Objective: Patients with non-traumatic rupture of an aneurysm located at the anterior communicating artery (ACoA) often experience cognitive disabilities. It is unknown whether location of aneurysm ...also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim was to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at discharge from rehabilitation. Additionally, age and FIM at admission were explored.
Method: Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data were analyzed using multivariable logistic regression.
Results: Patients with ACoA were admitted with poorer cognitive FIM (median 6 (IQR 5-14) compared to patients with aneurysms located elsewhere (median 12 (IQR 6-23) (p = 0.0129); no difference at discharge. No association between aneurysm location and functional independence was observed. Higher age was associated with poorer outcome in bowel management OR 0.54 (95% CI 0.31-0.92), bladder management OR 0.59 (95% CI 0.35-0.98), comprehension OR 0.53 (95% CI 0.30-0.94), and memory OR 0.48 (95% CI 0.25-0.93). Overall, FIM at admission was associated with functional independence at discharge with the exception of stair walking and bladder management which did not reach statistical significance.
Conclusion: ACoA was not associated with poorer level of functional independence compared to patients with a-SAH located elsewhere. Higher age was associated with poorer outcome in continence, comprehension, and memory, whereas higher FIM was associated with better functional independence across items at discharge.
Abstract
BACKGROUND
Cranioplasty after decompressive craniectomy is a common neurosurgical procedure, yet the optimal timing of cranioplasty has not been well established.
OBJECTIVE
To investigate ...whether the timing of cranioplasty is associated with differences in neurological outcome.
METHODS
A systematic literature review and meta-analysis was performed using MEDLINE, Scopus, and the Cochrane databases for studies reporting timing and neurological assessment for cranioplasty after decompressive craniectomy. Pre- and postcranioplasty neurological assessments for cranioplasty performed within (early) and beyond (late) 90 d were extracted. The standard mean difference (SMD) was used to normalize all neurological measures. Available data were pooled to compare pre-cranioplasty, postcranioplasty, and change in neurological status between early and late cranioplasty cohorts, and in the overall population.
RESULTS
Eight retrospective observational studies were included for a total of 528 patients. Studies reported various outcome measures (eg, Barthel Index, Karnofsky Performance Scale, Functional Independence Measure, Glasgow Coma Scale, and Glasgow Outcome Score). Cranioplasty, regardless of timing, was associated with significant neurological improvement (SMD .56, P = .01). Comparing early and late cohorts, there was no difference in precranioplasty neurological baseline; however, postcranioplasty neurological outcome was significantly improved in the early cohort (SMD .58, P = .04) and showed greater magnitude of change (SMD 2.90, P = .02).
CONCLUSION
Cranioplasty may improve neurological function, and earlier cranioplasty may enhance this effect. Future prospective studies evaluating long-term, comprehensive neurological outcomes will be required to establish the true effect of cranioplasty on neurological outcome.
This study analysed correlations between post-stroke, quantitative electroencephalographic (QEEG) indices, and cognition-specific, functional outcome measures. Results were compared between QEEG ...indices calculated from the standard 19 versus 4 frontal (or 4 posterior) electrodes to assess the feasibility and efficacy of employing a reduced electrode montage. Resting-state EEG was recorded at the bedside within 62–101h after onset of symptoms of middle cerebral artery, ischaemic stroke (confirmed radiologically). Relative power for delta, theta, alpha and beta, delta/alpha ratio (DAR) and pairwise-derived brain symmetry index (pdBSI) were averaged; over all electrodes (global), over F3, F4, F7, F8 (frontal) and P3, P4, T5, T6 (posterior). The functional independence measure and functional assessment measure (FIM–FAM) was administered at mean 105days post-stroke. Total (30 items) and cognition-specific (5 items) FIM–FAM scores were correlated with QEEG indices using Spearman's coefficient, with a Bonferroni correction. Twenty-five patients were recruited, 4 died within 3months and 1 was lost to follow-up. Hence 20 cases (10 female; 9 left hemisphere; mean age 68years, range 38–84) were analysed. Two QEEG indices demonstrated highly-significant correlations with cognitive outcomes: frontal DAR (ρ=−0.664, p≤0.001) and global, relative alpha power (ρ=0.67, p≤0.001). After correction there were no other significant correlations. Alpha activity – particularly frontally – may index post-stroke attentional capacity, which appears to be a key determinant of functional and cognitive outcomes. Likewise frontal delta pathophysiology influences such outcomes. Pending further studies, DAR from 4 frontal electrodes may inform early screening for post-MCA stroke cognitive deficits, and thereby, clinical decisions.
