Comparing Traditional Service Delivery and Telepractice for Speech Sound Production Using a Functional Outcome Measure

This study explored the effects of oral communication and demographic characteristics on intervention receipt. Oral communication characteristics included speech-sound production and receptive and expressive language status. Demographic characteristics included race, sex, residential strata, and neighborhood income level. With regard to speech-sound production and language, 1,929 kindergartners were divided into four speech-language subgroups: speech impaired only, language impaired only, speech and language impaired, and normal in both speech and language. In terms of expressive and receptive language modalities, the group of children was divided into four expressive-receptive subgroups: expressive impaired only, receptive impaired only, expressive and receptive impaired, and normal in both expressive and receptive language. Associations of speech versus language and expressive language versus receptive language with intervention receipt were examined in both categorical and continuous manners. Results showed that speech had a stronger effect on intervention receipt than language, but that this difference could not be explained by the effect of speech on social and academic functions compared to that of language. Expressive language had a stronger effect on intervention receipt than receptive language (when treated as continuous variables). This also could not be explained by the effect of these variables on social and academic function. These results suggest that the current referral and service delivery system depends on communication characteristics that are expressive and, thus, most readily observable. This referral and service delivery approach, however, fails to identify children that have the greatest social and academic risks. Methods of reversing this trend were discussed. Among all demographic variables examined, only sex is related to intervention receipt, that is, boys were more likely to have received intervention.

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Assessment of Intensive Inpatient Rehabilitation Program in Acquired Brain Injury Patients using UK FIM+FAM Scale: A Retrospective Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49437.15280 ◽

2021 ◽

Author(s):

Harleen Uppal ◽

Shipra Chaudhary ◽

Siddharth Rai

Keyword(s):

Brain Injury ◽

Functional Outcome ◽

Outcome Measure ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

P Value ◽

Functional Outcome Measure ◽

The Uk

Introduction: Acquired Brain Injury (ABI) can lead to a combination of physical, cognitive, and behavioural impairments and requires comprehensive and structured inpatient rehabilitation program. A multidisciplinary rehabilitation program can deal comprehensively with all these issues together rather than focussing on a single aspect like motor function. Number of people suffering from Traumatic Brain Injury (TBI) in India has been documented to be between 1.5 million to two million per year whereas out of this approximately one million die due to TBI. The rationale of the present study was to document the outcome of multidisciplinary inpatient rehabilitation program objectively using a standard functional outcome measure. Aim: To determine the change in functional outcomes of ABI patients being rehabilitated with a multidisciplinary inpatient neurorehabilitation program using UK version of Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). Materials and Methods: The retrospective observational study was conducted in Medanta Hospital, Gurugram, Haryana, India, from September 2017 to June 2018. Retrospective analysis of previously maintained data was done from June 2018 to November 2018. Data was collected from the Department of Neurorehabilitation. Demographic data was collected including age, sex, type of injury, time from injury to admission and duration of stay in the neurorehabilitation unit. Functional outcome measure used in the study was the UK FIM+FAM. Data was collected in paper forms and collated in Microsoft Excel and transferred to IBM® Statistical Package for the Social Sciences (SPSS)® version 22.0 (IBM Corp., Armonk, NY) for analysis. The UK FIM+FAM data was analysed as aggregate total scores and motor and cognitive subscales. Non parametric tests were used as UK FIM+FAM is an ordinal scale. The test used to measure the change in score was Wilcoxon Test. The p-value <0.05 was considered statistically significant. Results: Total number of patients who were analysed in the study were 45. Motor subset of scores showed significant improvement from admission (50) to discharge (72) (p-value=0.001). Similarly, the cognitive subset of scores also showed a significant improvement from admission (58) to discharge (68, p value=0.002). Apart from motor and cognitive subscales of UK FIM+FAM, change in score in sub divisions of self-care and transfers showed the maximum change with p-value=0.001. Other sub divisions of locomotion, sphincter, communication, psychological and cognition also showed a significant difference of p-value <0.05. Conclusion: A physiatrist led intensive interdisciplinary inpatient rehabilitation program for patients with ABI may significantly reduce residual disability and improve functional independence. Such a program is not only effective in high income countries but also in Low Middle Income Countries (LMIC).

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