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The purpose of this study was to determine functional independence measure (FIM) gains based on clinical factors after rehabilitation for cerebrovascular diseases, and to determine how FIM scores and FIM gains can predict rehabilitation outcomes. Of the 181 patients in the study 161 suffered strokes (cerebral infarction 107, cerebral hemorrhage 41, subarachnoid hemorrhage 12, subdural hematoma 1). There were also 12 traumatic brain injuries, and 8 other miscellaneous cases. Dementia, higher brain dysfunction, etiology, sex, age, history of cerebrovascular diseases, location involvement, disability severity, duration of hospitalization and period from onset to rehabilitation were analyzed using FIM. FIM gains decreased in relation to an increase in age. Patients with intermediate disability (FIM 41-80) on admission showed significantly higher FIM-total gain on discharge than others. Factors influencing FIM gain were revealed to be age, duration of hospitalization, FIM gain 4 weeks after admission, etiology, disability severity, dementia and past history of cerebrovascular diseases. Multiple regression analysis determined that significant factors to contribute FIM gain were duration of hospitalization, FIM gain at 4 weeks after admission, age, and disability severity. FIM scores and FIM gains could predict rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Background: The Barthel Index is considered the global gold standard for assessing performance in activities of daily living (ADL) tasks, but there has been little research undertaken on this outcome measure for a stroke population in a low to middle income country. The study aimed to determine the content validity of the modified Barthel Index (MBI) for assessing the ADL of stroke patients in an African country. Method: A mixed methods design using the nominal group technique was utilised. The study sample consisted of occupational therapists (n=11) and physiotherapists (n=4) with four or more years' experience working in the field of adult neurorehabilitation in South Africa. Each of the four focus groups analysed the content validity of the MBI using five questions based on the Table of Specifications methodology. Data analysis followed van Breda's steps to analysing multi-group nominal group technique to establish themes arising from each question and were presented according to final rank scores. Results: The findings highlighted aspects of content validity of the MBI related to language, clarity, content completeness and appropriateness that require revision. Conclusion: This study provides recommendations for the revision of the MBI to improve its content validity for the South African stroke population. IMPLICATIONS FOR PRACTICE * Methodology can be replicated in other multi-cultural and language countries * Training on administration of the MBI can overcome barriers related to language and item clarity where English is a healthcare worker's second language * The MBI is currently most suited to environments with water and sanitation infrastructure * A future study implementing recommendations for revision of the MBI for the African stroke populations is suggested [ABSTRACT FROM AUTHOR]

The purpose of this study is to determined characteristics of FIM gain after rehabilitation for patients with disuse syndrome and what factors are beneficial for increasing FIM gain. The subjects were 168 patients (87 males and 81 females). We investigated the relationship between the degree of FIM gain and etiology, age, sex, gender, history of cerebrovascular disease, dementia, body weight, body mass index(BMI), hemoglobin, protein, albumin, prognostic nutritional index, malnutrition, and dysphagia. The primary etiologies that resulted in disuse syndrome were COVID-19, respiratory disease, gastrointestinal disease, urinary disease, cardiovascular disease, and others. The average FIM-total gain by age decreased as age in-creased. FIM-total gain was 8.0 for patients in their 90s. FIM-total gain was 13.8 for patients with no past incident of cerebrovascular diseases, 7.6 for one past incident, and 4.0 for two or more past incidents. FIM-total gain of the patients of severe dysphagia was significantly lower than that of the patients of normophagia / mild or moderate dysphagia. There was a mild correlation between FIM-total gain and gain of body weight (r=0.21) and between FIM-total gain and gain of BMI (r=0.21). Patients with disuse syndrome over 90 or with two or more incidents of cerebrovascular diseases should be treated, not in rehabilitation but in nursing care.

Sarcopenia is widely believed to be linked to poorer outcomes in inpatient rehabilitation. This study aimed to assess the impact of sarcopenia on functional outcomes and dietary intake during hospitalization in adults undergoing convalescent rehabilitation. We conducted a retrospective cohort analysis at a single rehabilitation institution. The Asian Working Group Consensus Criteria for Sarcopenia was used to diagnose. The Functional Independence Measure (FIM) score was used at hospital discharge to measure the primary functional outcome. Energy and protein intakes during hospitalization were calculated as part of the nutritional assessment. There were 126 patients in the research (median age, 73 yr; 54% women). Stroke (n = 73; 53.4% sarcopenia) and musculoskeletal disorders (n = 53; 56.6% sarcopenia) were among the admission diagnoses. Multiple linear regression analysis revealed that the FIM total score at discharge was modestly associated with sarcopenia only in stroke patients (β = -0.1872, P = 0.09), as well as significantly and independently associated with protein intake during admission only in stroke patients (β = 0.3217, P < 0.05). In hospitalized stroke patients undergoing convalescent therapy, sarcopenia is related to lower functional results. Early identification of sarcopenia and treatment with rehabilitation nutrition should be implemented in this population. [ABSTRACT FROM AUTHOR]

