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Objective. The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed "Up & Go" test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury. Methods. This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 ([+ or -]4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0-3), 41 were community walkers with aids (ie, SCIM III score 4-6), and 75 were independent community walkers (ie, SCIM III score 7-8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed. Results. At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0-3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed "Up & Go," 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers. Conclusion. The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient's confidence in performing activities plays an important part in achieving walking ability in the community. Impact. The discharge SWAT is useful to optimize discharge planning. Keywords: Ambulation, Functional Outcome, Prediction, Rehabilitation, SCIM III, Spinal Cord Injury, Standing and Walking Assessment Tool, Introduction Validated outcome measures allow rehabilitation professionals to evaluate an individual's functional ability, plan treatment, and set appropriate rehabilitation goals. (1,2) They enable clinicians to objectively monitor progress and assess [...]

Common assessment tools for determining therapeutic success in rehabilitation typically focus on task--based outcomes. Task--based outcomes provide some understanding of the individual's functional ability and motor recovery; however, these clinical outcomes may have limited translation to a patient's functional ability in the real world. Limitations arise because (1) the focus on task--based outcome assessment often disregards the complexity of motor behavior, including motor variability, and (2) mobility in highly variable real-world environments requires movement adaptability that is made possible by motor variability. This Perspective argues that incorporating motor variability measures that reflect movement adaptability into routine clinical assessment would enable therapists to better evaluate progress toward optimal and safe real-world mobility. The challenges and opportunities associated with incorporating variability--based assessment of pathological movements are also discussed. This Perspective also indicates that the field of rehabilitation needs to leverage technology to advance the understanding of motor variability and its impact on an individual's ability to optimize movement. Impact. This Perspective contends that traditional therapeutic assessments do not adequately evaluate the ability of individuals to adapt their movements to the challenges faced when negotiating the dynamic environments encountered during daily life. Assessment of motor variability derived during movement execution can address this issue and provide better insight into a patient's movement stability and maneuverability in the real world. Creating such a shift in motor system assessment would advance understanding of rehabilitative approaches to motor system recovery and intervention. Keywords: Adaptability, Capacity Testing, Coordination, Motor Variability, Movement Assessment, Introduction Physical therapists are responsible for evaluating a patient's movement system to determine recovery potential, progress, and need for continued skilled rehabilitation. (1) Optimizing movement requires a focus on functional [...]

2024 FEB 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Research findings on mechanical engineering are discussed in a new report. According [...]

2024 FEB 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Research findings on spinal stenosis are discussed in a new report. According [...]

2024 FEB 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Research findings on cryotherapy are discussed in a new report. According to [...]

2024 FEB 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Cerebrovascular Diseases and Conditions - Stroke. According [...]

2024 FEB 10 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on gene therapy have been published. According to news [...]

Objective. The primary objective of this observational study was to analyze the time to the first edge-of-bed (EOB) mobilization in adults who were critically ill with severe versus non-severe COVID-19 pneumonia. Secondary objectives included the description of early rehabilitation interventions and physical therapy delivery. Methods. All adults with laboratory-confirmed COVID-19 requiring intensive care unit admission for [greater than or equal to]72 hours were included and divided according to their lowest Pa[O.sub.2]/Fi[O.sub.2] ratio into severe ([less than or equal to]100 mmHg) or non-severe (>100 mmHg) COVID-19 pneumonia. Early rehabilitation interventions consisted of in-bed activities, EOB or out-of-bed mobilizations, standing, and walking. The Kaplan-Meier estimate and logistic regression were used to investigate the primary outcome time-to-EOB and factors associated with delayed mobilization. Results. Among the 168 patients included in the study (mean age = 63 y [SD = 12 y]; Sequential Organ Failure Assessment = 11 [interquartile range = 9-14]), 77 (46%) were classified as non-severe, and 91 (54%) were classified as severe COVID-19 pneumonia. Median time-to-EOB was 3.9 days (95% CI = 2.3-5.5) with significant differences between subgroups (non-severe = 2.5 days [95% CI = 1.8-3.5]; severe = 7.2 days [95% CI = 5.7-8.8]). Extracorporeal membrane oxygenation use and high Sequential Organ Failure Assessment scores (adjusted effect = 13.7 days [95% CI = 10.1-17.4] and 0.3 days [95% CI = 0.1-0.6]) were significantly associated with delayed EOB mobilization. Physical therapy started within a median of 1.0 days (95% CI = 0.9-1.2) without subgroup differences. Conclusion. This study shows that early rehabilitation and physical therapy within the recommended 72 hours during the COVID-19 pandemic could be maintained regardless of disease severity. In this cohort, the median time-to-EOB was fewer than 4 days, with disease severity and advanced organ support significantly delaying the time-to-EOB. Impact. Early rehabilitation in the intensive care unit could be sustained in adults who are critically ill with COVID-19 pneumonia and can be implemented with existing protocols. Screening based on the Pa[O.sub.2]/Fi[O.sub.2] ratio might reveal patients at risk and increased need for physical therapy. Keywords: COVID-19, Critical Illness, Early Ambulation, Early Mobilization, Muscle Weakness, Physical Therapy Specialty, Physiotherapy, Rehabilitation, Introduction The coronavirus disease of 2019 (COVID-19) pandemic inflicted a substantial burden on health care systems around the world. Switzerland experienced a large second pandemic wave during the winter 2020-2021 [...]

