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The World Health Organization model of disablement was applied to patients 2 years after admission to rehabilitation centres. Various established measures were also applied. This study confirmed the usefulness of the concept of impairment, disability and handicap, as well as the applicability of the scoring methods in predicting rehabilitation outcome.

An on-stream method for describing patients' functional abilities is used to develop analyses of medical rehabilitation outcomes. Outcomes are the changes in status between admission, discharge and follow-up. Standardized observation and reporting make it possible to compare one date with another, one case with another or one agency or facility with another to determine program characteristics, effectiveness and efficiency.

The period after hospital discharge is the most critical for rehabilitation patients returning to a community setting. A friendly visitor surveillance program using nonprofessional volunteers was designed to monitor treatment regimen compliance by alerting medical professionals of impending crises among discharged rehabilitation patients. A randomized experimental design was used to evaluate the impact of 1 year of program exposure on rehospitalization, service use, and psychosocial outcomes experienced by 142 patients. Patients were randomized into 3 groups: friendly visitors (FV) and biannual nursing visits; biannual nursing (RN) visits only; and controls (CON). Over 1/3 of the sample was rehospitalized at least once during the 1-year impact period, yet no differences were found across experimental groups nor patients' diagnostic category. No meaningful pattern of significant differences between the groups was observed at the p less than 0.1 probability level in any of the other outcome areas. The need to alert the medical system of impending patient problems occurred rarely, suggesting that existing informal support systems and regular use of medical services may be sufficient to monitor rehabilitation patients' progress.

Occupational exposure to ethylene oxide (ETO) was manifested as a subacute polyneuropathy, with bilateral footdrop and denervation potentials on electromyography as the principal abnormalities in three young adults whom we examined. To our knowledge, this is the second report of neurotoxic effects caused by long-term ETO exposure in humans and brings the number of patients described with symptomatic polyneuropathy to five.

Part I of this series described the background of the study; the characteristics of the patient population; and their functional status before onset of stroke, at rehabilitation admission, at discharge, and at six months after discharge. Results at follow-up showed that patients with higher Barthel index scores living in the community were more likely to be satisfied with life in general, to have more person-to-person contacts, and to be more active in community affairs. Part II describes the utility of two sets of data derived from the admission Barthel index (combinations of independent performance of four basic items of the index vs the total score) in predicting the likely range of Barthel index scores at discharge and functional outcomes at six-month follow-up.

This is a concluding report of a study in which only patients with Bell's palsy initially seen within ten days of onset are included. The purposes are to observe the natural course of the disorder and to illustrate electromyographic EMG) criteria by which early forecast of recovery is possible. Appraisals of facila muscle strength, nerve stimulation responses and electromyographic needle electrode examinations correlated with the time required for recovery and the relative degree of recovery of patients with Bell's palsy. Three categories of recovery are evident. Of 90 patients, 79% recovered completely within two months (class I), 7% recovered adequately within two to six months (class II) and 14% required longer than six months (class III). Using clinical and electromyographic methods it should be possible to forecast recovery within three days after onset in order to preselect patients in need of any proposed curative treatment program designed to salvage the facial nerve. For prognosis in patients without clinically detectable facial muscle function, the data suggest that they be evaluated on a daily basis from onset until day 4 (past 72 hours). Finding that residual motor unit potentials are sustained in four to five muscles during that period strongly indicates a favorable outcome. Finding activity in two to three muscles could be less favorable and finding zero to one muscle with activity is clearly unfavorable. During this period of time there is a tendency for progressive loss of EMG activity in the facial muscles, both in patients with favorable and with less favorable outcomes.

A retrospective comparison was made of characteristics of stroke patients admitted to 3 distinct areas of the Union-Truesdale Hospital (renamed Charlton Memorial Hospital) in Fall River, MA. The Union Division has the option for admission to an acute care stroke unit or to the medical/surgical units. The Truesdale Division is separated by 1 mile and contains medical/surgical units. The Union Division also has a rehabilitation unit for post-acute care. The 2 divisions were separate corporations with generally separate medical staffs until a merger was effected in October, 1975. Using Professional Activity Studies (PAS) reports, a cohort of 418 patients discharged between October 1, 1975, and September 30, 1976, was developed. According to ICDA-8 coding, the 3 areas of the hospital had different profiles of patients. Outcomes in terms of types of discharges were also different between 4 categories of stroke pathology. Of 57 patients referred for rehabilitation, 43 had abrupt onset with persisting focal deficit (ICDA-8 codes 433/434/436), and 14 had less clear onset with diffuse neurologic loss (ICDA-8 codes 437/438). Of the patients referred for rehabilitation, 75% were returned home after an average of 16 acute hospital days and 23 rehabilitation hospital days. This study is on a small scale and may seem to have only local relevance, but the following estimates seem to offer a reasonable probability for planning rehabilitation facilities: approximately 25% of discharges with ICDA-8 codes of 433, 434, and 436; approximately 10% of discharges with ICDA-8 codes of 437 and 438; and approximately 2% of other stroke diagnoses. Average daily hospital charges were significantly less for patients cared for in the stroke unit.