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This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

International Classification of Functioning, Disability and Health for Children and Youth extends the list of categories of classification supplementing it with childhood-specific categories. These categories are targeted for child growth and development. The biggest addition of components is in Activities and Participation domains. Complexity of classification causes a problem in adaptation of classification in practice of clinical settings especially in child rehabilitation settings. For the practical application of the classification is drawn up sets of classification categories to assess the functioning of child with specific needs. The literature describes attempts of the practical application of the classification. Widespread measures of functioning are linking with categories of classification. Team members are training to apply the classification in daily practice. New questionnaires based on the classification are composed. It is recommended to focus on the child activities and participation but not only on body functions or structures. The article shows that the implementation of classification in children rehabilitation facility requires structural and organizational changes.

OBJECTIVE Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.

IntroductionSyringe aspiration for manual aspiration thrombectomy (MAT) is a cost- and time-efficient alternative to an aspiration pump with likely similar efficacy. It is counterintuitive to expect the pump to perform better than direct vacuum with a syringe, as the pump must deliver vacuum additionally through a canister and meters of tubing.ObjectiveTo present in vitro and clinical results of MAT with a syringe.MethodsAn in vitro analysis was performed comparing vacuum pressures generated by syringe aspiration and with pump aspiration. This was then complemented with prospective clinical data providing details of angiographic and clinical outcomes for syringe MAT.ResultsThe in vitro analysis demonstrated that equal to slightly greater vacuum pressures were generated by a 60 cc syringe as compared with the pump in both static and partial flow conditions. In our clinical series, 106/113 acute stroke thrombectomies over a 6-month period were performed with syringe MAT on the first pass. Syringe usage instead of pump tubing and a canister led to a total savings of $58 300. The rate of Thrombolysis in Cerebral Infarction 2b/3 recanalization was 93%. Adjunctive stentriever usage was performed in 23% of cases. Median puncture to reperfusion time was 25 min; mean change in National Institute of Health Stroke Scale score at 24 hours was an improvement of 5.1 (median 6). The in-hospital mortality rate was 10%. Seventy percent of patients were discharged to home (modified Rankin Scale (mRS) score 0–2) or a rehabilitation facility (mRS score 2–4).ConclusionMAT using a syringe is a safe, fast, and more cost-effective approach than using an aspiration pump.

Reports of iatrogenic cold thermal injuries are rare in the literature. Conductive cooling devices, typically employed for their neuroprotective effects, use conductive hydrogel pads to achieve rapid and precise temperature control approaching the level of water immersion. Despite a number of built-in safeguards, prolonged or improper use of these devices can lead to significant thermal injury. To the best of their knowledge, the authors describe the first report of a significant iatrogenic full-thickness injury caused by the use of a surface cooling system in a patient who had recently suffered a cerebrovascular accident. The patient required transfer to the authors' tertiary burn care facility for excisional debridement and coverage with extensive split-thickness skin grafting to the chest, flank, and thighs. The grafts achieved nearly complete take and the patient was ultimately discharged to a rehabilitation facility with improving neurological condition.

The aim of this paper was to explore the effect of seasonal temperature differences and cold indoor environment in winter on the physical performance of older people living in the community based on a field study. We recruited 162 home-dwelling older people from a rehabilitation facility in the Osaka prefecture, Japan; physical performance data were available from 98/162 (60.5%). At the same time, for some participants, a questionnaire survey and a measurement of the indoor temperature of individual houses were conducted. The analysis showed that there were seasonal trends in the physical performance of older people and that physical performance was worse in the winter compared with the autumn. Furthermore, people living in colder houses had worse physical performance. The findings indicate that keeping the house warm in the winter can help to maintain physical performance.

The aim of this study was to analyse the changes in psychological stress and identify its basal predictors among elderly stroke survivors after 6 months following discharge from hospital to home directly, rather than to a rehabilitation facility. The sample comprised 50 elderly stroke survivors. Data were collected at 2 weeks (T1), at 3 months (T2), and at 6 months (T3) after hospital discharge. The following instruments were applied: Perceived Stress Scale-10 items (PSS-10), National Institute of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale-15 items. Study records indicated that the age of the study participants ranged from 60 to 87 years old (mean = 70.3; standard deviation = 7.6). The number of male and female participants was similar. The PSS-10 score decreased almost 6 points between T1 (mean = 15.1) and T3 (mean = 9.7; p

Background: In the recent decades, the relationship between psycho-physical disorders and weather conditions has taken on an increased scientific solidity. Furthermore, it is known to every clinician that healthcare practice has an important role in the management of psycho-physical disorders of patients affected by multiple sclerosis. Given that meteorosensitivity is related to the psycho-physical feebleness, this study is an attempt to clarify if treatments in a non-acute care rehabilitation centre can reduce the meteorosensitivity in patients with multiple sclerosis. Methods: In the spring 2014, 42 patients with MS, at Fondazione Don Gnocchi Santa Maria Nascente Centre (Milan, Italy), were observed by two evaluations (initial and final). The initial evaluation was the administration of METEO-Q, a questionnaire able to quantify the meteorosensitivity degree of the subjects, and Beck Depression Inventory-II, mainly. For each patient, passed one month, the final evaluation was carried out with the same modalities. Results: A statistically significant difference was found between initial and final meteorosensitivity degree (P=0.01), with better scores in final evaluations for most of the subjects. The correlation between Beck Depression Inventory-II and meteorosensitivity degree resulted significant and positive (R=0.377; P=0.001) and it confirms the link between psycho-physical feebleness and meteorosensitivity. Finally, no significant correlation emerged between initial meteorosensitivity degree and body mass index (R=0.187; P=0.236). Conclusions: This study confirms the possibility of improving meteorosensitivity, probably by rehabilitation too. Future studies could clarify the effects of health care practice on meteorosensitivity.