[Purpose] To analyze the correlation between the timed up-and-go time and functional independence measure total score in postoperative elderly patients with vertebral and hip fractures. [Participants and Methods] The total functional independence measure scores and timed up-and-go times of 87 Japanese patients aged ≥65 years with a history of vertebral or hip fracture surgery were analyzed. Patients were classified based on age (<85 or ≥85 years), sex (female or male), fracture type (vertebral or hip fracture), and postoperative period (early or late). [Results] In the comparative analyses between the two datasets within the groups, significant differences were observed in functional independence measure scores and timed up-and-go times between patients in the early and late postoperative periods. In the correlation analyses using functional independence measure scores and timed up-and-go times, significant negative correlations were observed in all groups, except for one group of patients in the late postoperative period. In the contingency table analyses, several patients with low functional independence measure scores had a timed up-and-go time of >35 s. Receiver operating characteristic curve analysis indicated that a timed up-and-go time of >35 s can be a predictive marker of nursing care requirement in the early postoperative period. [Conclusion] In the present study, we clarified the relationship between functional independence measure score and timed up-and-go time in postoperative elderly patients with vertebral and hip fractures and confirmed that timed up-and-go time is a predictive marker of nursing care requirement., Competing Interests: The authors declare no conflict of interest., (2024©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Objectives Home discharge is a crucial goal for stroke patients in convalescent rehabilitation wards. While previous studies have identified relationships between Functional Independence Measure (FIM) scores and home discharge outcomes using conventional statistical methods, these analyses have limitations in visualizing combinations of independent FIM items. This study aimed to identify combinations of independent motor FIM items associated with home discharge in stroke patients using UpSet plots. Methods We analyzed 205 stroke patients admitted to a convalescent rehabilitation ward between April 2018 and March 2021. Independence in motor FIM items was defined as a score of 6 or higher. We used UpSet plots to visualize combinations of independent motor FIM items at discharge and identified major combinations (occurring in >7% of cases) in the home discharge group. Results Among 136 patients discharged to home, four major combinations of independent motor FIM items were identified: independence in all 13 items (22 patients, or 16.2%), independence in 12 items excluding stairs (18 patients, or 13.2%), independence in 10 items excluding bathing, tub transfer, and stairs (14 patients, or 10.3%), and dependence in all items (11 patients, or 8.1%). These combinations accounted for 47.8% of home discharge cases. Conclusions The visual analysis using UpSet plots revealed that, while higher levels of activities of daily living (ADL) independence increased the likelihood of home discharge, complete independence was not required. Dependence on specific items, such as bathing, tub transfer, and stairs, could be compensated through care services and environmental modifications. These findings provide practical insights for developing rehabilitation strategies and discharge planning., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of Japanese Red Cross Kanazawa Hospital issued approval 543. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nakaizumi et al.)

Traumatic brain injury (TBI) is suggested to be a risk factor for the onset of Alzheimer's disease (AD); however, the data remain controversial. This is the first report on cognitive decline in patients with TBI over 30 years post-injury. The medical significance/key learning points of this report are that (1) Functional Independence Measure (FIM) is useful in clinical settings, such as for higher brain dysfunction and dementia; (2) amyloid PET findings represent an essential biomarker for follow-up after TBI; and (3) cognitive decline can occur in patients with TBI more than 30 years post-injury. [ABSTRACT FROM AUTHOR]

Koji Naruishi,1,2 Akiko Kunita,3 Katsuyuki Kubo,1,2 Toshihiko Nagata,4 Shogo Takashiba,2,5 Seiji Adachi1 1Division of Local Care Center, Tottori Municipal Hospital, Tottori, Japan; 2Department of Periodontics and Endodontics, Okayama University Hospital, Okayama, Japan; 3Division of Rehabilitation, Tottori Municipal Hospital, Tottori, Japan; 4Department of Periodontology and Endodontology, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan; 5Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan Purpose: The number of elderly inpatients has been steadily increasing worldwide. However, the ability to predict the degree of improvement of functional capacity after comprehensive examination of elderly inpatients is still lacking. The purpose of this study was to investigate the predictors of improved functional outcome after rehabilitation of elderly inpatients.Methods: We performed a retrospective cohort study with 1,079 patients (age

