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Independence Measure (independence + measure)
Kinds of Independence Measure Selected AbstractsEffectiveness of a community-based 3-year advisory program after acquired brain injuryEUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007E. Grill Objective of this study was to examine the effectiveness of a coordinated, community based 3-year advisory program in 1534 patients with acquired brain injury. Patients and caregivers were offered a coordinated advisory program after discharge from rehabilitation. Patients in the historical control group received standard aftercare. The main outcomes were functional status [Functional Independence Measure (FIM)], and days spent in the acute hospital. The secondary outcome was survival. Patients were comparable for sex (intervention: 41.3% female, control: 38.0%), and younger in the control group (mean age intervention: 55.3, control: 49.6). Functional status at discharge was lower in the intervention group (mean FIM intervention: 66.2, control: 80.3). Patients in the intervention group experienced a moderate gain in FIM. Rate of days in hospital was 15.4 per 1000 person days (intervention) and 15.5 per 1000 person days (control). Patients of the intervention group had an increased rate of days in hospital. A total of 16.0% of patients in the intervention group and 19.3% in the control group died during follow-up. Patients in the intervention had a significant lower mortality risk depending on follow-up period and discharge FIM. The advisory program may be effective for all patients with acquired brain injury. [source] Cerebral blood flow in patients with diffuse axonal injury , examination of the easy Z -score imaging system utilityEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2007T. Okamoto To evaluate the utility of easy Z -score imaging system (eZIS) in 27 diffuse axonal injury (DAI) cases. Twenty-seven DAI patients were examined with an magnetic resonance imaging (MRI) T2* sequence and with eZIS (seven women, 20 men; age range, 19,35 years; median age: 26.6 years). In this investigation, we excluded patients who exhibited complications such as acute subdural hematoma, acute epidural hematoma, intracerebral hematoma, or brain contusion. We examined the neuropsychological tests and correlated with findings from MRI/eZIS. Furthermore, we evaluated the degree of ventricular enlargement in the bifrontal cerebroventricular index (CVI). Patients were divided into two groups: the enlargement group (bifrontal CVI > 35%, 12 patients) and the non-enlargement group (bifrontal CVI < 35%, 15 patients). All of the patients showed cognitive deficits as observed from the neuropsycological test results. Fifteen out of 27 patients by MRI T1/T2 weighted images and fluid attenuated inversion recovery (FLAIR), 22 out of 27 patients by MRI T2* weighted images and 24 out of 27 patients by eZIS showed abnormal findings. In MRI T2* weighted imaging, the white matter from the frontal lobe, corpus callosum, and brainstem showed abnormal findings. With eZIS, 22 patients (81.5%) showed blood flow degradation in the frontal lobe, and 12 patients (44.4%) in cingulate gyrus. In the enlargement group, Functional Independence Measure, Mini-Mental State Examination, Verbal IQ (VIQ)/Full Scale IQ (FIQ), Trail Making Test-B (TMT-B), and Non-paired of Miyake Paired Test were significantly lower. Amongst 12 patients without ventricular enlargement who had no abnormal findings in MRI T1/T2 weighted images and FLAIR, abnormal findings were detectable in seven patients with MRI T2* weighted imaging and to 10 patients with eZIS. Results of the MRI examination alone cannot fully explain DAI frontal lobe dysfunction. However, addition of the eZIS-assisted analysis derived from the single photon emission computed tomography (SPECT) data enabled us to understand regions where blood flow was decreased, i.e., where neuronal functions conceivably might be reduced. [source] Evaluation of a German version of the Rivermead Mobility Index (RMI) in acute and chronic stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2000M. R. Schindl The English Rivermead Mobility Index (RMI) has been proposed as a simple, valid and reliable measure in stroke rehabilitation. A German version was established and validated in two centres. In centre A 46 acute (median: 3.0 days after onset) and in centre B 151 chronic (median: 88.0 days after onset) stroke patients participated. Interrater reliability of the German RMI was tested in 12 subjects in the acute stage of stroke and was found to be statistically significant (r = 0.98, P < 0.0001). In centre A, a statistically significant correlation was found between the German RMI and the 10-m walk time at baseline (r = 0.73, P < 