•Post-stroke cognitive deficits are common but screening for these is challenging.•We compare early post-stroke QEEG (global/regional indices) to cognitive outcomes.•Global relative alpha power was significantly correlated with cognitive outcomes.•Frontal delta-alpha power ratio was significantly correlated with cognitive outcomes.•DAR from 4 frontal electrodes may inform screening for post-stroke cognitive deficits.
Assessment of the association between anemia and recovery of physical disability in patients with functional impairment.
A retrospective cohort study.
A convalescent rehabilitation ward.
The subjects ...were patients undergoing convalescent rehabilitation due to neurologic disease, musculoskeletal disorders, or hospital-associated deconditioning. Patients were classified into 3 groups (no anemia; mild anemia men: hemoglobin of 11.0-12.9 g/dL; women: hemoglobin of 11.0-11.9 g/dL; and moderate/severe anemia hemoglobin < 11.0 g/dL) based on hemoglobin levels.
Not applicable.
The study outcomes were functional independence measures for motor function (FIM-M) score at discharge, changes in the FIM-M score between hospital admission and discharge, length of stay, and FIM-M efficiency score (change in FIM-M score divided by length of stay). A linear regression model was constructed to explore the association of anemia with the FIM-M efficiency score. As a subgroup analysis, we constructed a linear regression model to explore the association of anemia with the FIM-M efficiency score in patients with or without stroke.
Of 376 consecutive patients with a mean age of 80 years, 258 (69%) had mild or moderate/severe anemia. There were no significant differences between the 3 groups in the FIM-M score at discharge, changes in the FIM-M score, length of stay, and FIM-M efficiency score. A multiple linear regression model showed that the FIM-M efficiency score was not associated with anemia (mild anemia group: β=-0.02, P=.8; moderate/severe anemia group: β=-0.005, P=.9). In the subgroup analysis of patients with or without stroke, the multiple regression model also showed no significant association between anemia and FIM-M efficiency score in each group.
Anemia on admission was common among patients in a convalescent rehabilitation ward but was not associated with improvement of FIM-M after rehabilitation.
Excessive assistance may decrease stroke patients' physical activity and make them more dependent on assistance. We have structured a system that provides an ADL (activities of daily living) ...educational program that focuses on stroke patients' toileting in our daily clinical practice. Here, we investigated the effect of a functional independence measure (FIM) scale on the recovery of patients with acute stroke.We retrospectively collected the data of 407 stroke patients from the medical record system of our emergency hospital in Tsukuba, Japan. The enrolled stroke patients (n = 373) were divided into FIM and control groups. Both groups received the standard treatment, but for the FIM group, ward and rehabilitation staff calculated the toilet FIM score for patients 1 ×/wk. The FIM scale measures the amount of assistance a patient needs to perform activities of daily living and is often used in rehabilitation settings. The rehabilitation staff then instructed the ward staff about better assistance methods based on each patient's physical function and executive dysfunction. We evaluated the usefulness of the FIM scale was based on the patients' FIM scores at discharge and improvements in their scores.The recoveries of the total, motor, and cognitive FIM scores recovery at discharge were significantly greater in the FIM group compared with the control group (68.0 vs 45.0, P = .004; 41.0 vs 24.0, P = .005; and 24.0 vs 20.0, P = .007, respectively). The use of the FIM scale contributes to the patients' recovery of physical function and cognitive function.The FIM scale can contribute to stroke patients' recovery of activities of daily living.