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background:  A proper rehabilitation program may prevent post-stroke neurological, structural, and functional disabilities. We aimed to evaluate the efficacy of caregiver training in the rehabilitation of stroke survivors and compare rehabilitation interventions done by the therapist., Methods:  This quasi-experimental study was conducted among 67 stroke survivors divided into group A (home-based exercise by family caregivers; n=33) and group B (hospital-based supervised exercise by a physiotherapist; n=34). Family caregivers were trained according to "The London Stroke Carers Training Course." The functional independence measure (FIM) evaluated all patients after three months of physiotherapy.  Results: The mean age of the participants in group A and group B were 56.85 ± 11.49 and 58.65 ± 16.92 years, respectively, where most of the patients in both groups were male. In group A, 17 (51.5%) participants had left-sided involvement, while in group B, 17 (50.0%) participants had left-sided involvement. There was no significant statistical difference in FIM between groups A and B at baseline (p=0.532). At three months, the mean FIM of the participants in group A (98.54 ± 11.85) was significantly higher than in group B (89.85 ± 8.15) (p=0.001). A quasi-significant difference was observed between the right (18.41 ± 9.37) and the left (23.42 ± 11.68) hemisphere involvement regarding mean improvement of FIM (p=0.057)., Conclusion:  Therapeutic approach provided by trained caregivers was found to be more effective and efficient than that done by a physiotherapist., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Islam et al.)

Sarcopenia is widely believed to be linked to poorer outcomes in inpatient rehabilitation. This study aimed to assess the impact of sarcopenia on functional outcomes and dietary intake during hospitalization in adults undergoing convalescent rehabilitation. We conducted a retrospective cohort analysis at a single rehabilitation institution. The Asian Working Group Consensus Criteria for Sarcopenia was used to diagnose. The Functional Independence Measure (FIM) score was used at hospital discharge to measure the primary functional outcome. Energy and protein intakes during hospitalization were calculated as part of the nutritional assessment. There were 126 patients in the research (median age, 73 yr;54% women). Stroke (n = 73;53.4% sarcopenia) and musculoskeletal disorders (n = 53;56.6% sarcopenia) were among the admission diagnoses. Multiple linear regression analysis revealed that the FIM total score at discharge was modestly associated with sarcopenia only in stroke patients (? = 0.1872, P = 0.09), as well as significantly and independently associated with protein intake during admission only in stroke patients (? = 0.3217, P < 0.05). In hospitalized stroke patients undergoing convalescent therapy, sarcopenia is related to lower functional results. Early identification of sarcopenia and treatment with rehabilitation nutrition should be implemented in this population. J. Med. Invest. 70 : 457-463, August, 2023.

Purpose: The number of elderly inpatients has been steadily increasing worldwide. However, the ability to predict the degree of improvement of functional capacity after comprehensive examination of elderly inpatients is still lacking. The purpose of this study was to investigate the predictors of improved functional outcome after rehabilitation of elderly inpatients. Methods: We performed a retrospective cohort study with 1,079 patients (age, 70 years: N=331, age 70 years: N=748) who had been admitted to Tottori Municipal Hospital. Functional Independence Measure (FIM) scores were measured both at admission and discharge to calculate FIM gain and efficiency. Of these patients, 262 patients had oral examinations on admission. The Mann-Whitney U-test or chi-square test was used for statistical analyses. Conditional logistic regression analysis was used to compute the odds ratio (OR) and 95% confidence interval (CI). Cut-off values of FIM scores to determine if elderly inpatients were able to return home after discharge were determined using a receiver operating characteristic curve. Results: FIM scores, including FIM gain and efficiency, of elderly patients were significantly lower than those of middle-aged patients. Inability to close the lips and dysfunctional tongue movement, but not the loss of teeth, were correlated with a reduced improvement of FIM scores. Cognitive impairment and aspiration pneumonia, but not cerebrovascular disease, were also correlated with a reduced improvement of FIM scores. Interestingly, FIM scores were significantly lower in patients with both cerebrovascular disease and a loss of posterior occlusion. Factors shown to have a significant impact on the improvement of FIM scores included the stable posterior occlusion (OR: 2.23, 95% CI: 1.2-4.1), closed lips (OR: 5.15, 95% CI: 2.3-11.7), functional tongue movement (OR: 5.74, 95% CI: 3.0-11.0), presence of cognitive impairment (OR: 0.31, 95% CI: 0.17-0.49), and presence of aspiration pneumonia (OR: 0.27, 95% CI: 0.15-0.51). Conclusion: Age and disorder of oral function may be significant predictors of improved functional capacity after rehabilitation for elderly inpatients. [ABSTRACT FROM AUTHOR]

