcome in stroke.
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PMID:A pilot study of the effect of L-threodops on rehabilitation outcome of stroke patients. 1547 Aug 25

Although a short leg brace (SLB) is mainly used for stroke rehabilitation, we should also remember the value of a long leg brace (LLB). The indications for LLB are discussed. For example, a LLB provides stability for the knee. The LLB can be used in any situation that creates instability for the knee. The practice of a 155-bed medium-sized rehabilitation hospital in Japan is investigated regarding stroke rehabilitation and the LLB from October 2001 to October 2003. The LLB was prescribed to 12 patients. If the patients made good progress, the LLB was converted to an SLB. The period of conversion from LLB to SLB shows the improvement of the conditions. Patients were divided into three groups according to the period of the conversion: less than 14 days, more than 15 days, and no conversion. Comparing the FIM points, there are more points for patients whose brace is converted in less than 14 days but there is a greater improvement in FIM points when the brace is converted in more than 14 days. It is advised that the patients who have the worse conditions should have the LLB earlier because then these patients can concentrate on their rehabilitation program and are not disturbed by the conversion of the brace.
Top Stroke Rehabil 2004
PMID:Stroke rehabilitation and long leg brace. 1548 Sep 48


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