Rehabilitation needs and participation restriction in patients with cognitive disorder in the chronic phase of traumatic brain injury

The purpose of this study was to clarify psychosocial factors/problems, social participation, quality of life (QOL), and rehabilitation needs in chronic-phase traumatic brain injury (TBI) patients with cognitive disorder discharged from the level-1 trauma center (L1-TC), and to inspect the effects of rehabilitation intervention to these subjects.A mixed-method research (cross-sectional and qualitative study) was conducted at an outpatient rehabilitation department.Inclusion criteria of subjects were transfer to the L1-TC due to TBI; acute-stage rehabilitation treatment received in the L1-TC from November 2006 to October 2011; age of ≥18 and <70 years at the time of injury; a score of 0-3 on the Modified Rankin Scale at discharge and that of 4-5 due to physical or severe aggressive behavioral comorbid disorders. Study details were sent, via mail, to 84 suitable candidates, of whom 36 replied. Thirty-one subjects (median age: 33.4 years; male: 17; and average time since injury: 48.1 months), who had consented to study participation, were participated. Cognitive function, social participation, QOL, psychosocial factors/problems, rehabilitation needs, and chronic-phase rehabilitation outcomes were evaluated using the Wechsler Adult Intelligence Scale, Third Edition, the Wechsler Memory Scale-Revised, the Zung Self-Rating Depression Scale, the Sydney Psychosocial Reintegration Scale, Version 2, and the Short Form 36, Version 2, qualitative analysis of semistructured interviews, etc.Participants were classified into achieved-social-participation (n = 11; employed: 8), difficult-social-participation (n = 12; unemployed: 8), and no-cognitive-dysfunction groups (n = 8; no social participation restriction). Relative to the achieved-social-participation group, the difficult-social-participation group showed greater injury and cognitive dysfunction and lower Sydney Psychosocial Reintegration Scale and Short Form 36 role/social component summary scores (64.9/49.1 vs 44.3/30.4, respectively, P < 0.05). Linear regression analysis showed that the social participation status was greatly affected by the later cognitive disorders and psychosocial factors/problems not by the severity of TBI. No changes were observed in these scores following chronic-phase rehabilitation intervention.Chronic-phase TBI with cognitive disorder led to rehabilitation needs, and improvement of subjects' psychosocial problems and QOL was difficult.

Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study

OBJECTIVE

To investigate the association between nutritional status and rehabilitation outcome in elderly inpatients with hospital-associated deconditioning.

DESIGN

A prospective cohort study.

SUBJECTS/PATIENTS

One hundred sixty-nine consecutive elderly inpatients diagnosed with hospital-associated deconditioning.

METHODS

Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center. Body mass index, haemoglobin, albumin, total lymphocyte count, C-reactive protein, cause of malnutrition, and feeding route were also investigated. Primary outcome was Barthel Index score at discharge.

RESULTS

A total of 148 patients (87.6%) were malnourished, and 21 were at risk for malnutrition. There were no patients with normal nutritional status. Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition. Chronic disease-related malnutrition, oral intake, and parenteral nutrition were associated with the Barthel Index score at discharge. There were significant correlations between the Barthel Index score at discharge and nutritional score, albumin, and total lymphocyte count. In multiple regression analysis, Mini Nutritional Assessment Short Form, albumin, and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge.

CONCLUSION

Most elderly inpatients with hospital-associated deconditioning are malnourished. Nutritional status, albumin, and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning.

Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation

OBJECTIVE

To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).

DESIGN

Case-controlled study.

SETTING

SCI unit in a rehabilitation center.

PARTICIPANTS

Seventeen patients with SCI-AA and 17 patients with traumatic SCI.

INTERVENTION

Standard rehabilitation therapy for SCI.

MAIN OUTCOME MEASURES

Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.

RESULTS

No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.

CONCLUSIONS

SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community.

Kinematic effects on gait of a newly designed ankle-foot orthosis with oil damper resistance: a case series of 2 patients with hemiplegia

The ankle joint of ankle-foot orthoses (AFOs) should restrict plantarflexion to prevent foot drop during the swing phase. However, excessive plantarflexion resistance causes excessive knee flexion during the stance phase. Plantarflexion resistive moment should be easily adjustable according to the gait ability of patients with hemiplegia. Because it is difficult to adjust plantarflexion resistive moment exactly, we developed an AFO with an oil damper. It is a small shock absorber that utilizes hydraulic resistance. The oil damper generates a resistive moment to the plantarflexion rotation of the ankle joint at the initial stance phase. The magnitude of the plantarflexion resistive moment at the heel strike can be easily adjusted to accommodate each patient's condition by simply turning an adjustment screw. We used a gait analysis system to compare the gait of 2 hemiplegic patients while they were wearing either the AFO with the oil damper or the AFO with the plantarflexion stop. The AFO with the oil damper achieved sufficient plantarflexion of the ankle and mild flexion of the knee by adjusting a proper plantarflexion resistive moment during initial stance phase, and provided a more comfortable gait than did the AFOs with a plantarflexion stop.