Objectives: To describe the functional level after 1 year in moderate and severe traumatic brain injury (TBI). Study design: Prospective, cross-sectional study. Setting and participants: Seventy individuals with TBI were admitted directly from acute care hospitals to a rehabilitation facility in Sawai Mansingh Medical College and Hospital, Jaipur (SMS). A follow-up of 58 patients was done up to 1 year later in the period from July 2011 to July 2012. Results: Mean change in FIM scores from admission to discharge was 51.26 and from admission to 12 months it was 85.3 in the moderate injury group. Mean change in DRS from admission to discharge was −8.19 and from admission to 12 months it was −17.76 in the moderate injury group and −8.55 and −19 in the severe injury group, respectively. The correlation coefficient ( r) between FIM and GOSE was 0.570 and between FIM and DRS was −0.8190, both of which were significant. Conclusions: All individuals improved significantly in the inpatient rehabilitation facility in the acute phase, with maximum gain in function seen from admission to discharge as assessed on FIM and DRS. The majority of the individuals continued to improve up to 6 months post-injury. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Optimizing nutritional intake has been recommended for geriatric patients undergoing hip-fracture surgery. Whether nutritional support guided by repeated measurements of resting energy requirements (REE) improves outcomes in these patients is not known. Methods: A randomized, controlled, unblinded, prospective, cohort study comparing provision of energy with a goal determined by repeated REE measurements using indirect calorimetry, with no intervention. Oral nutritional supplements were started 24 h after surgery and the amount adjusted to make up the difference between energy received from hospital food and measured energy expenditure. Results: 50 Geriatric patients were included in the study. Patients in the intervention group (n = 22) received significantly higher daily energy intake than the control group (n = 28) (1121.3 ± 299.0 vs. 777.1 ± 301.2 kcal, p = 0.001). This was associated with a significantly less negative cumulative energy balance (−1229.9 ± 1763 vs. −4975.5 ± 4368 kcal, p = 0.001). A significant negative correlation was found between the cumulative energy balance and total complication rate (r = −0.417, p = 0.003) as well as for length of hospital stay (r = −0.282, p = 0.049). Conclusion: We have demonstrated that nutritional support actively supervised by a dietician and guided by repeated measurements of REE was achievable and improved outcomes in geriatric patients following surgery for hip fractures. Clinicaltrials.gov Identifier: NCT017354435. [Copyright &y& Elsevier]

Abstract: Balance problems are a major sequelae of stroke and are implicated in poor recovery of activities of daily living. In a cross-sectional study, using 50-channel event-related functional near-infrared spectroscopy we previously reported a significant correlation between individual balance ability after stroke and postural perturbation-related cortical activation in the supplementary motor area (SMA) and the prefrontal cortex. However, the neural mechanisms underlying balance recovery after stroke remain unclear. Herein, we examined the cortical involvement in balance recovery after stroke by determining longitudinal regional cortical activation changes in patients with hemiplegic stroke. Twenty patients with subcortical stroke admitted to our hospital for post-acute inpatient rehabilitation participated in this study. Before and after intensive inpatient physical and occupational therapy rehabilitation, we evaluated cortical activation associated with external postural perturbations induced by combined brisk forward and backward movement on a platform. Postural perturbation-related cortical activation in the SMA of the affected and unaffected hemispheres was significantly increased after intensive rehabilitation. The increment of the postural-perturbation-related oxygenated hemoglobin signals in the SMA of the unaffected hemisphere was significantly correlated with the gain in balance function measured by the Berg Balance Scale. These findings support the conclusion that the SMA plays an important role in postural balance control, and suggest that the SMA is a crucial area for balance recovery after hemiplegic stroke. [Copyright &y& Elsevier]

Objective: To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. Study design: This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility–Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). Results: There were 13 798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). Conclusions: Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury. [Copyright &y& Elsevier]

Abstract: Aim: The aim of this study was to investigate the association between oral opportunistic infections and a recently adopted functional factor, the Functional Independence Measure (FIM), and a nutritional factor, the Geriatric Nutritional Risk Index (GNRI), in institutionalized elderly patients. Patients and methods: Fifty-three patients who were admitted to a long-term nursing hospital were included in this study. The oral opportunistic pathogens (OOPs) were gathered by scratching the dorsal surface of the tongue and then were cultivated. In each patient, the FIM and GNRI score, the method of nutrition, the number of remaining teeth, and whether or not dentures were worn was examined. Results: OOPs were found in 64.2% of the patients, and Pseudomonas aeruginosa was the most commonly detected OOP (43.4%). The FIM and GNRI scores of the OOP-positive patients were significantly lower than those of the OOP-negative patients, and the rate of denture wearing was also significantly lower in the OOP-positive patients. Similar results were found in P. aeruginosa-positive patients. In cases of P. aeruginosa infection, the tube-fed patients were significantly more likely to be OOP-positive than the orally fed patients. From the multivariate logistic regression model only the GNRI significantly associated with P. aeruginosa positivity. Conclusion: The OOP-positive patients and P. aeruginosa-positive patients had significantly lower scores of the FIM and GNRI. But from the multivariate logistic regression model significant correlation was found between only P. aeruginosa positivity and lower scores of the GNRI. [Copyright &y& Elsevier]

