Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap

Effects of an Occupational Therapy Program on Functional Outcomes in Older Stroke Patients

BACKGROUND

During the last decade, occupational therapy has gained increasing importance as component of the rehabilitation programs in disabled patients.

OBJECTIVE

To evaluate the efficacy of occupational therapy programs in patients with a recent stroke.

METHODS

We selected all patients with a primary diagnosis of ischemic stroke (n = 50) consecutively admitted to the two post-acute Geriatric Rehabilitation Units (CEMI 2 and 3) of the 'A. Gemelli' Hospital--Catholic University of Sacred Heart, Rome, Italy. Patients in the unit CEMI 3 (intervention group) received 8 weeks (3 h per day) of a combined rehabilitation program based on occupational therapy and physiotherapy. Patients admitted to the control unit (CEMI 2) received no input from the occupational therapist.

RESULTS

Overall, patients had a moderate-to-severe impairment in basic activities of daily living; the mean ADL score was 30.8 (SD +/- 7.8) in the intervention group and 30.7 (SD +/- 6.1) in the control group (p = 0.9). After 8 weeks of treatment the mean ADL score in the intervention group was 13.2 (SD +/- 9.9) compared to 20.3 (SD +/- 11.5) in the control group (p = 0.02). Differences between the intervention and control groups were statistically significant for transfers (+2.8 vs. +1.6 points on the ADL scale, p = 0.006), locomotion (+3.4 vs. +1.7 points on the ADL scale, p = 0.01), dressing (+3.0 vs. +1.8 points on the ADL scale, p = 0.01) and self-care (+3.4 vs. +1.8 points on the ADL scale, p = 0.005).

CONCLUSION

Our results show that patients with stroke who received occupational therapy had a greater level of independence in activities of daily living over a period of 8 weeks than patients who did not.

Participation after stroke compared to normal aging

OBJECTIVE

To examine the reduction in participation of people who have had a stroke compared with healthy people with normal aging.

DESIGN

Participation of people who had a stroke was compared with participation of healthy subjects.

SUBJECTS/PATIENTS

Forty-six people who had a stroke for 2-4 years and 46 healthy participants matched on age, sex and living environment.

MEASUREMENTS

Participation was estimated with the Assessment of Life Habits (LIFE-H). The LIFE-H (short version 2.1) is composed of 58 daily activities and social roles associated to the 12 categories of the Disability Creation Process model. The LIFE-H gives separate scores for each category, for 2 main subsections "Daily activities" and "Social roles" and a total score.

RESULTS

Scores of healthy subjects did not reach the maximum value (9/9) of the LIFE-H, their mean scores varying from 6.3 to 8.6, according to the categories. These scores are higher than of the participants with stroke for all categories (scores varying from 3.9 to 6.5; p-values from 0.002 to <0.001), except the interpersonal relationships category (score of 7.8 vs 8.0) where no difference was found (p=0.49). The disruption in participation after stroke varies according to the categories of the LIFE-H, but is more important in the daily activities categories.

CONCLUSION

The comparison of the scores obtained by the 2 groups suggests that a part of the reduction in participation in daily activities and social roles after stroke is attributable to normal aging and not entirely to the stroke itself. It helps to focus interventions on activities and roles disruption domains that are really attributable to stroke.

Relationship between strength, balance, and swallowing deficits and outcome after traumatic brain injury: A multicenter analysis11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To examine the relation among strength, balance, and swallowing deficits, as measured on rehabilitation admission, and functional outcome at discharge and 1 year after traumatic brain injury (TBI).

DESIGN

Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS) facilities.

SETTING

Seventeen TBIMS centers.

PARTICIPANTS

Adults and children older than 16 years of age with TBI (N=2363) enrolled in the national database from January 1989 to November 2000.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Transfers, locomotion, stairs, lower-body dressing, grooming, bathing, upper-body dressing, toileting, and eating as measured by the FIM instrument at acute rehabilitation discharge and at 1 year after TBI.

RESULTS

Lower-extremity strength less than 3/5 on admission to acute rehabilitation was associated with increased need for assistance in locomotion, transfers, and lower-body dressing and less than 3/5 upper-extremity strength was associated with the need for assistance in self-care at rehabilitation discharge and at 1 year postinjury. Similar relations were found between impaired swallowing and assistance with eating, grossly impaired dynamic sitting, or standing balance and assistance with locomotion, transfers, eating, and self-care at rehabilitation discharge and at 1 year after TBI.

CONCLUSIONS

Assessments of physical strength, swallowing ability, and dynamic balance on acute rehabilitation admission are helpful as screening tests in predicting the need for assistance of another person for mobility and self-care at rehabilitation discharge. This association remains strong at 1 year after TBI. By using this information, clinicians should initiate therapeutic interventions that optimize rehabilitation of the identified impairments and should make necessary arrangement for the patient's anticipated postdischarge needs. Further studies are necessary to delineate the amount of unique variance that these early physical examination findings contribute to outcome prediction.