Purpose. To report a case of internuclear ophthalmoplegia (INO) caused by cocaine.Method. We report a case of a 54-year-old female who presented with a left INO three days after snorting cocaine, and we review the literature.Results. MRI of the brain demonstrated several small abnormal foci in the pons on FLAIR and diffusion weighted imaging consistent with ischemic infarction. The patient’s symptoms remained stable throughout her hospitalization. She was sent to a rehabilitation facility and was lost to follow-up.Conclusion. In cases of extraocular movement abnormalities, it is important to inquire about recreational drug use.

Maternal addiction is a significant factor behind the endogenous and the exogenous problems in children. This study extends the works of Cicchetti and Rizley (1981) by providing developmental parameters to classify, categorize and identify common and salient problems of children of addicted mothers (COAM). An archival method was used to review files (36 files, 69 participants, male=39 and female=30) from a residential drug rehabilitation facility. Files were reviewed in terms of children’s health and psychological problems and the purpose of the study was to discover how maternal addiction negatively influences children in relation to specific drugs; and to determine the severity and the nature of those problems in terms of how maternal addiction translates to particular problems in children. Results showed that common endogenous problems ranged from biological to psychological problems, with cognitive deficits and emotional wellbeing being salient problems. In terms of exogenous problems, unstable home environments, neglect and abuse were salient. A novel finding of this study was the occurrence of enuresis and encopresis for children, up to the age of 17. Implications of the study are discussed.

This piece is an adaptation from my book, After a Fall: A Sociomedical Sojourn. It is an autoethnographic account of my first two days in a rehabilitation facility following ankle surgery. It introduces how class, gender, race, ethnicity, and aging intersect each other in the facility.

Background. Lateropulsion, a postural control disorder, delays recovery following hemispheric stroke. The number of stroke impairments may lead to differential recovery rates, depending on the intact systems available for recovery from lateropulsion. Objective. To study the impact of key postural control deficits on lateropulsion rate of recovery following stroke. Methods. Through retrospective analysis: 169 patients with hemispheric stroke in an in-patient rehabilitation facility were divided into 3 groups: (1) motor deficits only; (2) motor and hemianopic or visual–spatial deficits or motor and proprioceptive deficits; and (3) motor, proprioceptive, and hemianopic or visual–spatial deficits. Kaplan–Meier survival analysis determined if time to recovery from lateropulsion (achieving a score of 0 or 1 on the Burke Lateropulsion Scale) differed by group. Results. Log rank tests showed that time to recovery from lateropulsion differed based on the number of deficits (group, P = .012). Post hoc analyses by lesion side showed that group differences only occurred in right brain lesion ( P < .05) as compared with left brain lesions ( P = .34). Patients recovered from lateropulsion during in-patient rehabilitation if they had only motor deficits; those with all 3 postural control deficits showed the most protracted recovery. Conclusions. Rate of recovery from lateropulsion after stroke is dependent on the side of lesion, and number of key motor, proprioceptive, and/or hemianopic or visual–spatial deficits. The more postural control systems affected, the slower the recovery. Our data identify patients likely to need protracted rehabilitation targeting key postural control deficits.

Recent studies have shown that isolated traumatic subarachnoid hemorrhage (tSAH) in the setting of a high Glasgow Coma Scale (GCS) score (13-15) is a relatively less severe finding not likely to require operative neurosurgical intervention. This study sought to provide a more comprehensive assessment of isolated tSAH among patients with any GCS score, and to expand the analysis to examine the potential need for aggressive medical, endovascular, or open surgical interventions in these patients. By undertaking a retrospective review of all patients admitted to our trauma center from 2003-2012, we identified 661 patients with isolated tSAH. Only four patients (0.61%) underwent any sort of aggressive neurosurgical, medical, or endovascular intervention, regardless of GCS score. Most tSAH patients without additional systemic injury were discharged home (68%), including 53% of patients with a GCS score of 3-8. However, older patients were more likely to be discharged to a rehabilitation facility (p0.01). There were six (1.7%) in-hospital deaths, and five patients of these patients were older than 80 years old. We conclude that isolated tSAH, regardless of admission GCS score, is a less severe intracranial injury that is highly unlikely to require aggressive operative, medical, or endovascular intervention, and is unlikely to be associated with major neurologic morbidity or mortality, except perhaps in elderly patients. Based upon our findings, we argue that impaired consciousness in the setting of isolated tSAH should strongly compel a consideration of non-traumatic factors in the etiology of the altered neurological status.

For one year, I led a mother-baby group at a residential drug rehabilitation facility. All of the mothers had suffered extreme childhood relational trauma, had lost their older children to foster care, and were now agreeing to residential treatment in hope that they could retain custody of their babies. The mothers were very wary of me when we first started. They saw no value in meeting and sharing their thoughts and feelings. Over time they grew to appreciate the group. This article tracks the process that they, their babies and I went through to co-create a meaningful therapeutic experience.

