The Current State of Stroke Rehabilitation in Japan

1999 ◽  
Vol 13 (4) ◽  
pp. 219-223
Author(s):  
Yoshihisa Masakado ◽  
Naoichi Chino
Keyword(s):  
Regression Analysis ◽  
Chronic Conditions ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Stroke Outcome ◽  
Stroke Patients ◽  
Current State ◽  
Rehabilitation System

This paper presents the current state of stroke rehabilitation in Japan. The Japanese rehabilitation system is much different from those in other countries, mainly because of the Japanese insurance system, which covers from acute to chronic conditions. In this situation, a Japanese inpatient stroke rehabilitation program treats patients until they reach a plateau in impairment and disability. Thus we can evaluate the true func tional prognosis because of longer periods of observation for assessing the recovery pat tern of impairment and disability. As a result, we can predict stroke outcome much more precisely. We recently developed a new evaluation methods for stroke patients called the Stroke Impairment Assessment Set (SIAS) based on work from the Sym posium on Methodologic Issues in Stroke Outcome Research in 1989. Using the SIAS and the Functional Independence Measure, we have successfully predicted stroke out come using regression analysis.

Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

2001 ◽  
Vol 10 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Jan Coleman Gross ◽  
Stacey W. Goodrich ◽  
Mary E. Kain ◽  
Elizabeth A. Faulkner
Keyword(s):  
Nursing Care ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Two Factors ◽  
Staffing Needs ◽  
Care Index ◽  
Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Nneka Ifejika ◽  
Linda Aramburo-Maldonado ◽  
Chunyan Cai ◽  
Melvin R Sline ◽  
Elizabeth A Noser ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Assisted Living ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Advanced Age ◽  
Nursing Facilities ◽  
Stroke Patients ◽  
Home Discharge

Introduction: The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge. Hypothesis: Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement. Methods: We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression. Results: Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP). Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P<0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P<0.0001). For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P<0.001) compared to home. For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P<0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P<0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P<0.0001) compared to home. For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P<0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P<0.001). Conclusions: Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.

scholarly journals Correlation of Body Composition and Nutritional Status with Functional Recovery in Stroke Rehabilitation Patients

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1923 ◽  
Author(s):  
Hiroshi Irisawa ◽  
Takashi Mizushima
Keyword(s):  
Nutritional Status ◽  
Muscle Mass ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Risk Index ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Nutritional Risk ◽  
Stroke Patients ◽  
Nutritional Risk Index

Previous studies have suggested that the nutritional status after stroke is independently associated with long-term outcomes and that sarcopenia delays poststroke rehabilitation and worsens the prognosis. However, many stroke patients have a deteriorated nutritional status and a decreased muscle mass in the acute phase. This prospective study included 179 patients who were admitted to the stroke rehabilitation unit. We performed bioelectrical impedance analysis and determined the Geriatric Nutritional Risk Index (GNRI) to assess muscle mass and the nutritional status on admission. Furthermore, we analyzed the activities of daily living using the Functional Independence Measure (FIM) at the time of admission and four weeks later. Furthermore, we evaluated the change in motor FIM items and examined the relationship with the data. Multiple regression analysis revealed that a high muscle rate (skeletal muscle mass/body weight) (odds ratio OR = 2.43), high phase angle (OR = 3.32), and high GNRI (OR = 2.57) were significantly associated with motor FIM items at four weeks in male and female patients. Muscle mass maintenance through nutritional management and early rehabilitation in the acute period of stroke is essential for functional recovery in stroke patients.

scholarly journals EFFECTIVENESS OF ROBOTIC-ASSISTED GAIT TRAINING IN STROKE REHABILITATION: REVOLUTION IN PATIENT OUTCOME

2021 ◽  
Vol 9 (07) ◽  
pp. 1079-1087
Author(s):  
Amjad Annethattil ◽  
◽  
Joseph Prabahar Pushparaj ◽  
Ayman Sabbagh ◽  
Mohammad Farraj ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Gait Training ◽  
Functional Independence ◽  
Berg Balance Scale ◽  
Rehabilitation Program ◽  
P Value ◽  
Timed Up And Go ◽  
Robotic Assisted