Optimizing rehabilitation outcomes, including preventing pathology and its progression, relies on a comprehensive knowledge of the condition's etiology. Put simply, physical therapists cannot optimally prevent or treat what they do [...]

2023 MAY 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on heart failure is the subject of a new report. [...]

Pulmonary rehabilitation (PR) is an evidence-based intervention to manage symptoms related to chronic obstructive respiratory diseases (CORD). Paradoxically, few people with CORD actually engage in PR, and of those, up to one-third do not complete the program. Additionally, some of those who complete the program do not achieve worthwhile benefits. Therefore, the main challenge for the next decades is to offer PR to as many people (that would potentially benefit from it) as possible. This raises questions about factors influencing participation, completion, and responsiveness to PR programs. Among these factors, urinary incontinence (UI) is highly prevalent among people with CORD (much more than in the general population) and may worsen during PR exercise sessions. Paradoxically, UI is poorly explored in routine and scarcely assessed in research, and none of the actual guidelines about PR mention it. However, its potential influence on engagement, completion, and response to PR is of real concern. Therefore, the aim of this perspective is to describe the mechanisms of UI, particularly in the context of CORD, as well as to highlight its prevalence among people with CORD, their burden, and how it could affect a PR approach based on sustained and regular physical activity. Keywords: Chronic Obstructive Pulmonary Disease, Pulmonary Rehabilitation, Urinary Incontinence, Exercise, Introduction Chronic obstructive respiratory disease (CORD) is a group of health conditions associated with a high level of disease burden. (1) Progressive physical inactivity is common with CORD, and it [...]

Novel coronavirus disease 2019 (COVID-19) is a pandemic comparable with human immunodeficiency virus (HIV) in many ways. It is an infection with no known vaccine or cure and no licensed [...]

Objective. Although Medicare assessment files will include Standardized Patient Assessment Data Elements from 2016 forward, lack of uniformity of functional data prior to 2016 impedes longitudinal research. The purpose of this study was to create crosswalks for postacute care assessment measures and the basic mobility and daily activities scales of the Activity Measure for Post-Acute Care (AM-PAC) and to test their accuracy and validity in development and validation datasets. Methods. This cross-sectional study is a secondary analysis of AM-PAC, the Inpatient Rehabilitation Facility Patient Assessment Instrument, the Minimum Data Set, and the Outcome and Assessment Information Set data from 300 adults receiving rehabilitation recruited from 6 health care networks in 1 metropolitan area. Rasch analysis was used to co-calibrate items from the 3 measures onto the AM-PAC metric and to create lookup tables to create estimated AM-PAC (eAM-PAC) scores. Mean scores and correlation and agreement between actual and estimated scores were examined in the development dataset. Scores were estimated in a cohort of Medicare beneficiaries with hip, humerus and radius fractures. Correlations between eAM-PAC and Functional Independence Measure motor scores were examined. Differences in mean eAM-PAC scores were evaluated across groups of known differences (age, fracture type, dementia). Results. Strong correlations were found between actual and eAM-PAC scores in the development dataset. Moderate to strong correlations were found between the eAM-PAC basic mobility and Functional Independence Measure motor scores in the validation dataset. Differences in basic mobility scores across known groups were statistically significant and appeared to be clinically important. Differences between mean daily activities scores were statistically significant but appeared not to be clinically important. Conclusion. Although further testing is warranted, the basic mobility crosswalk appears to provide valid scores for aggregate analysis of Medicare postacute care data. Impact. This study reports on a method to take data from different Medicare administrative data sources and estimate scores on 1 scale. This approach was applied separately for data related to basic mobility and to daily activities. This may allow researchers to overcome challenges with using Medicare administrative data from different sources., Postacute care is an important area of health services research, accounting for a substantial proportion of Medicare spending. (1) Questions about comparative effectiveness, dosage, timing and sequencing of alternative treatments, [...]