Abstract: The aim of this study was to investigate the effects of transplantation with umbilical cord mesenchymal stem cells in patients with sequelae of traumatic brain injury (TBI). The study hypothesis was that umbilical cord mesenchymal stem cell transplantation could safely and effectively improve neurological function in patients with sequelae of traumatic brain injury. Forty patients with sequelae of TBI were randomly assigned to the stem cell treatment group or the control group. The patients in the stem cell treatment group underwent 4 stem cell transplantations via lumbar puncture. All patients of the group were also evaluated using Fugl-Meyer Assessments (FMA) and Functional Independence Measures (FIM) before and at 6 months after the stem cell transplantation. The patients in the control group did not receive any medical treatment (i.e., neither surgery nor medical intervention), and their FMA and FIM scores were determined on the day of the visit to the clinic and at 6 months after that clinical observation. The FMA results demonstrated an improvement in upper extremity motor sub-score, lower extremity motor sub-score, sensation sub-score and balance sub-score in the stem cell transplantation group at 6 months after the transplantation (P<0.05). The FIM results also exhibited significant improvement (P<0.05) in the patient self-care sub-score, sphincter control sub-score, mobility sub-score, locomotion sub-score, communication sub-score and social cognition sub-score. The control group exhibited no improvements after 6 months (P>0.05). All in all, the study results confirmed that the umbilical cord mesenchymal stem cell transplantation improved the neurological function and self-care in patients with TBI sequels. Umbilical cord mesenchymal stem cell transplantation may be a potential treatment for patients with sequelae of TBI. Further research, including a multicenter and large sample size prospective randomized clinical trial, will be required to define definitively the role of umbilical cord mesenchymal stem cell transplantation on sequelae of TBI. [Copyright &y& Elsevier]

Objective: To evaluate the occurrence of hypothalamic-pituitary dysfunction following a traumatic brain injury (TBI) and to determine its effect on functional improvement in acute inpatient rehabilitation. Methods: A retrospective chart review identified male patients with a primary diagnosis of TBI with or without a skull fracture, an onset date within 6 months prior to admission, and were 16 years of age or older. The percentage of individuals in this population with abnormal hormone levels was determined on the basis of the established normal reference range for each hormone assay. The functional independence measure, which assesses functional outcomes in acute inpatient rehabilitation, was used to examine the relationship between hormone levels and functional improvement. Results: Hypothalamic-pituitary dysfunction was identified in nearly 70% of men following TBI. Hypogonadism, or low testosterone levels, was observed in 66% of the patients, followed by low levels of free T4 in 46% and low levels of insulin growth factor-1 in 26% of patients. Hypopituitarism associated with impaired functional recovery. Specifically, the functional independence measure change per day was significantly lower in patients with low levels of testosterone and insulin growth factor-1. Conclusions: These findings suggest the importance of testosterone and insulin growth factor-1 activity in the early stages of physical and cognitive rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose - Traumatic brain injuries (TBIs) are a significant public health problem that affect an estimated 1.7 million US residents yearly. TBI patients experience a variety of symptoms related to physical functioning, sensory processing, cognition, communication, behavior, and mental health, all of which differ in severity by individual. Recent evidence suggests that hypothalamic pituitary dysfunction may be impacting recovery. The purpose of this paper is to increase awareness about the frequency of hypothalamic pituitary dysfunction following a TBI and its effect on functional recovery. Design/methodology/approach - The paper reviews the literature regarding hypothalamic pituitary dysfunction following TBI and discusses the potential benefits of hormone replacement therapy for individuals with hormone deficiencies. Findings - The rate of hypothalamic pituitary dysfunction following TBI has been reported as anywhere between 25 and 80 percent. Specifically, abnormal hormone levels, both chronic and acute, are generally estimated to be approximately 5-22 percent for thyroid hormones, 15-33 percent for growth hormone (GH), and 25-80 percent for testosterone. The effect of hypopituitarism has been reported on several aspects cognitive and physical function as well as overall quality of life. In these studies, GH and testosterone deficiencies appear to underlie the observed impairments. Originality/value - The paper suggests the importance of understanding and screening for hypothalamic pituitary dysfunction as hormone replacement therapy may be a beneficial intervention to promote physical and cognitive rehabilitation. [ABSTRACT FROM AUTHOR]