Objective: To evaluate the effectiveness of robotic-assisted gait training (RAGT) in improving the functional outcomes among stroke survivors Design: Retrospective matched control study. Setting: Inpatients stroke unit, Qatar Rehabilitation Institute. Outcome Measures: The Functional Ambulation classification (FAC), The Functional independence measure (FIM), The Berg Balance Scale (BBS), The Dynamic Gait index (DGI), The Ten-meter walk test (10MWT), The timed up and Go test (TUG) and the Five times sit to stand (5XSTS) Data Analysis: A retrospective comparison of stroke patients who received robotic assisted gait training performed statistically using the 20th version of SPSS statistical package (SPSS Inc. Chicago, IL, USA) Study Procedures: The investigators reviewed the medical records, the physiotherapy treatment sessions records and data from the Clinical Management System of Qatar rehabilitation institute of the patients during the period from 1stJanuary 2018 to 31 December 2019. RAGT group was created to assign the patients who received more than four RAGT sessions. The other group was created from the patients who completed the stroke rehabilitation program without RAGT to cross match Conclusion: All the outcome measures were compared between admission and discharge regardless of their group and found that there was a good improvement in the outcome and statistically significant (p value 0.0001) While comparing the lokomat and non lokomat group in functional outcome measurements lokomat group (RAGT) had significant improvement in discharge scores.

scholarly journals Community Stroke Rehabilitation: How Do Rural Residents Fare Compared With Their Urban Counterparts?

2015 ◽  
Vol 43 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Laura Allen ◽  
Amanda McIntyre ◽  
Shannon Janzen ◽  
Marina Richardson ◽  
Matthew Meyer ◽  
...  
Keyword(s):  
Linear Regression ◽  
Stroke Rehabilitation ◽  
Linear Regression Analysis ◽  
Depression Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Stroke Survivors ◽  
Multivariate Linear Regression Analysis ◽  
Rehabilitation Care

AbstractBackground: Rural living has been demonstrated to have an effect on a person’s overall health status, and rural residing individuals often have decreased access to health and specialized rehabilitation services. Aim: The aim of this study was to determine if there are differences in recovery from stroke between urban and rural-dwelling stroke survivors accessing an in-home, community-based, interdisciplinary, stroke rehabilitation program. Methods: Data from a cohort of 1222 stroke survivors receiving care from the Community Stroke Rehabilitation Teams between January 2009 and June 2013 was analyzed. This program delivers stroke rehabilitation care directly in a person’s home and community. Functional and psychosocial outcomes were evaluated at baseline, discharge, and six -month follow-up. A series of multiple linear regression analyses was performed to determine if rural versus urban status was a significant predictor of discharge and 6-month health outcomes. Results: The mean age of the rural cohort was 68.8 (±13.1) years (53.6% male), and the urban cohort was 68.4 (±13.0) years (44.8% male). A total of 278 (35.4%) individuals were classified as living in a rural area using the Rurality Index for Ontario. In multivariate linear regression analysis, no significant differences on the Functional Independence Measure, the Stroke Impact Scale, the Hospital Anxiety and Depression Scale, or the Reintegration to Normal Living Index were found between urban and rural cohorts. Conclusions: When provided with access to a home-based, specialized stroke rehabilitation program, rural dwelling stroke survivors make and maintain functional gains comparable to their urban-living counterparts.

scholarly journals Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program

2014 ◽  
Vol 72 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Leonardo Halley Carvalho Pimentel ◽  
Francisco José Alencar ◽  
Leonardo Raphael Santos Rodrigues ◽  
Francisca Cléa Florenço de Sousa ◽  
João Batista Mendes Teles
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Functional Independence Measure ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Gait Velocity ◽  
Stroke Patients ◽  
Hemiparetic Stroke

The objective of this study was to evaluate the effects of botulinum toxin type A (BTX-A) on spastic foot in stroke patients in a rehabilitation program. Method: Hemiparetic stroke patients (n=21) enrolled in a rehabilitation program were divided into two groups. The first group (n=11) received a total of 300UI BTX-A, and the second group (n=10) received 100 UI BTX-A. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for Modified Ashworth Score, time walking 10 meters, and the Functional Independence Measure (mFIM) motor score. Results: The higher-dose group exhibited a significant improvement in spasticity, and both groups showed an improvement in time walking 10 meters and mFIM, with no significant differences between them. Conclusions: Our findings suggest that gains in gait velocity and functional independence were not correlated to BTX-A dose.