For nearly 50 years, the Delancey Street Foundation has offered an alternative to prison. But does the celebrated program really work The headquarters of the Delancey Street Foundation occupies a [...]

2022 MAR 5 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Aging Research - Geriatrics and Gerontology have been [...]

Background. Physical activity remains low and nearly unchanged from preoperative levels following total knee arthroplasty (TKA), and diis is thought to underlie long-term functional limitations, secondary health problems, and higher [...]

Background and Purpose. Pompe disease is an inherited disorder notable for severe progressive ventilatory compromise. Although ventilatory failure has been attributed to myofiber dysfunction secondary to diaphragmatic glycogen accumulation, neural involvement of the phrenic motor system is also a prominent feature. Direct diaphragm pacing supplements respiratory function in other disorders of the phrenic motor system. Accordingly, it is hypothesized that augmented neuromuscular activity via diaphragm pacing would promote weaning from mechanical ventilation in patients with Pompe disease who are unresponsive to conventional, muscle-directed treatments. Case Description. Three patients with Pompe disease developed diaphragm paresis that resulted in chronic mechanical ventilation dependence. After preoperative inspiratory muscle strengthening exercises failed to improve function, fine-wire pacing electrodes were laparoscopically implanted into the diaphragm. Diaphragm conditioning was initiated the first postoperative week and consisted of gradual increases in stimulation parameters, lengthening of stimulation sessions, and ventilator weaning. Ventilation and intramuscular electromyographic activity were recorded periodically during conditioning to quantify diaphragm neuromuscular function. Outcomes. During paced breathing without mechanical ventilation, tidal volumes increased, and 2 patients were weaned from daytime ventilator dependence within the first 3 months of pacing, which has been sustained over the long-term. A third patient reduced reliance on daytime ventilation, but weaning was delayed by malacia of the large airways. In all patients, pacing appeared to facilitate spontaneous phrenic motor unit activity during independent breathing without ventilator or pacer support. Discussion. The findings are consistent with the view that diaphragm pacing has potential rehabilitative value to reduce reliance on mechanical ventilation in people with Pompe disease but further study is needed. Diaphragm pacing represents a paradigm shift in the management of respiratory insufficiency for Pompe disease that warrants further controlled examination., Pompe disease is an inherited neuromuscular disorder characterized by a deficiency or absence of acid α-glucosidase (GAA), resulting in glycogen aggregations in various tissues, including striated muscle and neural tissue. [...]

'The best antidotes to addiction are joy and competence--joy as the capacity to take pleasure in the people, activities, and things that are available to us; competence as the ability [...]

Background. Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. Purpose. The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. Data Sources. Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. Study Selection. Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. Data Extraction. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Data Synthesis. Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. Limitations. Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. Conclusions. The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported., Clinicians are faced with using the current best evidence to make decisions for individual clients and to demonstrate their treatments improve clinical outcomes. (1) Knowledge translation (KT) is an active [...]

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion., The knowledge-to-practice gap in rehabilitation has spurred the development of knowledge translation (KT) initiatives aimed at changing clinician behaviors and improving patient care. (1,2) Knowledge translation is defined as 'a [...]

ABSTRACT Background: There is a paucity of studies, which have described malnutrition in patients with acquired brain injury (ABI) across etiology. This study describes weight change, malnutrition, and potential associations [...]

Background. Aerobic activity positively affects patients recovering from stroke and is part of best practice guidelines, yet this evidence has not been translated to routine practice. Objective. The objective of this study was to evaluate the feasibility of a model of care that integrated aerobic training in an inpatient rehabilitation setting for patients in the subacute stage of stroke recovery. Key elements of the program were personalized training prescription based on submaximal test results and supervision within a group setting. Design. This was a prospective cohort study. Methods. Participants (N=78) completed submaximal exercise testing prior to enrollment, and the test results were used by their treating physical therapists for exercise prescription. Feasibility was evaluated using enrollment, class attendance, adherence to prescription, and participant perceptions. Results. Overall, 31 patients (40%) were referred to and completed the exercise program. Cardiac comorbidities were the main reason for nonreferral to the fitness group. Program attendance was 77%; scheduling conflicts were the primary barrier to participation. The majority of participants (63%) achieved 20 minutes of continuous exercise by the end of the program. No adverse events were reported, all participants felt they benefited from the program, and 80% of the participants expressed interest in continuing to exercise regularly after discharge. Limitations. Cardiac comorbidities prevented enrollment in the program for 27% of the admitted patients, and strategies for inclusion in exercise programs in this population should be explored. Conclusions. This individualized exercise program within a group delivery model was feasible; however, ensuring adequate aerobic targets were met was a challenge, and future work should focus on how best to include individuals with cardiac comorbidities., The majority of individuals recovering from a stroke are left with residual disability or activity limitations, which lead to a lower quality of life. (1,2) Many of these limitations are [...]

