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Functional Independence (functional + independence)
Terms modified by Functional Independence Selected AbstractsEffects of Provider Practice on Functional Independence in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004Elizabeth A. Phelan MD Objectives: To examine provider determinants of new-onset disability in basic activities of daily living (ADLs) in community-dwelling elderly. Design: Observational study. Setting: King County, Washington. Participants: A random sample of 800 health maintenance organization (HMO) enrollees aged 65 and older participating in a prospective longitudinal cohort study of dementia and normal aging and their 56 primary care providers formed the study population. Measurements: Incident ADL disability, defined as any new onset of difficulty performing any of the basic ADLs at follow-up assessments, was examined in relation to provider characteristics and practice style using logistic regression and adjusting for case-mix, patient and provider factors associated with ADL disability, and clustering by provider. Results: Neither provider experience taking care of large numbers of elderly patients nor having a certificate of added qualifications in geriatrics was associated with patient ADL disability at 2 or 4 years of follow-up (adjusted odds ratio (AOR) for experience=1.29, 95% confidence interval (CI)=0.81,2.05; AOR for added qualifications=0.72, 95% CI=0.38,1.39; results at 4 years analogous). A practice style embodying traditional geriatric principles of care was not associated with a reduced likelihood of ADL disability over 4 years of follow-up (AOR for prescribing no high-risk medications=0.56, 95% CI=0.16,1.94; AOR for managing geriatric syndromes=0.94, 95% CI=0.40,2.19; AOR for a team care approach=1.35, 95% CI=0.66,2.75). Conclusion: Taking care of a large number of elderly patients, obtaining a certificate of added qualifications in geriatrics, and practicing with a traditional geriatric orientation do not appear to influence the development of ADL disability in elder, community dwelling HMO enrollees. [source] Early differentiation and migration of cranial neural crest in the opossum, Monodelphis domesticaEVOLUTION AND DEVELOPMENT, Issue 2 2003Janet L. Vaglia SUMMARY Marsupial mammals are born at a highly altricial state. Nonetheless, the neonate must be capable of considerable functional independence. Comparative studies have shown that in marsupials the morphogenesis of many structures critical to independent function are advanced relative to overall development. Many skeletal and muscular elements in the facial region show particular heterochrony. Because neural crest cells are crucial to forming and patterning much of the face, this study investigates whether the timing of cranial neural crest differentiation is also advanced. Histology and scanning electron microscopy of Monodelphis domestica embryos show that many aspects of cranial neural crest differentiation and migration are conserved in marsupials. For example, as in other vertebrates, cranial neural crest differentiates at the neural ectoderm/epidermal boundary and migrates as three major streams. However, when compared with other vertebrates, a number of timing differences exist. The onset of cranial neural crest migration is early relative to both neural tube development and somite formation in Monodelphis. First arch neural crest cell migration is particularly advanced and begins before any somites appear or regional differentiation exists in the neural tube. Our study provides the first published description of cranial neural crest differentiation and migration in marsupials and offers insight into how shifts in early developmental processes can lead to morphological change. [source] Depressive Symptoms in Middle Age and the Development of Later-Life Functional Limitations: The Long-Term Effect of Depressive SymptomsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Kenneth E. Covinsky MD OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61. PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS. MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves. RESULTS: Eight hundred eighty-seven (12%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06,2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25,1.66). CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age. [source] Anemia and its impact on function in nursing home residents: What do we know?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 1 2010CRNP Assistant Professor, Valerie K. Sabol PhD Purpose: To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes. Data Sources: Literature review of current peer-reviewed research articles. Conclusions: In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community-dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes. Implications for Practice: Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence-based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence. [source] Energetic Adaptation to Chronic Disease in the ElderlyNUTRITION REVIEWS, Issue 3 2000Michael J. Toth Ph.D. Several chronic diseases occur with increased prevalence in the elderly. Body weight loss is a common feature of many chronic diseases. Weight loss increases the risk for morbidity and mortality and contributes to decreased functional independence and poor quality of life. Thus, an understanding of the effect of chronic disease on energy balance has important implications for nutritional supplementation and clinical outcome. This brief review will consider recent studies that have examined the effect of several chronic diseases (i.e., Alzheimer's disease, Parkinson's disease, and congestive heart failure) on daily energy expenditure in elderly individuals. Additionally, we put forth a model to explain the energetic adaptation to chronic disease in the elderly that is based on measurements of daily energy expenditure and its components. Studies suggest that chronic disease decreases daily energy expenditure in elderly