Aims: This study's primary aim was to identify factors associated with discharge disposition and length of stay (LOS) at an interdisciplinary inpatient rehabilitation unit for patients who underwent total knee arthroplasty/unilateral or bilateral knee surgery (TKA/KS) or total hip arthroplasty (THA). Methods: This was a retrospective medical chart review of 719 veterans receiving post joint replacement rehabilitation at a United States Department of Veterans Affairs Medical Center at an interdisciplinary inpatient rehabilitation unit between December 2008 and May 2010 following joint replacement surgery. Patient demographic, health/function, and outcome factors were abstracted. Findings: Approximately 96% of patients who received post joint replacement rehabilitation were discharged to a home setting. For every 1 point score increase on the Functional Independence Measurement (FIM) scale at discharge, patients were 1.29 times more likely to be discharged to home (95% Cl=l .02-1.63; P<0.04), but this effect diminished after accounting for age. Older veterans had longer LOS. Discharge to a non-home setting following inpatient rehabilitation was associated with older age, lower functional independence at admission, and poorer functional gain between admission and discharge. Conclusions: Interdisciplinary inpatient rehabilitation is an effective transitional step from the surgical intervention to the home setting for veterans undergoing TKA/KS or THA. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the functional outcomes of adult patients with West Nile Virus who were admitted to a rehabilitation hospital in the U.S. Researchers evaluated 48 patients with a mean age of 67.8. They found that the functional outcomes of the patients after comprehensive rehabilitation vary from patient to patient and that higher numbers of comorbid conditions led to more complex disease presentation.

This prospective experimental study was conducted from 1st July 2008 to 31st December 2009. Out of 33 patients 29 patients completed 6 weeks' scheduled programs. All the patients were housewives with the age from 17 to 45 years with the mean of 27.48 ± 7.20years. Presenting disability of the patients, pretreatment and post treatment Functional Independence Measures (FIM) scores of self-care, sphincter control, transfers and locomotion were recorded and compared. FIM scores for the normal population are-selfcare 42, sphincter control 14, transfer 21, locomotion 14 and the combined scores for the above four motor functions 91. The pre and post-treatment FIM scores of the patients studied were- self-care 15.45 ± 5.19 Vs 35.86 ± 7.67 (95% ±0.370 (95% CI-5.32 to -1.51), transfer 5.52±2.35 Vs 5.52 ±2.35 (95% CI-12.30 to -9.70), locomotion 3.24± 1.45 Vs 9.65 ±3.33 (95% CI-7.40 to -5.42) and the combined scores 34.86 ± 12.49 Vs 75.59 ± 13.95 (95% CI-45.22 to -36.22) with (p= < 0.001) in all the mentioned motor functions that were examined. The study showed that the physiatric management is effective for patients with peripartum paralysis. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The perceived Quality of Life (QOL) was evaluated in one-hundred and eleven participants after a first-ever stroke, who were admitted in a rehabilitation center and completed a 2-month program. The World Health Organization (WHO) QOL-100 was applied. Two domains were correlated with the functional status at discharge, namely, the level of independence and the social relations. The study confirmed the strong correlation between the functional status at admission and at discharge. Other predictive parameters of outcome were age and depression. The functional improvement was highly significant (p < 0.0001) at Wilcoxon test (40 points at functional independence measure (FIM) scale). The gain was gender-independent. Nevertheless, among females, a significant correlation was found between the FIM score at discharge and either distress value at Hospital Anxiety and Depression Scale (HADS) or QOL. In conclusion, the perceived QOL should be considered by a stroke rehabilitative team. [ABSTRACT FROM AUTHOR]

[Purpose] We evaluated the clinical efficacy of concentric inpatient hospital rehabilitation (CIHR) for HTLV-1 associated myelopathy (HAM). We estimated the change of activity of daily living (ADL) using objective clinical parameters before and after rehabilitation. [Subjects] Fifteen HAM patients (male 3, female 12, mean age 51.9) at the chronic stable stage participated in this study. [Methods] These HAM patients were hospitalized for rehabilitation for six weeks periods at our hospital. We assessed the usefulness of CIHR therapy by the Functional Independence Measure (FIM) ratings and Osame's Motor Disability Score (OMDS) before and after rehabilitation. We also evaluated the changes of each FIM subcategory, especially focusing on gait ability. [Results] FIM ratings showed statistically significant increases after CIHR. Especially, the walking ratings in FIM and OMDS showed statistically significant improvements after CIHR. FIM subcategories related to lower limb movement improved remarkably whereas subcategories related to bladder and bowel management were without significant changes. [Conclusion] The improvement of ADL by CIHR was confirmed, mainly as a remarkable improvement in the gait ability. Concentric rehabilitation for HAM patients may be a promising therapy for improvement of ADL. [ABSTRACT FROM AUTHOR]

The article presents a comparison of two assessment systems in determining the functional outcomes on patients with musculoskeletal (MSK) disorders. It examines the effectivity of Functional Independence Measure (FIM) and interRAI/ Minimum Data Set (MDS) assessments through Post Acute Care (PAC) which are designed to improve the quality of life of older patients receiving inpatient rehabilitation. It notes that PAC was more efficient than the FIM assessment for patients with MSK.