0.0001) and after three weeks (r = 0.92, P < 0.0001). In centre B, the German RMI correlated significantly with the motor part of the Functional Independence Measure (motor-FIM) on admission (r = 0.78, P < 0.0001) and after three weeks (r = 0.79, P < 0.0001), respectively. The change of the RMI correlated significantly with the change in 10-m walk time in acute patients (r = 0.87, P < 0.0001) and with the change in motor-FIM in chronic patients (r = 0.54, P < 0.0001). A moderate ceiling-effect was detected in the chronic study population. The German RMI appears to be a reliable, valid and responsive measure for mobility disability in acute and chronic stroke patients. [source] Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Joseph G. Ouslander MD Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes. Design: Randomized, controlled, crossover trial. Setting: Four VA nursing homes. Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55). Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial. Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios. Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were "responders" based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period. Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care. [source] Neurorehabilitation of Upper Extremities in Humans with Sensory-Motor ImpairmentNEUROMODULATION, Issue 1 2002Dejan B. Popovic PhD Abstract Today most clinical investigators agree that the common denominator for successful therapy in subjects after central nervous system (CNS) lesions is to induce concentrated, repetitive practice of the more affected limb as soon as possible after the onset of impairment. This paper reviews representative methods of neurorehabilitation such as constraining the less affected arm and using a robot to facilitate movement of the affected arm, and focuses on functional electrotherapy promoting the movement recovery. The functional electrical therapy (FET) encompasses three elements: 1) control of movements that are compromised because of the impairment, 2) enhanced exercise of paralyzed extremities, and 3) augmented activity of afferent neural pathway. Liberson et al. (1) first reported an important result of the FET; they applied a peroneal stimulator to enhance functionally essential ankle dorsiflexion during the swing phase of walking. Merletti et al. (2) described a similar electrotherapeutic effect for upper extremities; they applied a two-channel electronic stimulator and surface electrodes to augment elbow extension and finger extension during different reach and grasp activities. Both electrotherapies resulted in immediate and carry-over effects caused by systematic application of FET. In studies with subjects after a spinal cord lesion at the cervical level (chronic tetraplegia) (3,5) or stroke (6), it was shown that FET improves grasping and reaching by using the following outcome measures: the Upper Extremity Function Test (UEFT), coordination between elbow and shoulder movement, and the Functional Independence Measure (FIM). Externally applied electrical stimuli provided a strong central sensory input which could be responsible for the changes in the organization of impaired sensory-motor mechanisms. FET resulted in stronger muscles that were stimulated directly, as well as exercising other muscles. The ability to move paralyzed extremities also provided awareness (proprioception and visual feedback) of enhanced functional ability as being very beneficial for the recovery. FET contributed to the increased range of movement in the affected joints, increased speed of joint rotations, reduced spasticity, and improved functioning measured by the UEFT, the FIM and the Quadriplegia Index of Function (QIF). [source] Mobility on discharge from an aged care unitPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2007Edward Gorgon Abstract Background and Purpose.,Independent mobility is a crucial element of independent living and quality of life. However, little is known about the mobility of older people around the time of discharge from inpatient rehabilitation. The present study aimed to describe mobility on discharge from an aged care rehabilitation unit. Method.,The study utilized a descriptive, cross-sectional design. Ninety-five patients (mean age 81 (±8) years; 60% female) with diverse chronic conditions (median 5) who were able to walk at least 10,m without weight-bearing restrictions were recruited from the aged care rehabilitation wards. Scores on the Barthel Index were obtained on admission and discharge to provide information about their overall level of function. Within the last week of rehabilitation stay, scores on the mobility and locomotion subsections of the Functional Independence Measure, gait velocity, and time and distance