This study aimed to elucidate the stepwise progression of robotic skills required, the natural progression from thoracoscopic to robotic technique with a focus on approaching the hilar structures, and the nuances of perioperative care, in a community hospital and solo surgeon practice. It was a case-control analysis comparing 22 consecutive robotic-assisted lobectomy (RAL) procedures with 22 matched historic video-assisted lobectomy (VAL) procedures from June 2011 to December 2012. Patients undergoing VAL had 1.09 days greater length of stay than did patients who underwent RAL. Although hospital charges were significantly higher for RAL patients, patients undergoing VAL had greater blood loss, required longer hospital stay, had greater readmission rates, and were transferred more often to a rehabilitation facility at discharge. Subjectively, dexterity, ergonomics, and optics with the RALs were superior to the VALs. Favorable outcomes were demonstrated for patients undergoing RALs. Effective communication is paramount for the skill set and team building for a safe transition to practice.

Society is recognized that stroke is a life- threatening condition.Although the death rate from stroke decreases cerebrovasculardisease remains one of the major causes of death and disabilityreasons in many European Union countries, and the high incidencerate of stroke and serious consequences is one of the most importantmedical problems of today . The aim was to evaluate patients afterstroke functional status change in the rehabilitation process. 112stroke patients in treatment and rehabilitation facility in patientswith an average age of 46 years old. Of these, 53.6 per cent. werewomen. Patients were subject to complex rehabilitation treatment,which patients worked full rehabilitation team. Data analysis wasused to case history data. Patients‘ health status was assessed on twopatients on arrival and departure from the medical establishment. Their cognitive function was assessed using a standardized briefmental state examination (MMSE) and the independence of theirdaily lives was assessed in a standardized Functional IndependenceMeasure (FIM). The data were processed using SPSS softwarepackages and STATSTICA . Statistical analysis of data showed that the patients‘ functional status after stroke other positive changes asrehabilitation and improvement of cognitive , self-care and dailyfunctions. General cognitive status of patients differed significantlyin the course of rehabilitation received strong positive relationship,it shows the ratio p (0.85), which indicate a strong positiverelationship. The analysis of the overall condition of subjectsdepending on the type of stroke, it was found that patients withischemic stroke general cognitive status was better than before therehabilitation of patients with hemorrhagic stroke. Recovering, theyalso achieved better results , their data is statistically significantlydifferent (p< 0.05). Overall the condition of independence in dailylife as well as a statistically significant difference in the course ofrehabilitation , and the correlation coefficient p (0.93) showed a verystrong positive relationship. Our results showed improvements inpatients after stroke and cognitive and self-care functions changeduring the course of inpatient rehabilitation. It was also found thatthe improvement in cognitive function and improving self-carein daily life. This shows the correlation coefficient p (0.54). Theanalysis of patients with stroke rehabilitation efficiency dependingon demographic characteristics , they found that patients‘ functionalstatus significantly improved dynamics depending on the typeof stroke . It was also found that patients felt better living in thecity than in rural areas , although these data are not statisticallysignificant . The analysis of functional status changes depending onthe sex , it was found that the general condition was better for menthan for women. As well as their rehabilitation was more successfulthan women , although these data were not significantly different

On May 5, 2011, 23 short-finned pilot whales, Globicephala macrorhynchus, were stranded along the coastline near Cudjoe Key, FL. Five animals (two adult females, two juvenile females, and an adult male) were transported to a rehabilitation facility in Key Largo, FL. Auditory evoked potentials (AEPs) were recorded in response to amplitude modulated tone pips modulated at 1000 Hz. AEP thresholds were determined at 10, 20, 40, 80, and 120 kHz for the four females. However, the adult male was euthanized prior to testing. Short-finned pilot whales had peak sensitivity at lower frequencies than other odontocetes such as bottlenose dolphins. Greatest sensitivity was around 40 kHz for all whales, while thresholds for the two adult females were 25-61 dB higher at 80 kHz than the juveniles. Click evoked potentials were similar between the four whales and comparable to other echolocating odontocetes. Click evoked potential data from a fifth short-finned pilot whale that had stranded in Curacao showed no response. These findings add to the limited database of pilot whale (short- and long-finned) hearing studies, of which there are only two others [Schlundt et al. (2011). J. Acoust. Soc. Am. 129, 1111-1116 and Pacini et al. (2010). J. Exp. Biol. 213, 3138-3143].

This study is a secondary analysis of the Outcome and Assessment Information Set (OASIS) and administrative billing records of 6,153 adults ≥ 65 years old who received home health (HH) from a not-for-profit HH agency in upstate New York in CY 2017. We evaluated the association between the use of home health services (HH) with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer’s disease and related dementia (ADRD). Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, or rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of each discipline, including skilled nursing (SN), physical therapy (PT), occupational therapy (OT), social work (SW), and home health aide (HA), separately. ADRD was identified by diagnosis (ICD-10 codes) and cognitive impairment (M1700, M1710, M1740 [OASIS]). In multivariable Cox Proportional hazard models that adjusted for time-varying effects of HH intensity, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n=1,525), and decreases of 56% and 90% respectively among patients without ADRD (n=4,628). This is the first study in the United States showing that receiving a sufficient amount and appropriate mix of HH services was associated with substantially reduced risk of unplanned facility admission among patients with ADRD by up to 86%.

