Accuracy of prediction of walking for young stroke patients by use of the FIM

Relationship between characteristics of segmental phase angles and walking ability in patients with hemiplegia after stroke and traumatic brain injury in a convalescent rehabilitation ward

This study determined the characteristics of the phase angles (PhAs) of the trunk, affected limb, and unaffected limb at admission and their relationship with walking ability at discharge in patients with stroke and traumatic brain injury in a convalescent rehabilitation ward. Stroke and traumatic brain injury survivors with hemiplegia admitted to a convalescent rehabilitation ward were divided into independent- and dependent-walking groups. The trunk, affected limb, and unaffected limb PhAs were evaluated using bioelectrical impedance analysis and compared between the independent- and dependent-walking groups. Friedman's test was performed to analyze differences in the trunk, affected limb, and unaffected limb PhAs within each group. Multiple regression was performed to examine the association between walking ability and segmental PhAs. We enrolled 47 patients (independent-walking group: n  = 12; dependent-walking group: n  = 35). The dependent-walking group had a significantly lower trunk, affected limb, and unaffected limb PhAs. The segmental PhA was higher in the trunk than in the affected and unaffected limbs in the independent-walking group and lower in the affected limb than in the trunk and unaffected limb in the dependent-walking group. Only the trunk PhA at admission was significantly associated with walking ability at discharge ( β = 0.367; P  = 0.002). The trunk PhA at admission may be related to walking ability at discharge in patients undergoing stroke and traumatic brain injury rehabilitation.

Use of the Functional Independence Measure in people for whom weaning from mechanical ventilation is difficult

BACKGROUND

The Functional Independence Measure (FIM) has been proposed as an outcome measure for people receiving pulmonary rehabilitation after an acute exacerbation of chronic obstructive pulmonary disease. Objective The purpose of this study was to examine the clinical utility of the FIM after a weaning program in people for whom weaning from mechanical ventilation is difficult. Design This was a retrospective observational study.

METHODS

People who had had a tracheostomy, for whom weaning from mechanical ventilation was difficult, and who were participating in a weaning program (WP group) were retrospectively evaluated. People receiving pulmonary rehabilitation after an acute exacerbation of chronic obstructive pulmonary disease (PR group) were included as a validated control group. The scores on the FIM questionnaire and the Medical Research Council dyspnea scores were assessed at admission to and at discharge from the programs.

RESULTS

Admission and discharge data from 56 participants in the WP group and 63 participants in the PR group were compared. At admission, according to the FIM, 5 participants in the WP group (7.7%) were defined as functionally independent, 34 (52.3%) were defined as partially dependent, and 26 (40.0%) were defined as completely dependent. At discharge, the mean FIM global score was significantly improved, from 47.9 (SD=22.8) to 62.6 (SD=30.0). For participants in the WP group, changes in the FIM score were significantly inversely related to the admission Acute Physiology and Chronic Health Evaluation (R=-.286) and Simplified Acute Physiology (R=-.293) scores and directly related to the admission FIM score (R=.355). At admission, 46 participants in the PR group (67.7%) were defined as functionally independent, 19 (27.9%) were defined as partially dependent, and 3 (4.4%) were defined as completely dependent. After pulmonary rehabilitation, the mean FIM global score was significantly improved, from 97.4 (SD=27.5) to 102.5 (SD=25.7). Limitations The study was not randomized and involved a relatively small sample size.

CONCLUSIONS

The FIM can be used as a functional status outcome measure in people for whom weaning from mechanical ventilation is difficult.

Early cycling test as a predictor of walking performance in stroke patients

BACKGROUND AND PURPOSE

To assess the relative contribution and the predictive value of an early cycling test to walking performance three months after stroke.

METHOD

This follow-up study included subjects who were inpatients after afirst stroke (n=44). A cycling test was performed at the beginning of rehabilitation, followed by three-months' post-stroke evaluation of walking performance. The independent variables were the ability to cycle at constant rhythm of 50 rpm, without and with resistance, lower extremity motor strength and walking function, scored by the Scandinavian Stroke Scale. Dependent variables were gait velocity, distance and stair-climbing three months after stroke.

RESULTS

Multiple linear regression analysis demonstrated that rhythmic, constant cycling is the best predictor of walking velocity (r2 = 0.4), gait distance (r2 = 0.2) and number of stairs climbed (r2 = 0.26). Lower extremity motor strength and walking function had no additional separate contribution to the prediction of study outcomes.

CONCLUSIONS

The inability to cycle at a constant rhythm for one minute, two weeks after stroke is a more significant predictor than lower extremity motor strength or walking function of walking performance at three months post-stroke.