Background. Individuals with stroke are at increased risk for falls soon after hospital discharge. The ability to react to a balance perturbation, specifically with a rapid step, is critical to maintain balance and prevent falls. Objective. The purpose of the study was to determine the prevalence of impaired reactive stepping responses in an ambulatory group of patients with stroke who were preparing for discharge from inpatient rehabilitation and the relationship to patient performance on commonly used clinical measures of balance, mobility, and lower limb impairment. Design. This study was a retrospective analysis of patient admissions over a 3-year period. Methods. Charts were reviewed for patients who, at time of discharge, had completed a perturbation-evoked reactive stepping assessment. Results. Ninety-nine (71%) of 139 patients had impaired stepping reactions characterized by the need for assistance, an inability to step with either lower limb, or the need for multiple-step responses. There was a statistically significant difference in clinical scores between those with and without impaired stepping, but groups were characterized by considerable variation in clinical profiles. For example, Berg Balance Scale scores ranged from 25 to 55 versus 20 to 56 and gait speeds ranged from 0.17 to 1.43 versus 0.26 to 1.55 m/s for patients who demonstrated a failed step versus a successful step, respectively. Limitations. Not all patients who attended stroke rehabilitation received a reactive stepping assessment at discharge. Conclusions. Impaired reactive stepping is a prevalent problem for ambulatory patients with stroke preparing for discharge, possibly increasing their risk of falling when faced with the challenges of community ambulation. Specific tests that target the capacity to perform perturbation-evoked stepping reactions may be important to identify those at risk for falls and to direct appropriate intervention strategies., The risk of falls for survivors of stroke is high, (1,2) with significant physical (3) and psychosocial (4) consequences that contribute to decreased independence, activity, and participation. (5) Falls are [...]

Background. People with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak, and little is known about the effect on functional outcomes and long-term effects. Objective. The purpose of this study was to assess immediate and long-term effects of RIMT in people with SCI. Design. This was a single-blinded randomized controlled trial. Setting. The study was conducted at 4 specialized SCI units in the Netherlands. Patients. The study participants were 40 people with SCI (15 with motor complete tetraplegia, 16 with incomplete tetraplegia, 8 with motor complete paraplegia, and 1 with incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation. Intervention. Study participants were randomized to an RIMT group or a control group. All participants received usual rehabilitation care. In addition, participants in the intervention group performed RIMT with a threshold trainer. Measurements. Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and 1 year after discharge from inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health-related quality of life, limitations in daily life due to respiratory problems, and respiratory complications. Results. During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT group than in the control group (11.7 cm [H.sub.2]O, 95% confidence interval=4.3 to 19 0). At follow-up, this effect was no longer significant. No effect on other primary or secondary outcome measures was found except for an immediate effect on mental health. Limitations. The sample size was insufficient to study effects on respiratory complications. Conclusions. Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation., In most people with acute spinal cord injury (SCI), respiratory function is seriously impaired. Even though partial recovery takes place during the first year after onset, many people continue to [...]

Background. Botulinum toxin A (BoNT-A) injections are increasingly used to treat muscle spasticity and are often complemented by adjunctive rehabilitation therapies; however, little is known about the effect of therapy after injection. Purpose. The aim of this study was to identify and summarize evidence on rehabilitation therapies used after BoNT-A injections to improve motor function in adults with neurological impairments. Data Sources. Searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, National Research Register, metaRegistry of Controlled Trials, PEDro, and OTseeker. Study Selection. Randomized and quasi-randomized controlled trials were considered for inclusion. Participants with neurological impairments received BoNT-A to treat focal spasticity in limbs, with rehabilitation interventions provided to experimental groups only. Primary outcome measures were joint mobility, function of the affected limb, and spasticity. Eleven studies with 234 participants, most of whom had stroke, were included in the review. Data Extraction. Two reviewers extracted study details and data. Data Synthesis. Methodological quality was rated using the PEDro scale. Both fixed-effects and random-effects models were used to calculate effect size. Results. Studies were of variable quality: 3 were poor (PEDro score 1 to 4), and 8 were moderate (PEDro score 6 to 7). No study investigated effects for longer than 24 weeks (6 months). Included trials presented 9 therapy types, including ergometer cycling, electrical stimulation, stretch (casting, splinting, taping, or manual or exercise-induced stretch), constraint-induced movement therapy, task-specific motor training, and exercise programs. Statistical findings suggest that combined therapy and BoNT-A is slightly more effective than BoNT-A alone. Conclusion. Evidence relating to impact of adjunct therapy is available, but the heterogeneity of studies limits the opportunity to demonstrate overall impact. Researchers need to consider the benefits of greater consistency in study approaches and measures so that meaningful evaluations of overall adjunct therapy effects can be made., Spasticity is a common impairment after central nervous system damage. It was defined by Lance in 1980 as 'a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes [...]