[Purpose] We examined the perception held in clinical practice, that the greater the number of exercise units the better the outcome in a retrospective survey which investigated the relationship between Activities of Daily Living (ADL) outcome and the number of exercise units performed in exercise limited to 2 hours, with the objective of obtaining basic data for studies of the effects of exercise limits of 3 hours. [Subjects] The subjects were 362 patients who were admitted and discharged from the Recovery Stage Rehabilitation Ward of the Fujita Health University Nanakuri Sanatorium in 2005. [Method] We examined the total number of occupational and physical therapy exercise units during the hospital stay and calculated the daily average, analyzed the discharge to home rate and investigated their correlation with the Motor Items Score of the Functional Independence Measure (FIM-M) and the return to home rate. [Results] Total exercise units was negatively correlated with FIM-M at admission and discharge from the ward, and gain in FIM-M showed a positive correlation. The group which performed on average 5-6 units per day did not show better results compared to those performing less, but they had a higher return to home rate. [Conclusion] Performing the upper limit of exercise (6 units) did not always lead to a high ADL outcome. When investigating the relationship between exercise dose and outcome, the effects of restrictions of exercise dose and lifestyle when not at exercise should also be considered. [ABSTRACT FROM AUTHOR]

[Purpose] In this study, in order to establish the clinical path for Activities of Daily Living (ADL) training, and utilizing Functional Independence Measure (FIM) we estimated the predictable goals (independence levels) of individual items of ADL and the time it would take to achieve them. [Subjects] The subjects were 1,479 hospitalized stroke patients admitted to a rehabilitation ward in the recovery period. [Method] Based on the totals of the FIM motor item scores on admission (FIMM), the patients were divided into 9 groups, and for each group, for each of the individual items of FIMM, we calculated the percentage of patients achieving independence, and analyzed the times needed to achieve independence. [Results] The degree of disability in ADL on admission shows characteristics of achievement of independence and time to achieve independence [Conclusion] These results suggest that knowing a combination of these could serve as an index for ADL training of hospitalized hemiplegic stroke patients in rehabilitation wards in the recovery period. [ABSTRACT FROM AUTHOR]

[Purpose] The purpose of this study was to determine related factor of outcomes at the time of hospital discharge of acute stroke patients who were in rehabilitation. [Subjects and Methods] The subjects were 61 acute stroke patients, and we performed related factor analysis. [Results] In analysis by outcomes at the time of hospital discharge, Functional Independence Measure (FIM) at the start of rehabilitation of the discharge to home group was higher than that of other groups. FIM at discharge from hospital of the group moving to a convalescent hospital was higher than that of the group moving to a general hospital. [Conclusion] From the results, we think that patients whose FIM at the start of rehabilitation is high need instruction on activities of daily living and maintenance of living environments for discharge to home. Also, it is necessary to pick up on FIM changes early and to predict where patients should move after discharge from hospital. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of an increase in the intensity of rehabilitation on the functional outcome of patients with traumatic brain injury (TBI). Design and methods: Sixty-eight patients (age 12-65 years) with moderate-to-severe TBI were included. They were randomized into high (4-hour/day) or control (2-hour/day) intensity rehabilitation programmes at an average of 20 days after the injury. The programmes ended when the patients achieved independence in daily activities or when 6 months had passed. Outcome and results: No significant differences were found in the Functional Independence Measure (FIM) (primary outcome) and Neurobehavioural Cognitive Status Examination (NCSE) total scores between the two groups. There were significantly more patients in the high intensity group than in the control group who achieved a maximum FIM total score at the third month (47% vs. 19%, p = 0.015) and a maximum Glasgow Outcome Scale (GOS) score at the second (28% vs. 8%, p = 0.034) and third months (34% vs. 14%, p = 0.044). Conclusions: Early intensive rehabilitation may improve the functional outcome of patients with TBI in the early months post-injury and hence increase the chance of their returning to work early. Intensive rehabilitation in this study speeded up recovery rather than changed the final outcome. [ABSTRACT FROM AUTHOR]

Although exercise therapy intervention for frail elderly people was not of great interest in the past, it has recently drawn attention as a method to prevent and improve conditions requiring care since the enforcement of the Long-Term Care Insurance Law and the revision of the long-term care insurance system. This randomized controlled trial was performed to evaluate the effects of exercise therapy using the Takizawa Program. In this randomized controlled trial, we evaluated the effects of exercise therapy on the frail elderly, including those who need a high level of care, in terms of two factors: the range of motion and the functional independence measure. The subjects were 145 females admitted to special nursing homes for the elderly. They were stratified according to their care levels and randomly assigned to either the exercise therapy intervention group or the control group. The range of motion values in the flexions of both shoulders, the right knee extension, and the dorsal flexions of both ankles significantly increased only in the exercise therapy intervention group. The functional independence measure score did not improve in the exercise therapy intervention group. Exercise therapy should be used for the frail elderly requiring a high level of care. [ABSTRACT FROM AUTHOR]