individuals due to a marked reduction in physical activity energy expenditure. Moreover, these changes in daily energy expenditure often occur in the presence of increased resting energy expenditure. Thus, the net effect of chronic disease is to decrease daily energy expenditure. These results do not favor the hypothesis that increased energy expenditure contributes to disease-related weight loss. Instead, reduced energy intake appears to be a more likely mediator of the negative energy imbalance and weight loss that frequently accompany chronic disease in the elderly. [source] Frequency of the sit-to-stand task: a pilot study of free-living adultsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2008Andy Kerr Purpose.,To report contemporary data on the daily frequency of the sit-to-stand (STS) movement in a healthy, independently living, adult population.,Relevance.,As a key determinant of functional independence, which has a high mechanical load, the STS movement is a common feature of rehabilitation. Knowledge of STS frequency during daily activities could inform rehabilitation goals and content, but has rarely been examined. To date, only McLeod et al. (1975) have investigated this, reporting an average of 92 daily STS transitions in healthy young participants.,Methods.,Fifteen healthy, free-living, ambulant adults (three males; mean age 40 years) were recruited from the general population. An activity monitor (activPALTM, PALtechnologies, Glasgow, UK) reported free-living activity for each subject for seven consecutive days.,Analysis.,The average number of STS transitions per day was calculated from the whole period. Data were separated into working and non-working days, and compared using a paired t-test.,Results.,On average, participants performed 64 (±19) STS movements each day, with large individual differences [range 35,105]. Participants performed significantly (p = 0.047) more STS movements on a working day [68 (±24)] than on a non-working day [55 (±17)].,Discussion.,Fewer STS movements were recorded than previously reported (McLeod et al., 1975). This may reflect general changes in lifestyle; however, comparisons should consider the small samples involved and methodological differences.,Conclusion.,This study provides contemporary data for STS frequency and demonstrates a significant difference between working and non-working days. This information could guide rehabilitation and future research. Copyright © 2008 John Wiley & Sons, Ltd. [source] Too Close for Comfort: Inadequate Boundaries With Parents and Individuation in Late Adolescent GirlsAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2009Ofra Mayseless PhD This longitudinal study examined the ramifications of psychological control-guilt induction, parentification, triangulation, and blurring in parent-adolescent relationships for girls' individuation and adjustment. The study followed 120 girls in their transition from high school to military service. Results from the variable-centered and person-centered analyses merged in underscoring the somewhat different developmental path of two groups of inadequate boundary constellations. The group with high guilt induction and psychological control, which involves rejection and invalidation of the child's autonomous self, evinced the worst coping and adjustment to the transition and the lowest level of individuation with a combination of angry entanglement and strivings for overindependence. The blurred-parentified group resembled the adequate boundaries group regarding some indicators (e.g., low levels of engulfment anxiety and high conflictual independence), but further revealed overdependence and immaturity (e.g., high nurturance seeking, low emotional independence, and the lowest functional independence). Implications for preventive work with adolescents and their families are suggested. [source] Planum parietale of chimpanzees and orangutans: A comparative resonance of human-like planum temporale asymmetryTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 1 2005Patrick J. Gannon Abstract We have previously demonstrated that leftward asymmetry of the planum temporale (PT), a brain language area, was not unique to humans since a similar condition is present in great apes. Here we report on a related area in great apes, the planum parietale (PP). PP in humans has a rightward asymmetry with no correlation to the L>R PT, which indicates functional independence. The roles of the PT in human language are well known while PP is implicated in dyslexia and communication disorders. Since posterior bifurcation of the sylvian fissure (SF) is unique to humans and great apes, we used it to determine characteristics of its posterior ascending ramus, an indicator of the PP, in chimpanzee and orangutan brains. Results showed a human-like pattern of R>L PP (P = 0.04) in chimpanzees with a nonsignificant negative correlation of L>R PT vs. R>L PP (CC = ,0.3; P = 0.39). In orangutans, SF anatomy is more variable, although PP was nonsignificantly R>L in three of four brains (P = 0.17). We have now demonstrated human-like hemispheric asymmetry of a second language-related brain area in great apes. Our findings persuasively support an argument for addition of a new component to the comparative neuroanatomic complex that defines brain language or polymodal communication areas. PP strengthens the evolutionary links that living great apes may offer to better understand the origins of these progressive parts of the brain. Evidence mounts for the stable expression of a neural foundation for language in species that we recently shared a common ancestor with. © 2005 Wiley-Liss, Inc. [source] NS12 THE MANAGEMENT OF SPASTICITY IN THE SPINAL INJURED PATIENTANZ JOURNAL OF SURGERY, Issue 2007R. H. Acland Spasticity is one of the hallmarks of the upper motor neurone syndrome which occurs following injury to the spinal cord anywhere above the level of the conus medullaris (approx L1). Early effective management of spasticity can prevent a multitude of complications. Persistent spasticity can