Polytrauma in veterans has increased because improvements in medicine and technology have led to improved survival rates for individuals injured in armed conflicts. Medical-surgical nurses caring for today's veterans are faced with new patient needs. Rehabilitation using a multidimensional approach seems to be most effective in helping patients with polytrauma., Thanks to the advancement of medicine, veterans in armed conflicts who may not have survived previously are returning home. When they come home, they are faced with long rehabilitation processes [...]

Dosing of pediatric rehabilitation services for children with cerebral palsy (CP) has been identified as a national priority. Establishing dosing parameters for pediatric physical therapy interventions is critical for informing clinical decision making, health policy, and guidelines for reimbursement. The purpose of this perspective article is to describe a path model for evaluating dosing parameters of interventions for children with CP. The model is intended for dose-related and effectiveness studies of pediatric physical therapy interventions. The premise of the model is: Intervention type (focus on body structures, activity, or the environment) acts on a child first through the family, then through the dose (frequency, intensity, time), to yield structural and behavioral changes. As a result, these changes are linked to improvements in functional independence. Community factors affect dose as well as functional independence (performance and capacity), influencing the relationships between type of intervention and intervention responses. The constructs of family characteristics; child characteristics (eg, age, level of severity, comorbidities, readiness to change, preferences); plastic changes in bone, muscle, and brain; motor skill acquisition; and community access warrant consideration from researchers who are designing intervention studies. Multiple knowledge gaps are identified, and a framework is provided for conceptualizing dosing parameters for children with CP., The purpose of this perspective article is to describe a path model for evaluating the dosing of interventions for children with cerebral palsy (CP) that may inform clinical effectiveness research. [...]

Background. Standardized assessment of patients' activity limitations in acute care settings can provide valuable information. Existing measures have not been widely implemented. Objectives. The aim of this study was to provide evidence for validity of scores on Activity Measure for Post-Acute Care (AM-PAC) '6-Clicks' measures of basic mobility and daily activity in acute care. Design. A retrospective measurement study was conducted. Methods. The study used a database from one health system containing '6-Clicks' scores from first and last physical therapist and occupational therapist visits for 84,446 patients. Validity was analyzed by examining differences in '6-Clicks' scores across categories of patient characteristics; the ability of '6-Clicks' scores to predict patients' having more than one therapy visit; correlation of '6-Clicks' scores with Functional Independence Measure (FIM) scores; and internal responsiveness over the episode of care. Internal consistency reliability also was determined. Results. The '6-Clicks' scores differed across patients' age, preadmission living situation, and number of therapy visits. The areas under receiver operating characteristic curves derived using '6-Clicks' scores at the first visit to predict patients receiving more than one visit were 0.703 and 0.652 using basic mobility and daily activity scores, respectively. The '6-Clicks' scores at the final visit were correlated with scores on subscales of the FIM completed on admission to inpatient rehabilitation facilities (r=.65 and .69). Standardized response means were 1.06 and 0.95 and minimal detectable changes with 90% confidence level ([MDC.sub.90]) were 4.72 and 5.49 for basic mobility and daily activity scores, respectively. Internal consistency reliability of basic mobility and daily activity scores was .96 and .91, respectively. Limitations. Using clinical databases for research purposes has limitations, including missing data, misclassifications, and selection bias. Rater reliability is not known. Conclusions. This study provides evidence for the validity of '6-Clicks' scores for assessing patients' activity limitations in acute care settings., In the acute care setting, the case mix index of hospitals provides a means to measure the medical complexity and burden of illness for the patients they serve and the [...]

Clients who undergo audiologic rehabilitation get more from their hearing aids and improve their overall hearing. But to take advantage, clinics need to find the AR model that works best [...]