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Objectives: Advances in cancer treatment have led to extended survival, and, as a result, the number of patients with bone metastases is increasing. Activities of daily living (ADL) decrease with bone metastasis and the need for rehabilitation is increasing. This study examined the effects of rehabilitation in patients with bone metastases., Methods: We retrospectively reviewed data of cancer patients with bone metastasis who received rehabilitation between 2016 and 2018. Efficacy of rehabilitation was evaluated in 92 patients as the change in the Functional Independence Measure (FIM) score divided by rehabilitation days (FIM change/day) and assessed by different metastatic sites., Results: Overall FIM scores significantly improved after rehabilitation. Moreover, FIM change/day improved in patients with pelvic metastases (n=44) more than in patients with other metastatic sites (n=48) (P=0.015). In FIM motor components, improvements in toilet, tub/shower, walk/wheelchair, and stairs were significantly greater in patients with pelvic metastasis than in those with other metastasis sites., Conclusions: Rehabilitation improved ADL status to a greater extent in patients with pelvic metastases than in those with other metastasis sites. Patients with pelvic metastases may fear fractures, limiting their ADL, but rehabilitation could eliminate this fear and improve FIM., Competing Interests: CONFLICTS OF INTEREST: The authors report no conflicts of interest., (2022 The Japanese Association of Rehabilitation Medicine.)

Objective Stroke among young adults is the leading cause of disability worldwide. Efforts are being taken to control stroke in the general population, but in parallel, there is an increasing trend of stroke among the young population. These patients are often affected by physical disability, cognitive impairment, and loss of productivity, all of which have personal, social, and economic implications. The main aim of this study was to determine the risk factors associated with stroke among young patients admitted to a tertiary care rehabilitation center and determine the effect of rehabilitation on the outcome of their daily life activities. Materials and Methods A retrospective hospital-based cohort study was conducted between January 2015 to December 2019. Prevalence of stroke-related risk factors like hypertension, hyperlipidemia, diabetes, and cardiac disease was assessed. Results Out of 710 young stroke adults, 71.97% were described as ischemic, and 28.03% reported as non-ischemic. Mean age (SD) was found to be 44.54 ± 9.3. Univariate analysis demonstrated that hyperlipidemia, cardiac disease, and diabetes indicated a significantly higher risk for ischemic stroke with an OR (95% CI) at 2.5 (1.7-3.7), 2.11 (1.2-3.6), and 1.66 (1.2-2.3) respectively. A significant improvement was observed in their Functional Independence Measure (FIM0 score after their rehabilitation irrespective of age and gender. Conclusion Association of risk factors associated with stroke should be subjected to close follow-up and management, thus reducing the risk of developing long-lasting disabilities at a young age. The identification of risk factors for young stroke incidence is a step towards improving health in the young adult population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Si Larbi et al.)

Purpose To explore the needs for basic community-based rehabilitation services for disabled persons in Xuanwu District, Beijing, China, and to identify factors which influence disabled persons to accept rehabilitation services. Method One hundred and eight disabled persons were selected by systematic sampling and simple random sampling to assess their needs for community-based rehabilitation services. Results Of the interviewees, 57.4% needed the community-based rehabilitation services, but only 13.9% took advantage of it. The main factors influencing the interviewees to accept these services were cost (P<0.05), knowledge about rehabilitation medicine (P<0.05); and the belief in the therapeutic benefit of the community-based rehabilitation service (P<0.05). Conclusion A considerable gap exists between the supply of community-based rehabilitation services in Beijing and the needs for these services by disabled residents underscoring the need for improved availability, and for additional research. [ABSTRACT FROM AUTHOR]

Background: Endocrinopathy, including hypogonadism, is common following traumatic brain injury (TBI). Prior evidence suggests hypogonadism is associated with poorer function., Objective: Determine the feasibility, safety, and efficacy of testosterone (T) therapy in hypogonadal men following TBI in acute rehabilitation., Design: Randomized, double blind, placebo-controlled pilot trial., Setting: Inpatient rehabilitation brain injury unit., Participants: Men ages 18 -65, post moderate to severe TBI receiving inpatient rehabilitation., Interventions: Transdermal T gel or placebo., Main Outcome Measures: Revised FIM™ score, strength, adverse events., Results: Of 498 screened, 70 participants were enrolled, and 22 meeting all criteria were randomized into placebo (n = 10) or physiologic T therapy (n = 12). There was no significant difference between groups in rate of improvement on the FIM™ (intercepts t = -0.31, p = 0.7593, or slopes t = 0.61, p = 0.5472). The Treatment group demonstrated the greatest absolute improvement in FIM™ scores and grip strength compared to Placebo or Normal T groups. There was no difference in adverse events between groups. Percentage of time with agitation or aggression was highest in the Placebo group., Conclusions: Although there were no significant differences in rates of recovery, treatment group subjects showed greater absolute functional and strength improvement compared to the Placebo or Normal T groups.