Patients with Trousseau syndrome, a common complication of advanced cancer, typically have poor survival. For that reason, there is a need to determine the effectiveness of rehabilitation treatment ...and develop a comprehensive treatment strategy earlier than that in the general stroke population. We investigated the relationship between physical function and its outcome 1 month after the start of intensive rehabilitation treatment in patients with Trousseau syndrome, to obtain insights for determining the indications for intensive rehabilitation in these patients.
The development of Trousseau syndrome may worsen the performance status (PS), often necessitating a reevaluation of the indications for treatment of the primary cancer. Furthermore, the primary cancer may progress during rehabilitation therapy.
These patients were diagnosed with Trousseau syndrome.
All patients underwent training under the supervision of a therapist for 2 to 3 hours per day, 7 days per week, with a focus on exercise therapy. The functional independence measure (FIM) 1 month after admission to the convalescent rehabilitation ward, modified Rankin scale (mRS) score on admission and on the date of last assessment, and its outcome was examined.
The time from stroke onset to admission to rehabilitation ranged from 22 to 60 days. Primary cancers were lung, bladder, prostate, ovarian, uterine, and unknown primary. Four patients had advanced cancer with distant metastasis. Two patients were discharged to home with independent activities of daily living (ADL) status. Two patients were transferred to palliative care, and 3 patients died. The 2 patients with independent ADL status had a mean motor score of 90 and a mean cognitive score of 30 on FIM, while the other 5 patients had a mean motor score of 29 and a mean cognitive score of 21 at 1 month of admission. Patients with mRS > 3 on admission did not have independent ADL status at 1 month.
Intensive rehabilitation therapy may be indicated for patients with Trousseau syndrome who are expected to improve physical function after approximately 1 month of rehabilitation. Palliative care should be considered if recovery is inadequate.
Purpose The longitudinal changes in motor subscale scores of the Functional Independence Measure (FIM) of stroke patients discharged to home from a convalescence rehabilitation ward (CRW) were ...investigated. Participants and Methods Forty-one stroke patients who received home-based rehabilitation (HBR) immediately after discharge from CRW were enrolled in this retrospective cohort study. The 13 motor subscale scores of FIM were assessed at the time of discharge from CRW, a few days after discharge, and three months after discharge, and together with the sum of motor scores were compared among the three times. Results A few days after discharge from CRW, sphincter control (bowel management) had improved, while the locomotion (walking) score had decreased. Three months after CRW discharge, scores of the self-care subscales (eating, bathing, dressing-lower, and toileting), transfer subscales (bed, toilet, and tub), and locomotion scale (stairs) had improved. On the other hand, scores of grooming, dressing-upper, and the locomotion subscales had not changed. Conclusion The results of this study suggest that each motor subscale of FIM shows a distinct change during the course of community living after discharge from CRW.
Abstract
Purpose: This systematic review summarizes the utility of variables available at acute discharge after stroke for predicting functional independence at discharge from inpatient ...rehabilitation. Methods: A systematic review of four electronic databases (Medline, EMBASE, PsycINFO and CINAHL) was conducted to identify studies reporting multivariable models predicting post-rehabilitation Barthel Index (BI) or Functional Independence Measure (FIM®) scores. In studies meeting inclusion criteria, the frequency with which candidate predictors were found statistically significant was calculated and summarized. Results: A total of 3260 articles were screened, of which 27 were included and 63 multivariable models of discharge BI or FIM® were reported. In all, 126 candidate predictors of BI or FIM® were explored. Variables found to be significant most frequently included admission functional level (BI or FIM®), National Institute of Health Stroke Scale (NIHSS), dysphasia, impulsivity, neglect, previous stroke, and age. Conclusions: Only a selected group of variables have repeatedly proven to be significant predictors of functional ability after post-stroke inpatient rehabilitation.