Introduction Stem cell transplant (SCT) is associated with deconditioning and variable need for assistance in instrumental activities of daily living at discharge. Discharge to a rehabilitation facility (RF, [e.g.: skilled nursing (SNF) or inpatient rehabilitation facility (IRF)]) is preferentially avoided due to immunocompromised state and lack of post-transplant expertise. Despite this risk, there are no published reports of poor patient outcomes in SCT recipients discharged to RF. We hypothesized that patients discharged to RF following SCT would experience increased non-relapse mortality (NRM) and decreased overall survival (OS) compared to those discharged to home. Methods A retrospective, matched case-control study was conducted using a case-control ratio of 1:4. The study period included 2007-2017 and cases included patients discharged to SNF or IRF following initial hospital admission for SCT. Controls were matched by autologous or allogeneic source and date of transplant. Pre- and during transplant risk factors for RF discharge were explored. NRM and OS were described via Kaplan-Meier method and compared by log-rank test. Results Over the 10 year period, 2245 transplants were performed with 56 cases identified (3% incidence; 2% allogeneic, 3% autologous). Increasing age, decreasing albumin, female sex, reduced-intensity conditioning regimen, and high risk hematopoietic cell transplant comorbidity index (HCT-CI) score were associated with increased risk of RF discharge (table 1). During transplant, culture-positive or serologically confirmed infection (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.36 – 4.69, p=0.0027) and new or worsening arrhythmia (OR: 2.93, 95% CI: 1.39 – 6.16, p=0.0058) were associated with increased risk of RF discharge. One-year OS and NRM were better for home compared to RF discharged patients (OS: 88.8% [95% CI: 83.6-92.4%] v. 70.5% [95% CI: 55.8% - 81.1%], p = 0.0055; NRM: 4.9% [95% CI: 2.6% - 8.9%] v. 14.6% [95% CI: 7.2% - 28.4%], p = 0.0237). OS for allogeneic RF discharges was 82.4% at 100 days (95% CI: 54.7% - 92.9%) and 38.8% at 1 year (95% CI: 16.3% - 61.1%). OS and NRM are shown in Figures 1 and 2. Discussion We have demonstrated greater odds of all-cause and non-relapse mortality associated with RF compared to home discharge. Early OS for autologous RF discharges is similar to allogeneic home discharges. The risk of RF discharge may be reduced by mitigating pre-transplant factors including nutritional status and HCT-CI. In cancer care, pre-habilitation is any intervention prior to cancer-directed therapy designed to increase tolerability. Our identification of pre-transplant risk factors for RF discharge warrants further prospective study of pre-habilitation, especially as it relates to nutritional status. Exploring the role of caregiver status for female gender transplant recipients requires further exploration.

The World Health Organization Atlas reveals lower bed and mental health professionals ratio per population in India. This may be due to a poor allocation of funding in the mental health sector by the Government. This resulted in a lack of complete and comprehensive care ranging from acute treatment to long-term rehabilitation throughout the country. The spiral of specialist care needs such as deaddiction, child psychiatric needs, and rehabilitation facility are available only to a handful of the population in metropolitan cities in India. The launching or establishment of new Mental Health Establishments (MHEs) and upgrading mental health service may provide strategies to bridge this gap from the private mental health sector. Following the inception of "Mental Healthcare Act 2017" (MHCA 2017), the process of setting up MHEs and their operations comes with new legal and healthcare aspects that remain debatable and unsettled. We put forth the basic measures that can be considered and undertaken to establish an exemplary MHE under the MHCA 2017.

The following is an unusual case of a patient with hypotension and electrocardiographic changes who required air medical transport. A change in diagnosis occurred after the initial presentation. Without a short pause to further analyze patient information, this patient may have suffered serious harm. Patient Presentation An 80-year-old woman presented by ambulance to a local emergency department with chest pain and hypotension after a fall from the toilet at a rehabilitation facility. She had been admitted to the rehabilitation facility 4 weeks earlier to regain strength after surgical repair of a fractured left femur and closed reduction of a left humerus fracture sustained from a

Upper-limb lymphedema (ULL) occurs in 15-20% of women after breast-cancer treatment. Its intensive therapy relies on complete (complex) decongestive physiotherapy (CDP), whose duration is not well-established.Determine optimal intensive-phase CDP duration for lymphedema-volume reduction and factors predicting its success, with the hope of halving it from 11 to 4 days.All patients with ULL (08/2011-06/2012) after breast-cancer treatment referred to our Department of Lymphology in a rehabilitation facility for 11 days of CDP were eligible. Lymphedema volume was calculated using the truncated-cone formula. Volume reduction considered clinically relevant after 4 days was defined as ≥ 75% of the total reduction obtained after 11 days.We included 129 women (median age: 64 (range: 42-88) years). Mean (sd) lymphedema volume was 907 (558) ml at CDP onset, decreased to 712 (428) ml after 4 days (vs. onset, P.0001) and 606 (341) ml after 11 days (vs. 4, P.0001), corresponding to 33% total lymphedema-volume reduction. For all patients, 4 days of CDP achieved 63% (sd 40%) of that total reduction, with ≥ 75% for 50 (39%) patients. Surgery-to-lymphedema-onset interval2 years was the only factor significantly associated with 4 days achieving ≥ 75% of the total lymphedema-volume reduction.Intensive phase CDP for 11 days obtained significantly more volume reduction of breast cancer-related ULL than 4.