result in contractures which significantly impair functional independence. There is a long history of the use of various surgical interventions for this complication. Physical therapy is pivotal in the overall management. A variety of pharmacological approaches are commonly used, however efficacy has to be balanced against adverse effects. The botulinum industry has limited benefit but can be useful in focal spasticity. In this presentation I will discuss the use of baclofen delivered via intrathecal catheters connected to sophisticated implanted pumps. In Christchurch we have had a multidisciplinary team providing this service for New Zealand. I will provide the results of our eight years experience in the use of intrathecal baclofen therapy (ITB). Assessment, baclofen pharmacology, surgical technique, efficacy, complications and costs will be discussed. The future challenges will also be highlighted. [source] Clock drawing from the occupational therapy adult perceptual screening test: Its correlation with demographic and clinical factors in the stroke populationAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2010Deirdre M. Cooke Background/aim:,The aim of this study was to explore the relationships between clock drawing ability following stroke, and key clinical variables including cognition, functional independence, side and type of stroke, educational level and age. Methods:,One hundred and ninety-seven people with stroke were recruited from 12 hospital and rehabilitation facilities. The participants' scores from the Clock Drawing Test in the Occupational Therapy Adult Perceptual Screening Test were the dependent variables and were entered into logistic regression with Functional Independence Measure motor scores, side of stroke, Oxfordshire Classification System of Stroke, educational level and age as independent variables. Correlation with the Mini-Mental State Examination was analysed independently, due to its strong correlation with other variables. Results:,The Mini-Mental State Examination correlated significantly with the Clock Drawing Test ( Exp (B) = 0.826, P < 0.001). In the multivariate analysis, a significant relationship was found with age (Exp ( B) = 1.052, P < 0.001), Functional Independence Measure , motor (Exp (B) = 0.984, P = 0.030) and side of stroke (Exp (B) = 0.384, P = 0.003). Age demonstrated the strongest correlation with the Clock Drawing Test ability and the greatest decline was from approximately 70 years of age. Conclusions:,The Clock Drawing Test may be a useful and quick screen of cognitive impairments following stroke. Age-related decline must be considered and it is essential that clinicians use this only as a strategy to determine whether a more comprehensive assessment is required. [source] Music therapy in physical medicine and rehabilitationAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2000Stanley Paul The therapeutic effects of music are being recognized increasingly in the field of rehabilitation medicine. More music therapists are being employed in physical medicine and rehabilitation centres, with the goal of using music therapy services to assist in the physical recovery and health maintenance of clients. In spite of the benefits of physical rehabilitation programs, client participation to their full potential is often not observed. Music encourages participation in exercises and activities. Music can ease the discomfort and difficulty associated with exercise and therapy activities, and help ensure consistent participation. One of the goals of the music therapist is to provide a means for the client to express him/herself in a musical activity. Music therapy and rehabilitation medicine are starting to find a common niche in working together with clients who have various neurological, orthopaedic, and paediatric conditions. Therapeutic application of music in rehabilitation contributes to the quality of life of individuals with disabilities. Combined goals could include improving strength, range of motion, balance, communication, and cognition. Continued efforts in clinical practice and research will build on the information already available to further define possible applications of music therapy in rehabilitation, and its outcome and benefits. Occupational therapists can use the therapeutic medium of music, and the services of the music therapy discipline, in assisting clients to maximize their functional independence in their daily occupational roles. [source] Combined thrombolysis with abciximab and rtPA in patients with middle cerebral artery occlusionACTA NEUROLOGICA SCANDINAVICA, Issue 1 2010G. Gahn Background,,, In patients with acute middle cerebral artery (MCA) occlusion, recanalization rates with intravenous (IV) recombinant tissue plasminogen activator (rtPA) are limited. Aim, We evaluated the feasibility and safety of combined IV thrombolysis with abciximab and reduced dose rtPA in a 3- to 6-h time window. Methods,,, We prospectively (March 2002 to February 2005) studied patients with symptomatic MCA occlusion on computed tomography (CT) angiography and absence of major early ischemic changes (EIC) on non-contrast CT (NCCT) within 3,6 h from symptom onset. Patients were treated with IV abciximab and half-standard dose rtPA. Outcome parameters were symptomatic intracerebral hemorrhage (sICH), early clinical improvement and functional independence at discharge (modified Rankin Scale score , 2). Results,,, Of 13 patients, mean age was 62 ± 11 years, onset-to-treatment time 4.8 ± 0.9 h and median baseline National Institutes of Health Stroke Scale score 11 (interquartile range 6.5,13.5). sICH occurred in one patient (8%). We observed early clinical improvement in four patients (31%). Six patients (46%) were functionally independent at discharge. Conclusions,,, In patients with acute symptomatic MCA occlusion and absence of major EIC on NCCT, combined IV thrombolysis with abciximab and half-standard dose rtPA was feasible and seemed to be safe if applied within 3,6 h from symptom onset. [source] | |||||||||||||