parameters of gait were obtained. Gait variables were measured by use of the GAITRiteTM, an instrumented walkway. Medians and interquartile ranges (IQR) were reported for mobility variables. Results.,Following inpatient rehabilitation, many patients achieved independence in bed or chair transfers (83%), toilet transfers (81%), shower transfers (60%) and level-surface walking (74%). Only 31% achieved independence in stair climbing. Patients walked slowly at a median (IQR) gait velocity of 45.96 (31.51) cm/s and with markedly diminished cadence and step length. Subjects with a low number of chronic conditions generally performed better on mobility measures than those with a high number of chronic conditions. Conclusions.,Although many older people are able to transfer and walk independently around the time of discharge from inpatient rehabilitation their mobility is still often impaired. For example, only 9.5% achieved a walking velocity considered to be adequate for street crossing and few demonstrated the ability to negotiate stairs. This highlights the need for ongoing rehabilitation for many of these older people. The possible cumulative effects of chronic conditions on mobility require further investigation. Copyright © 2006 John Wiley & Sons, Ltd. [source] Accuracy of prediction of walking for young stroke patients by use of the FIMPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2001Heather Thornton Senior Lecturer Abstract Background and Purpose Clinical prediction of walking outcome after a stroke is essential for effective discharge planning. However, its accuracy has hardly been explored. This study took place in a regional unit admitting patients with complex neurological disabilities for specialist inpatient rehabilitation. The aim was to compare predicted outcome (goal score) with achieved outcome (discharge score) on the seven-point locomotion subscale of the Functional Independence Measure (FIM), to evaluate its precision and identify factors influencing accuracy. Method Admission, goal and discharge scores were analysed retrospectively for 141 subjects (90 M; 51 F) admitted consecutively to the Unit with median age 54 years (range 15,68 years) with median length of stay 13.6 weeks (range 3,35 weeks). Results Ninety subjects (64%) gained from two to six points; 50 subjects (35%) gained one point or showed no change. One patient deteriorated by two points. Excluding patients admitted with the highest score (FIM level 7), the overall level of agreement between predicted and discharge scores was moderate (weighted kappa 0.47). Prediction was accurate to ±1 point in 113 subjects (80%). Overprediction by ,2 points occurred in 16 subjects (11%) and underprediction by ,2 points in 12 subjects (9%). Analysis of the most-disabled cohort, admitted with FIM levels 1 or 2 scores, revealed a higher sensitivity for predicting ,independence' (FIM levels 5,7) (78%) than ,dependence' (FIM levels 1,4) (65%). Accuracy was not affected by age, gender or side of stroke. Inaccurate predictions were associated with lower admission FIM level scores (p=,0.26;p=0.002) and a greater length of stay (p=0.36;p<0.001). Subjects with quad-riplegia were more likely to have inaccurate outcome predictions made than those with hemiplegia (p=0.025) and those with neglect were more likely to have inaccurate outcome predictions made than those without neglect (p=0.017). Conclusion Further investigation into clinical prediction and the variables which confound accuracy is needed for effective planning. Copyright © 2001 Whurr Publishers Ltd. [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] Agreement in activities of daily living performance after stroke in a postal questionnaire and interview of community-living personsACTA NEUROLOGICA SCANDINAVICA, Issue 6 2009Y. Daving Objective,,, To compare assessments of activities of daily living (ADL) made in a postal questionnaire and an interview. Design,,, Comparative study of a convenience sample. Subjects,,, Results in 36 persons with stroke >10 years previously. Methods,,, Data on ADL were gathered in a self-administered postal questionnaire followed by a semi-structured interview (within 1,2 weeks) using items in the Functional Independence Measure, combined with instrumental items, Instrumental Activity Measure or the ADL taxonomy (personal and instrumental items). Results,,, There was generally moderate to good agreement between the postal questionnaire and the interview. Other dependence identified was reported during the interviews. Although the operational descriptions of the items varied between the ADL indices, they primarily identified ADL independence in the same persons. Conclusion,,, The use of a self administrated postal ADL questionnaire was feasible for studying ADL