Objectives: To evaluate long-term morbidity, mortality, and quality of life (QoL) after pancreaticoduodenectomy (PD) in elderly adults. Design: Retrospective cohort study. Setting: Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. Participants: One hundred and sixty-eight individuals aged 70 and older who underwent PD between 1995 and 2010. Measurements: A prospective pancreatic surgery database was analyzed for postoperative morbidity; mortality; intensive care unit (ICU), hospital, and rehabilitation facility stay; and readmissions after surgery. QoL was assessed using a validated questionnaire completed 3, 6, and 12 months after surgery. Results: Seventy-two percent of the participants had an American Society of Anesthesiologists score of 3 or greater. There was no intraoperative death. Thirty- and 60-day postoperative mortality rates were 5.9% and 6.5%, respectively. Median ICU stay was 2 days, and median hospital stay was 22 days. Sixty-four participants (37.5%) were discharged to a rehabilitation facility. The first-year readmission rate was 31%. One- and 2-year overall survival rates were 58% and 36%, respectively. Global QoL scores 3 and 12 months after surgery were 68% and 73%, respectively. Scores were lower yet comparable with those of matched individuals undergoing laparoscopic cholecystectomy. Conclusion: Most elderly adults with pancreatic cancer survive longer than 1 year after PD; 36% survive longer than 2 years. These individuals are likely to have acceptable long-term morbidity and overall good QoL, corresponding with their age.

We report a case of 66 years old man with sever osteoarthritis (OA) in both knees with severe varus deformity. Patient was treated with bilateral total knee arthroplasty (TKA) simultaneously with wedge augmentation of medial tibial plateau depression of both knees to restore the weight bearing axis of lower limbs. Although the recent trend and countless studies indicates the effectiveness of unilateral TKA and not to address both knees at the same time, this patient was operated same day keeping in mind the challenging surgery of primary bilateral TKA using revision armamentum, and all the possible complications of a lengthy surgery, but the rational was to provide rehabilitation simultaneously to both knees and to maximize the functional outcome of the surgery. Patient was functionally scored prior and post-surgery using international knee score. We report excellent outcome of the procedure using the full potential of a rehabilitation facility.

Objective—To document venous blood gas, acid-base, and plasma biochemical values for stranded juvenile loggerhead turtles at admission to a rehabilitation facility, compare these values among stranding causes, investigate differences in these values for turtles that survived versus those that died, and establish the baseline values for successfully rehabilitated loggerhead turtles (Caretta caretta). Design—Retrospective case series. Animals—66 stranded juvenile loggerhead turtles that were hospitalized between 2008 and 2009. Procedures—Venous blood gas, acid-base, and plasma biochemical values at the time of admission were compared retrospectively among turtles with different stranding causes. Initial results were compared between turtles that survived and turtles that died. Results for survivors were compared between the time of admission and time of release. Results—57 (86.36%) turtles had various types of acid-base disorders at the time of admission to the rehabilitation facility. Of these, 33 (579%) had mixed acid-base disorders and 24 (42.1%) had primary acid-base disorders. All acid-base disorders were classified as mild to moderate, except 1 case of severe metabolic and respiratory acidosis. Except for the debilitated turtles (in which the mean initial glucose concentration was much lower than that observed for the rest of turtles), there was no difference in initial values when comparing stranding causes. Turtles that died during rehabilitation had significantly higher initial anion gap and osmolality, compared with turtles that survived. Conclusions and Clinical Relevance—Acid-base disorders were present in most stranded juvenile loggerhead turtles. Evaluation of accurately obtained, temperature-corrected venous blood gas, acid-base, and plasma biochemical values can provide important clinical and prognostic information and a valuable basis for the implementation of adequate and rapid treatment for stranded loggerhead turtles admitted to rehabilitation facilities.

Rehabilitation of marine turtles in Queensland has multifaceted objectives. It treats individual animals, serves to educate the public, and contributes to conservation. We examined the outcome from rehabilitation, time in rehabilitation, and subsequent recapture and restranding rates of stranded marine turtles between 1996 and 2013 to determine if the benefits associated with this practice are cost-effective as a conservation tool. Of 13,854 marine turtles reported as stranded during this 18-year period, 5,022 of these turtles were stranded alive with the remainder verified as dead or of unknown condition. A total of 2,970 (59%) of these live strandings were transported to a rehabilitation facility. Overall, 1,173/2,970 (39%) turtles were released over 18 years, 101 of which were recaptured: 77 reported as restrandings (20 dead, 13 alive subsequently died, 11 alive subsequently euthanized, 33 alive) and 24 recaptured during normal marine turtle population monitoring or fishing activities. Of the turtles admitted to rehabilitation exhibiting signs of disease, 88% of them died, either unassisted or by euthanasia and 66% of turtles admitted for unknown causes of stranding died either unassisted or by euthanasia. All turtles recorded as having a buoyancy disorder with no other presenting problem or disorder recorded, were released alive. In Queensland, rehabilitation costs approximately $1,000 per animal per year admitted to a center, $2,583 per animal per year released, and $123,750 per animal per year for marine turtles which are presumably successfully returned to the functional population. This practice may not be economically viable in its present configuration, but may be more cost effective as a mobile response unit. Further there is certainly benefit giving individual turtles a chance at survival and educating the public in the perils facing marine turtles. As well, rehabilitation can provide insight into the diseases and environmental stressors causing stranding, arming researchers with information to mitigate negative impacts.

