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Post-injury confusional state is a common phenomenon following acquired brain injury. A multi-faceted approach for decreasing confusion is recommended, but there is a paucity of research related to non-pharmacological management. The main objective was to present a conceptual model of multi-faceted approaches for confusion, and secondly to investigate the rehabilitation outcome following these approaches. The setting is a specialized ward for rehabilitation of patients with severe cognitive difficulties following acquired brain injury. The conceptual model encompasses neurobehavioral strategies, pharmacological treatment, engagement in meaningful occupations, next of kin involvement, organizational demands, the physical environment, along with differential diagnostics. Patient cases are provided to illustrate the impact of each approach. A total of 141 of 281 patients were in a confusional state at admission. At discharge, 62% had emerged from the confusional state. Patients in a confusional state due to traumatic brain injury and subarachnoid hemorrhage had clinically important differences of >22 points in the functional independence measure from admission to discharge, following rehabilitation efforts based on the conceptual model. No clinically important difference was seen in patients with non-SAH stroke and patients with other types of brain injuries. The proposed conceptual model should be further evaluated in complex intervention studies. [ABSTRACT FROM AUTHOR]

The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM. A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM. Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor. The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with transfemoral amputation walking with a locked prosthetic knee joint (LPKJ) have compromised degree of freedom in leg movement compared with walking with an unlocked prosthetic knee joint (UPKJ), thus presenting a risk for compensatory gait strategies, with risk of lower back pain. The objective was to compare gait strategies in individuals with transfemoral amputation walking with an LPKJ and a UPKJ. Materials and Methods: This was a crossover trial. Nine individuals with transfemoral amputation habitually walking with a UPKJ completed an intervention of 1 to 2 weeks of walking with a UPKJ followed by 1 to 2 weeks of walking with an LPKJ. Gait strategies were analyzed after each intervention using three-dimensional gait analysis. The outcome was pelvic and lumbar spinal movement from terminal stance to initial swing in the sagittal and transversal plane. Results: The maximum anterior tilt of the pelvis in the sagittal plane and the pelvic rotation shifted from preswing to initial swing in the gait cycle when walking with an LPKJ compared with the UPKJ. Conclusions: A compensatory gait strategy was observed among individuals with transfemoral amputation walking with an LPKJ compared with a UPKJ. Studies should investigate the incidence of low back pain in individuals with transfemoral amputation walking with LPKJ compared with those walking with UPKJ. [ABSTRACT FROM AUTHOR]

Objectives: To do a systematic review covering assessments and interventions for central facial palsy (CFP) in patients with acquired brain injury. Methods: PubMed, Embase, Cinahl, PsycInfo, and Web of Science were screened until April 2019. Assessments were defined as clinical- and instrumental tools and rating scales. Interventions were defined as rehabilitation interventions alleviating CFP. Results: 690 articles were screened based on the title and abstract. Interrater agreement was 98.12%. Sixteen articles were included: six clinical trials and 10 observational studies. Assessment: Commonest scale for assessing CFP was the House-Brackmann facial nerve Grading System. Strain gauges for measuring lip and cheek strength were applied in five studies and neurophysiological methods of assessing motor neuron pathways were applied in three studies. Interventions: An oral screen for improving lip strength was reported in three studies. Other interventions reported were neuromuscular electrical stimulation, Castillo Morales therapy, mirror therapy, exercises with electromyography feedback, and acupuncture. Conclusions: Scales for assessing peripheral facial palsy were applied for assessing CFP. Based on neurophysiological differences in the manifestation of peripheral facial palsy and CFP, these scales should be validated in patients with CFP. More studies on interventions for CFP are required before conclusions may be drawn about their effectiveness. [ABSTRACT FROM AUTHOR]

To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD). Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN). Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five. There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted. Assessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information. Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable. Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments. Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD. [ABSTRACT FROM AUTHOR]

Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (≥10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80–2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33–1.96 and adjusted odds ratio 1.02; 95% CI 0.83–1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred. [ABSTRACT FROM AUTHOR]