Abstract TP316: When Push Comes to Shove… Pulling is Better: Achieving Better Outcomes by Actively Seeking (Pulling) Stroke Patients for Rehabilitation

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kien Y Chan ◽  
Andrew S Granger ◽  
Scott Lee
Keyword(s):  
Stroke Rehabilitation ◽  
Discharge Planning ◽  
Functional Independence Measure ◽  
Cost Effective ◽  
Functional Independence ◽  
Acute Hospital ◽  
Financial Benefit ◽  
Stroke Patients ◽  
Rehabilitation Outcome ◽  
Before And After

Background: The length of stay (LOS) of stroke patients in the acute hospital coming to our stroke rehabilitation unit (SRU) has remained largely unchanged despite increasing administrative pressure for earlier discharge in recent years. Reducing this LOS can ease bed pressure and may also improve patient outcome. We explore the effect of changing the model of stroke rehabilitation consultation from patients being referred (or “push”) by the acute team, to the SRU team actively seeking (or “pull”) patients prior to referral. Methods: From November 2010 to December 2011, potential stroke rehabilitation patients were sought daily in targeted wards in Sir Charles Gairdner Hospital (our main referring hospital), lead by a consultant geriatrician. Patients were identified by screening the nurses’ hand over sheet, discussing with the treating medical and allied health team, and reviewing the patients and case notes. Patients were reviewed regularly until their rehabilitation/discharge plan is finalised. The patients’ characteristics and rehabilitation outcome over the two periods before and after service initiation were compared. Results: Over the 14 months, 89 patients were admitted to our SRU, with an average acute hospital LOS of 12.5 days, a 5 days reduction compared to previous years (1996-October 2010: 17.9 days, n=716). The 89 patients were more disabled (average admission functional independence measure [FIM] 69 compare to 73), but with no worsening of outcome (including discharge FIM, FIM efficacy, FIM efficiency, LOS in SRU, % discharged home and mortality). Discussion and Conclusion: The “pull” model in consultation avoids delays from administrative inefficiencies in referring a patient, and allows earlier involvement in discharge planning. This is likely to have contributed to the earlier rehabilitation admission. While this did not change the patients’ outcome, however, the reduction in acute hospital LOS has financial benefit (445 bed days and $800,000 AUD saved over this period). The earlier involvement in patients’ care also facilitates a more seamless transition to rehabilitation. In conclusion, ‘pulling’ patients for stroke rehabilitation is a cost-effective way to reduce LOS in the acute hospital, and may improve rehabilitation outcome.

scholarly journals Sex Differences in Stroke Rehabilitation Care in Alberta

2020 ◽  
Vol 47 (4) ◽  
pp. 494-503
Author(s):  
Eric Tanlaka ◽  
Kathryn King-Shier ◽  
Theresa Green ◽  
Cydnee Seneviratne ◽  
Sean Dukelow
Keyword(s):  
Stroke Rehabilitation ◽  
Living Arrangement ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
The Impact

ABSTRACT:Background:Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.Methods:Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.Results:Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.Conclusion:There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.

scholarly journals Efficacy of a Training on Executive Functions in Potentiating Rehabilitation Effects in Stroke Patients

2021 ◽  
Vol 11 (8) ◽  
pp. 1002
Author(s):  
Vincenza Tarantino ◽  
Francesca Burgio ◽  
Roberta Toffano ◽  
Elena Rigon ◽  
Francesca Meneghello ◽  
...  
Keyword(s):  
Executive Functions ◽  
Functional Independence Measure ◽  
Training Group ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Functional Improvement ◽  
Control Group ◽  
Stroke Patients ◽  
Treatment As Usual ◽  
Wide Range

Cognitive impairment after a stroke has a direct impact on patients’ disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary rehabilitation program, regardless of the specific brain damage and clinical impairment (motor, language, or cognitive), could improve rehabilitation outcomes in patients with stroke. An EF training was designed to have minimal motor and expressive language demands and to be applied to a wide range of clinical conditions. A total of 37 stroke patients were randomly assigned to two groups: a training group, which performed the EF training in addition to the ordinary rehabilitation program (treatment as usual), and a control group, which performed the ordinary rehabilitation exclusively. Both groups were assessed before and after the rehabilitation program on neuropsychological tests covering multiple cognitive domains, and on functional scales (Barthel index, Functional Independence Measure). The results showed that only patients who received the training improved their scores on the Attentional Matrices and Phonemic Fluency tests after the rehabilitation program. Moreover, they showed a greater functional improvement in the Barthel scale as well. These results suggest that combining an EF training with an ordinary rehabilitation program potentiates beneficial effects of the latter, especially in promoting independence in activities of daily living.

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