The aim of our study was to determine independent predictors of discharge disposition to rehabilitation or skilled care (SC) facilities and investigate whether discharge location is associated with unplanned readmission and/or reoperation rates. All elective spinal surgery patients in a national surgical registry were analyzed using between 2011 and 2012. Multivariable logistic regression analysis was used to assess for predictors of discharge to rehabilitation or SC facilities versus home as well as to determine whether discharge disposition was significantly associated with the 30-day unplanned readmission or reoperation. Of 34,023 elective spinal surgery patients, the distribution of discharge locations was as follows: 30,606 (90.0%) discharged home, 1674 (4.9%) discharged to rehabilitation, and 1743 (5.1%) discharged to SC. Patients discharged home were associated with the lowest complication rate relative to rehabilitation and SC facilities. Following multivariable regression analysis, there was a significant increase in the odds of discharge to rehabilitation associated with age, male gender, current smoking, ASA class three and four, history of diabetes, operative time, total hospital length of stay, preoperative neurologic morbidity and having at least one postoperative morbidity event. Moreover, there were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. After risk adjustment, discharge to rehabilitation was independently associated with decreased odds of 30-day unplanned readmission (OR=0.41; p=0.008) but not reoperation.

Although postoperative readmissions are frequent in vascular surgery patients, the reasons for these readmissions are not well characterized, and effective approaches to their reduction are unknown. Our aim was to analyze the reasons for vascular surgery readmissions and to report potential areas for focused efforts aimed at readmission reduction.The 2012 to 2013 American College of Surgeons National Quality Improvement Program (ACS NSQIP) data set was queried for vascular surgery patients. Multivariable models were developed to analyze risk factors for postdischarge infections, the major drivers of unplanned 30-day readmissions.We identified 86,403 vascular surgery patients for analysis. Thirty-day readmission occurred in 8827 (10%), of which 8054 (91%) were unplanned. Of the unplanned readmissions, 61% (n = 4951) were related to the index vascular surgery procedure. Infectious complications were the most common reason for a surgery-related readmission (1940 [39%]), with surgical site infection being the most common type of infection related to unplanned readmission. Multivariable analysis showed the top five preoperative risk factors for postdischarge infections were the presence of a preoperative open wound, inpatient operation, obesity, work relative value unit, and insulin-dependent diabetes (but not diabetes managed with oral medications). Cigarette smoking was a weak predictor and came in tenth in the mode (overall C index, 0.657). When operative and postoperative factors were included in the model, total operative time was the strongest predictor of postdischarge infectious complications (odds ratio [OR] 1.2 for each 1-hour increase in operative time), followed by presence of a preoperative open wound (OR, 1.5), inpatient operation (OR, 2), obesity (OR, 1.8), and discharge to rehabilitation facility (OR, 1.7; P .001 for all). Insulin-dependent diabetes, cigarette smoking, dialysis dependence, and female gender were also predictive, albeit with smaller effects (OR, 1.1-1.3 for all; P .001). The overall fit of the multivariable model was fair (C statistic, 0.686).Infectious complications dominate the reasons for unplanned 30-day readmissions in vascular surgery patients. We have identified preoperative, operative, and postoperative risk factors for these infections with the goal of reducing these complications and thus readmissions. Expected patient risk factors, such as diabetes, obesity, renal insufficiency, and cigarette smoking, were less important in predicting infectious complications compared with operative time, presence of a preoperative open wound, and inpatient operation. Our findings suggest that careful operative planning and expeditious operations may be the most effective approaches to reducing infections and thus readmissions in vascular surgery patients.

To explore the perceived needs, obstacles to services, psychological distress and social problem-solving abilities of family members of persons with ABI at a post-acute community-based brain injury rehabilitation facility and offer suggestions for methods of assessment and providing support.Twenty-nine family members who did not provide daily care, but were involved in the care process.Participants completed self-report questionnaires including the FNQ:R, SOS, DASS-21, WHO-QOL BREF and SPSI:R-S.Participants reported informational and professional needs as most met and involvement in care, instrumental support and emotional support as most unmet. Most were satisfied with the amount of professional help and services and had confidence in the quality of care. Nearly half of the family members felt there were few ABI-related resources in the community and one third were unaware of good ABI treatment resources in their community. Psychosocial functioning was generally average.Family members who do not provide daily care are still impacted by the neurobehavioural changes that progress throughout the long-term, post-acute community phase. This study offers suggestions regarding an effective methodology for assessing family needs and recommends accessible and practical supports.

Anliegen: Die exzessive Nutzung des Internets wird als substanzungebundene Form einer Abhangigkeitserkrankung diskutiert. Laut Pravalenzschatzungen ist 1 % der deutschen Bevolkerung betroffen. Ungeklart ist, inwieweit Internetsucht komorbid unter Patienten der stationaren Suchtrehabilitation auftritt. Methode: In 15 Kliniken wurden alle innerhalb eines halben Jahres aufgenommenen Patienten auf das Vorliegen von Internetsucht gescreent. Ergebnisse: 4,2 % der Patienten erfullten die Kriterien. Diese waren haufiger mannlich mit den Primardiagnosen Cannabisabhangigkeit und pathologisches Glucksspiel. Schlussfolgerungen: Dies verdeutlicht den Bedarf an entsprechenden Routinescreenings innerhalb von Reha-Kliniken.