Implications for RehabilitationThis review identifies, and summarizes, studies that have used a multivariable model to predict Barthel Index (BI) or Functional Independence Measure (FIM®) after post-stroke inpatient rehabilitation.Clinicians making decisions about admission to inpatient rehabilitation should consider age and a measure of stroke severity, functional status and progress to date.Variables that have been demonstrated to be useful most commonly included age, admission functional level (BI or FIM), National Institute of Health Stroke Scale, dysphasia, impulsivity, neglect, and previous stroke.
IntroductionRecently, a method was developed to predict the motor Functional Independence Measure (FIM) score at discharge in patients with stroke by stratifying the effects of factors such as age ...and cognitive function and multiplying those by the influence coefficients of these factors. However, an evaluation of the predictive performance of the method is required for clinical application. The present study aimed to evaluate the predictive performance of this prediction method.MethodsPatients with stroke discharged from a rehabilitation ward between April 2021 and September 2022 were included. Predicted values of the motor FIM score at discharge were calculated after data collection from the hospital’s patient database. The concordance between predicted and actual values was evaluated using the interclass correlation coefficient; moreover, the residual values were calculated.ResultsIn total, 207 patients were included in the analysis. The median age was 79 (69–85) years, and 112 (54.1%) patients were male. The interclass correlation coefficient between predicted and actual values was 0.84 (95% confidence interval 0.75–0.89) for the motor FIM score at discharge. Meanwhile, the median residual value was 5.3 (−2.0–10.3) for the motor FIM score at discharge.DiscussionThe prediction method was validated with good performance. However, the residual values indicated that some cases deviated from the prediction. In future studies, it will be necessary to improve the predictive performance of the method by clarifying the characteristics of cases that deviate from the prediction.
Background:
It is important to predict poststroke cognitive outcome to guide individualized treatment and prevention strategy. We aimed to evaluate the predictive value of the combination of a serum ...biomarker for axonal damage (neurofilament light chain NfL) and neuroimaging markers (volume of infarction and white matter hyperintensities WMH) for neuronal abnormality in poststroke cognitive outcome.
Methods:
A total of 1028 patients were screened; among them, 144 patients with acute ischemic stroke (stroke group) and 30 patients without stroke (control group) were enrolled. Serum NfL levels of samples obtained from both groups were measured through single molecule array assay. Neuroimaging markers of neuroaxonal injury, including infarct volume and WMH in the stroke group were quantified on magnetic resonance images using an in-house MATLAB code (MATLAB 2017; MathWorks). The primary outcome was the functional independence measure (FIM) cognitive subscores on discharge. We assessed the association of serum NfL levels and neuroimaging markers with cognitive outcome. The prognosis value of the combination of serum NfL levels and imaging markers for predicting FIM cognitive subscores on discharge was calculated using the area under curve (AUC) of the receiver operating characteristic.
Results:
Serum NfL levels of the stroke group were 9-fold higher than those of the control group (1449.7 vs 157.2 pg/mL, n = 144/30, P < .001). There was a correlation of serum NfL levels with infarct volume (r = 0.530, P < .001) and functional outcome, including FIM cognitive subscores (r = −0.387, P < .001) and FIM motor subscores on admission (r = −0.306, P < .001), but not with WMH volume after adjusting for infarct volume (r = −0.196, P = .245). Serum NfL levels on admission independently predicted poststroke FIM cognitive subscores on discharge (AUC = 0.672, P < .001). The predictive value for poststroke cognitive outcome was improved by combining serum NfL levels with infarct and WMH volume (AUC = 0.760, P < .001).
Conclusion:
The combination of serum NfL levels with volume of infarct and WMH shows an improved predictive value for cognitive function during acute rehabilitation phase after stroke, providing a promising panel of biomarkers for prognosis and guidance of treatment.