Relation Between 24-h Heart Rate Variability and Blood Pressure Fluctuation During Exercise in Stroke Patients

BACKGROUND

In some stroke patients blood pressure (BP) fluctuates extensively during medical rehabilitation, so the present study investigated the influence of autonomic nervous dysfunction on the change in BP during exercise.

METHODS AND RESULTS

The subjects consisted of 55 stroke inpatients (males, 29; mean age, 58.8 years old; ischemic/hemorrhagic etiology, 30/25) who were admitted to the Stroke Center within 2 weeks of their first stroke. The control group consisted of 15 age-matched healthy volunteers. The 24-h heart rate (HR) variability (HRV) and BP variability (BPV) were examined, and then the increase and recovery of BP and HR were measured during bicycle ergometer exercise at 4 METs. Components of 24-h HRV (low-frequency power (LF), high-frequency power (HF), LF/HF, and asleep-awake ratio of LF/HF (LF/HF(d-n)) were lower (p < 0.01) and BPV was greater in the stroke group (p < 0.05) than in the control group. There was a negative correlation between BP change during exercise and LF/HF or LF/HF(d-n) (r = -0.43 or r = -0.58, p < 0.01), and a greater increase in systolic BP (102 +/-9.8 mmHg, n = 7) during exercise was observed in stroke patients with lower LF/HF(d-n) (< or = 1.0).

CONCLUSIONS

Lower HRV in stroke patients may relate to an increase in BP during exercise. HRV is useful for estimating the risk during medical rehabilitation.

Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty

OBJECTIVE

To study the effect of a home program of physical therapy.

DESIGN

Nonrandomized control trial.

SETTING

Home based.

PATIENTS

Subjects had total hip arthroplasty (THA) for hip osteoarthritis (hip-OA) without THA failure, or cardiopulmonary, neurological, or cognitive problems. Twenty-three subjects (mean age 63.4 years; mean post-THA period 793 days, 6 to 48 months) were divided into 3 groups matching with age, gender, and postoperative periods.

INTERVENTION

The 6-week home program included range of motion (ROM) exercises, and low resistance isometric and eccentric exercises of hip abductors. Physical therapists prescribed ROM and isometric exercises for group A, all programs for group B, and no programs for the control group. The programs were modified every 2 weeks as necessary.

MAIN OUTCOME MEASURE

Hip ROM, maximum isometric hip abduction torque measured by Cybex II, gait speed, and cadence were evaluated.

RESULTS

The practice ratio of the program was about 70% for both groups. Maximum isometric torque improved in the THA side of group A (p < .01) and the control group (p < .05), and on both sides in group B (p < .01). Gait speed and cadence also improved significantly. No correlation coefficient existed between practice days and the improvement ratio of the maximum torque.

CONCLUSION

The home program was effective in long-term post-THA.

The practice of a day-care welfare facility for profoundly handicapped persons

In Japan, many profoundly handicapped persons and their families are demanding day-care welfare facilities to ensure continued community life. Thus, 'Houmon-no-ie' was organized in 1986 to fulfil these needs. Forty-nine persons are enrolled at this facility; 67% suffer from cerebral palsy, and 43% exhibit very serious physical and mental disability (impossible to sit and IQ below 25). They show many medical problems such as poor general condition, respiratory disorder, etc. We report the purpose of this facility and the effects of day-care programmes.

Arthrographic findings in hemiplegic shoulders

To discover the influence of hemiplegia on arthrographic changes in hemiplegic shoulders, we compared arthrographic findings from paralyzed and nonparalyzed shoulders in 77 patients with hemiplegia. The correlation between arthrographic changes in paralyzed shoulders and characteristics of the hemiplegic condition was also investigated. Hemiplegic changes were considered to be responsible for adhesive changes in affected shoulders because those changes were found in paralyzed shoulders at a statistically significant higher rate (54.6%) than in the nonparalyzed side (32.5%). The occurrence rate of contrast leakage from capsule tear on the subscapular bursa and the bicipital tendon sleeve was higher on the nonparalyzed side than on the paralyzed side. It is suggested that capsular contracture due to hemiplegia prohibits capsular tear during arthrographic maneuvers. No significant difference was found in the occurrence of rotator cuff tear between the paralyzed and the nonparalyzed shoulder. Those changes on the paralyzed side were not correlated with any characteristics of hemiplegics except for shoulder pain prior to the onset of hemiplegia.