performance. However, in some persons, interviews may be needed to complement the results. [source] Interpersonal leveling, independence, and self-enhancement: a comparison between Denmark and the US, and a relational practice framework for cultural psychology,EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY, Issue 3 2007Lotte Thomsen We argue that the relational model that people use for organizing specific social interactions in any culture determines whether people self-enhance. Self-enhancement is not a functional consequence of the (independent or interdependent) cultural model of self. Across three studies, Danes self-enhanced considerably less than did Americans but were more independent on the Twenty Statements Test, made more individual attributions about social life, made more autonomous scenario choices, and were more independent on the self-construal scale. Public modesty did not account for these Danish-American differences in self-enhancement. However, Danes practiced interpersonal leveling, preferring equality of outcome more than did Americans. This leveling strongly and inversely predicted self-enhancement within both cultures and mediated Danish-American differences in self-enhancement. In contrast, no independence measure systematically predicted self-enhancement within both cultures nor mediated the cultural differences in self-enhancement. This dissociation of independence and self-enhancement demonstrates that self-enhancing downward social comparisons are not functionally necessary for an independent concept of self. We conclude that social relationships, not the model of the self, mediate the mutual constitution of psyche and culture. Copyright © 2006 John Wiley & Sons, Ltd. [source] Long-Term Outcomes of Continuous Intrathecal Baclofen Infusion for Treatment of Spasticity: A Prospective Multicenter Follow-Up StudyNEUROMODULATION, Issue 3 2008Elmar M. Delhaas MD ABSTRACT Long-term outcomes of 115 patients treated with continuous intrathecal baclofen infusion are reported. A prospective follow-up study was conducted in eight centers. Patients were followed up over a 12-month period. The follow-up scores on the three spasticity scales (Ashworth, spasm, and clonus scales) were significantly lower at every follow-up visit in comparison to the intake score, except for the clonus scale scores at 12 months. Improvements in health-related quality of life (EQ-5D) and functionality (SIP-68, functional independence measure) were small and nonsignificant. A significant reduction in severity of self-reported personal problems rating scale was observed. Sixty-six patients had no adverse events. Types of adverse events reported were wound complications (22%), catheter problems (36%), cerebrospinal fluid leakage (25%), and other complications (17%). Intrathecal baclofen reduces spasticity and severity of patient-reported problems but its effect on quality of life and functionality is less apparent. Improvements are desired in selection criteria, design of spinal catheters, and outcome scales. [source] Auditory and visual distractor decrement in older worker manual assembly task learning: Impact of spatial reasoning, field independence, and level of education,HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 4 2009S. F. Wiker This study examined the impact of age on manual assembly task learning in the presence of visual and auditory distracters. Manual assembly task learning (e.g., number of learning trials needed to obtain consistently accurate assembly and near asymptote performance times) was studied in men and women between 18 and 65 years of age. Higher spatial reasoning capabilities were associated with fewer trials to reach the learning criterion, faster manual assembly times, and material prophylaxis for the type of distractors addressed in this study that are likely to be encountered in the workplace. Years of formal education and field independence showed no impact on distractor-based decrements in task learning. For the oldest group of subjects (>50 years), concomitant presentation of visual and auditory distractors that are commonly encountered in industry were associated with a greater number of learning trials that were needed to achieve asymptotic manual assembly task learning. Spatial reasoning and field independence measures were lower in the older than in the younger age groups (p < 0.05). When spatial reasoning was treated as a covariate, however, nearly all age differences found in learning performance in the face of distractors were removed. The findings suggest that selection of workers based on spatial reasoning ability, rather than age, would yield better manual task learning in the face of visual and auditory distraction. © 2009 Wiley Periodicals, Inc. [source] | ||||||||||