This article documents a cross-sectional survey of 135 males between the ages of 12 and 17.5 years, who were exposed to militancy, in Swat, Pakistan. The data were collated from Sabaoon, a rehabilitation facility. The results reveal the mean age of the males to be15.5 years. Fifty-two per cent of the sample was in the middle birth order. Fifty-two per cent came from low socioeconomic status (i.e.

To investigate the effects of whole-body vibration in addition to an exercise programme on functional mobility and related outcomes for frail older fallers.Single-blind randomized parallel group trial.UK; National Health Service assessment and rehabilitation facility for older people.Frail older fallers: 38 (80 ± 8.6 years) performed the exercise with whole-body vibration (vibration group), and 39 (82 ± 8.1 years) without (exercise group).Sixty minutes supervised exercise class three times weekly for eight weeks ± whole-body vibration (up to 5 × 1 minute, 15-30 Hz and 2-8 mm peak-to-peak).Timed Up and Go, 6-m walk, static balance, fear of falling (FES-I) and self-reported health status (SF-12 version 2) were assessed at baseline, four weeks (mobility measures only), eight weeks and six months.Timed Up and Go and 6-m walk improved in both groups at eight weeks (P0.01), but significantly more in the vibration group (timed up and go: 38 vs. 20%, P0.05); 6-m walk: (36 vs. 18.1%, P0.05, respectively). Balance, fear of falling and physical component of the self-reported health status improved similarly in both groups (P0.05). At follow-up, no significant differences from baseline remained for any measure. The mean total time experienced was 37% of maximal target.The addition of whole-body vibration to strength and balance exercise resulted in greater improvements in functional mobility than exercise alone, despite achieving lower than anticipated exposure. Gains from neither intervention were sustained at six months.

Evidence has suggested that oral health may be linked with general health, and oral care potentially decrease pneumonia in frail elderly. However, it remains uncertain whether oral care by dental professionals is superior to that by non-professionals in terms of improvement in general health in elderly patients. In 2009, Japanese long-term care insurance system introduced additional reimbursement for oral care by dental professionals in geriatric rehabilitation facilities. This system innovation prompted us to conduct a quasi-experimental study using a nationwide database of long-term care to analyze the impact of oral care by dental professionals on the outcomes (incidence of critical illness, hospitalization, or mortality; discharge to home; and costs) among elderly patients in geriatric rehabilitation facilities. We identified in 294,541 patients in 1168 facilities that provided oral care by dental professionals, and 329,678 patients in 1523 facilities that did not provide oral care by dental professionals from 2008 to 2012. In difference-in-difference analyses, no significant difference was shown in the incidence of critical illness, hospitalization, mortality, or costs between patients with and without oral care by dental professionals. Significant increases in the proportions of discharge to home were observed in patients with oral care by dental professionals, being 0.16% (95% confidence interval, 0.02% to 0.30%) at 1 year, 0.26% (0.05% to 0.48%) at 2 years and 0.37% (0.10% to 0.65%) at 3 years. The results suggest that oral care by dental professionals may improve general condition of elderly patients in geriatric rehabilitation facilities and promote their discharge to home.

Objective: The High-level Mobility Assessment Tool (HiMAT) was developed to measure high-level mobility limitations following traumatic brain injury. The aim of this study was to investigate if the revised HiMAT is valid for use with adults with neurological conditions other than traumatic brain injury. Design: Cross-sectional study. Subjects: Ninety-five participants with neurological conditions. Methods: HiMAT score sheets were retrieved from the central medical files of people who had attended a major rehabilitation facility for a neurological condition from January 2006 to October 2007. Additional HiMAT score sheets were submitted by therapists who participated in the HiMAT User’s Group. Rasch analysis (RUMM2030 software) was used to determine the overall fit of the model, individual item fit and differential item functioning. Results: Rasch analysis supported the internal validity of the revised eight-item HiMAT for individuals with neurological conditions. It showed good overall fit ( P = 0.74), no misfitting items and excellent internal consistency (Person Separation Index = 0.91). The HiMAT is unidimensional with no evidence of response dependency and no differential item functioning for age or sex. Conclusion: Further development of the revised HiMAT is required to investigate other aspects of validity, reliability and responsiveness in different neurological populations. However, the results support the internal validity of the revised HiMAT when used for people with neurological conditions who are able to walk without gait aids.

To be considered for release, raptors undergoing rehabilitation must have recovered from their initial injury in addition to being clinically healthy. For that purpose, a good understanding of reference hematologic values is important in determining release criteria for raptors in a rehabilitation setting. In this study, retrospective data were tabulated from clinically normal birds within 10 days of release from a rehabilitation facility. Hematologic values were compiled from 71 red-tailed hawks (Buteo jamaicensis), 54 Eastern screech owls (Megascops asio), 31 Cooper's hawks (Accipiter cooperii), 30 great-horned owls (Bubo virginianus), 28 barred owls (Strix varia), 16 bald eagles (Haliaeetus leucocephalus), and 12 broad-winged hawks (Buteo platypterus). Parameters collected included a white blood cell count and differential, hematocrit, and total protein concentration. Comparisons were made among species and among previously published reports of reference hematologic values in free-ranging birds or permanently captive birds. This is the first published report of reference values for Eastern screech owls, barred owls, and broad-winged hawks; and the first prerelease reference values for all species undergoing rehabilitation. These data can be used as a reference when developing release criteria for rehabilitated raptors.

The aim of this study was to compare people with and without dementia with regards to their levels of functioning prior to fractured neck of femur (NOF), nursing care needs, and length of hospitalisation and discharge destination. Data were extracted from the medical records of 50 patients with fractured NOF and dementia and 50 patients with a fractured NOF who did not have dementia. Patients with dementia were more likely to have been admitted from a residential aged care facility, were more impaired prior to admission, and had more care needs relating to agitation, confusion, eating and drinking, intravenous cannulae, showering and dressing, and incontinence. People with dementia spent two more days in acute care and were less likely to be discharged to a rehabilitation facility. The placement of patients with dementia in dedicated areas of orthopaedic wards, where nurses with specialised skills are able to care for them, and use of practice guidelines are possible solutions to address the current inequity in care.

Objective: To describe a protocol for the examination of free-living raptors and report the ophthalmic examination findings of seven raptor species native to central Illinois, namely the barred owl, Cooper’s hawk, eastern screech owl, great horned owl, American kestrel, red-tailed hawk, and turkey vulture and to determine if the findings relative to visual prognosis affected eligibility for future release. Animals studied: Seventy-nine free-living raptors. Procedures: Under manual restraint, complete ophthalmic examination including slit-lamp biomicroscopy and indirect funduscopy, applanation tonometry, rebound tonometry, ocular morphometrics, B-mode ultrasound, and electroretinography (ERG) were performed on each bird. Histopathology of enucleated globes was performed after euthanasia or death in selected cases. Results: The examination protocol was easily performed using manual restraint alone on all birds. Ocular lesions were detected in 48.1% of birds, with 47.3% affected unilaterally and 52.6% affected bilaterally. Ocular lesions were considered to be vision threatening in 29.0% of the unilaterally affected birds and 29.0% of the bilaterally affected birds. The most common case outcomes were discharge from hospital to rehabilitation facility (45.6%) followed by euthanasia (43.0%). The presence of an ocular lesion or a vision-threatening ocular lesion was not significantly associated with outcome. Reference ranges are reported for B-mode ultrasound, ocular morphometrics, and horizontal corneal diameter in all species. Conclusion: Complete ophthalmic examination can be supplemented by the use of ocular morphometrics, ultrasound, and ERG in the manually restrained raptor. These advanced diagnostic techniques may be useful in developing more objective criteria for evaluating eligibility for release following rehabilitation of free-living birds of prey.

Objectives To describe the iterative process of emergency planning and preparedness: risk assessment, planning, rehearsal, implementation, and refinement. Design A narrative reflection of two complete facility evacuations in advance of major hurricanes in 2005 (hurricane Rita) and 2008 (hurricane Ike) conducted by a postacute rehabilitation facility located on the Texas gulf coast. Participants Facility staff involved in the evacuation and ongoing care post evacuation, and adults with moderate to severe acquired brain injury receiving residential postacute rehabilitation and long-term care services. Results Experiences from two evacuations revealed that planning and preparation beyond what is required by licensing and accrediting agencies is necessary; attending to the needs of staff during and after and the emergency is a critical component of planning and preparedness; and the necessity of incorporating "lessons learned" into refinement of emergency preparedness plans. Conclusions Facilities providing residential services to persons with neurological injury are potentially vulnerable to a number of natural and manmade disasters. Careful planning, preparation, and practice are necessary to ensure safe evacuation of persons served and facility personnel in response to an emergency. Experiences (i.e., "lessons learned") from each evacuation, subsequent changes to emergency preparedness plans, and recommendations for emergency preparedness beyond a natural disaster, such as a hurricane, are presented.

A number of patients in a rehabilitation setting were being transferred to acute-care facilities with a diagnosis of congestive heart failure (CHF). A transfer penalty was charged to the rehabilitation facility based on each patient's length of stay. A multidisciplinary team was assembled with physician support to address the problem. The team's goal was to develop a CHF protocol with guidelines that would allow for more frequent nursing assessments and reporting to physicians. The protocol interventions were initiated consistently and monitored on each shift. These interventions allowed for more timely assessment and treatment of patients with signs and symptoms of CHF. As a result, the number of patients being transferred to acute-care hospitals has decreased, allowing patients to complete their rehabilitation process without interruption. The decreased number of patients being transferred to the acute-care setting has resulted in fewer transfer penalties for the rehabilitation facility.

The index case lived in the D rehabilitation facility in Gyeongsan-si and an additional epidemiological investigation was carried out there. The cases could not be questioned due to their mental handicaps. The teachers were interviewed instead. A patient case was defined as a resident with diarrhea more than one time a day from September 18 to September 26, 2008 or a resident with confirmed

The intent of this research was to explore the influence of physical activity on the appetite of older adults in long-term care. Given the impact of the anorexia of aging and the increasing numbers of older adults, this could have significant health implications. Residents (N = 93) of a long-term care, assisted living, and rehabilitation facility were surveyed using the "Appetite & Activity Questionnaire." There was no relationship found between physical activity and appetite regardless of the participants' sex or age. BMI appeared to correlate well with the amount of activity that was performed. The most salient finding was the near absence of physical activity, even in the presence of facilities, support personnel, and available time.