Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

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Functional recovery in post-stroke patients on hemodialysis during the convalescent phase: a comparison with those not undergoing hemodialysis

Renal Replacement Therapy ◽

10.1186/s41100-021-00347-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takeki Ishida ◽

Kenichi Kono ◽

Yuusuke Nishida ◽

Masahiro Yoshida

Keyword(s):

Functional Recovery ◽

Functional Independence Measure ◽

Functional Independence ◽

Hemodialysis Patients ◽

Stroke Patients ◽

Post Stroke ◽

Rehabilitation Hospital ◽

Convalescent Phase ◽

The Difference ◽

Impaired Motor Function

Abstract Background Low physical fitness is often found in patients undergoing hemodialysis. It may be possible that the recovery of impaired motor function with rehabilitative training might be affected when the patient is on hemodialysis. So far, however, no researcher has clinically investigated this issue in post-stroke patients. The purpose of this study is to clarify the difference of functional recovery during the convalescent phase between post-stroke patients with and without hemodialysis. Methods A cohort of 82 post-stroke hemiparetic patients who were admitted to our rehabilitation hospital, were subjected. On the day of admission and discharge, some clinical parameters including Functional Independence Measure (FIM) and Functional Ambulation Category (FAC) were evaluated for each patient. The changes during the hospitalization and the values at the discharge in these parameters were statistically compared between the patients with and without hemodialysis. Results The FIM motor score at the discharge was significantly lower in hemodialysis patients than non-hemodialysis patients (64.7 ± 21.2 points in hemodialysis patients and 81.8 ± 28.0 points in non-hemodialysis patients, p < 0.05). In addition, the frequency of FAC at the discharge of ≥ 3 was significantly lower in hemodialysis patients than non-hemodialysis patients (40.0% in hemodialysis patients and 72.2% in non-hemodialysis patients, p < 0.05). Conclusion In patients undergoing hemodialysis seem to experience a worse functional recovery during the convalescent phase compared to those not undergoing hemodialysis. We might have to modify the rehabilitative program during the convalescent phase after stroke if the patient was on hemodialysis.

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

Nutrients ◽

10.3390/nu12071923 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1923 ◽

Cited By ~ 1

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.

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The Potential Predictors of Motor Performance Outcomes after Rehabilitation for Patients with Stroke

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.284-287.1656 ◽

2013 ◽

Vol 284-287 ◽

pp. 1656-1660

Author(s):

Jiann Der Lee ◽

Tzyh Chyang Chang ◽

Shih Ting Yang ◽

Chung Hsien Huang ◽

Ching Yi Wu

Keyword(s):

Motor Performance ◽

Functional Independence Measure ◽

Functional Independence ◽

Performance Outcomes ◽

Motor Ability ◽

Stroke Patients ◽

Performance Outcome ◽

Rehabilitation Outcomes ◽

Movement Performance ◽

Motor Outcome

The identification of potential predictors for motor outcome after rehabilitation helps underscore the factors that may affect treatment outcomes and target individuals who benefit the most from the therapy. In this study, we addressed and utilized a classifier to identify the potential predictors for motor performance outcome for patients with stroke after rehabilitation. The potential predictors selected and used by different assessments in this study were age, sex, time since stroke, education, neurologic status, and the movement performance of the upper extremity. This study aimed to identify predictors of motor performance outcomes after rehabilitation for stroke patients. The PSO-SVM was chosen in this study to find the predictor of motor function for clients with stroke. The potential predictors for motor outcome after rehabilitation were motor ability assessment of the Fugl-Meyer Assessment (FMA) and the Functional Independence Measure (FIM). This study is to investigate the potential demographic and clinical characteristics of stroke that can serve to predict rehabilitation outcomes in motor performance.

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

Stroke ◽

10.1161/str.44.suppl_1.atp316 ◽

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.

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AN EVALUATION OF MULTIDISCIPLINARY INTERVENTION GOVERNED BY FUNCTIONAL INDEPENDENCE MEASURE (FIMSM) IN INCONTINENT STROKE PATIENTS

Scandinavian Journal of Rehabilitation Medicine ◽

10.1080/003655098444273 ◽

1998 ◽

Vol 30 (1) ◽

pp. 15-21 ◽

Cited By ~ 36

Author(s):

Barbro Wikander, Peter Ekelund, Ian Milsom

Keyword(s):

Functional Independence Measure ◽

Functional Independence ◽

Stroke Patients ◽

Multidisciplinary Intervention

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Postural Assessment Scale for Stroke Patients in Acute, Subacute and Chronic Stage: A Construct Validity Study

Diagnostics ◽

10.3390/diagnostics11020365 ◽

2021 ◽

Vol 11 (2) ◽

pp. 365

Author(s):

Cecilia Estrada-Barranco ◽

Roberto Cano-de-la-Cuerda ◽

Vanesa Abuín-Porras ◽

Francisco Molina-Rueda

Keyword(s):

Construct Validity ◽

Functional Independence Measure ◽

Functional Independence ◽

Assessment Scale ◽

Validity Study ◽

Stroke Patients ◽

Chronic Stage ◽

Post Stroke ◽

Valid Instrument ◽

Postural Assessment

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months).

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Development and Validation of Crosswalks Between FIM® and SCIM III for Voluntary Musculoskeletal Movement Functions

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211033854 ◽

2021 ◽

pp. 154596832110338

Author(s):

Linda A. T. Jones ◽

Chih-Ying Li ◽

David Weitzenkamp ◽

John Steeves ◽

Susie Charlifue ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Recovery ◽

Systems Of Care ◽

Functional Independence Measure ◽

Correlation Coefficients ◽

Functional Independence ◽

Cord Injury ◽

Parametric Analyses ◽

Development And Validation

Background. In spinal cord injury, there are multiple databases containing information on functional recovery, but data cannot be pooled or compared due to differences in how function is measured. A crosswalk is needed to link or convert scores between instruments. Objectives. To create a crosswalk between the voluntary musculoskeletal movement items in the Functional Independence Measure (FIM®) and the Spinal Cord Independence Measure III (SCIM III) for spinal cord injury. Methods. Retrospective datasets with FIM® and SCIM III on the same people were used to develop (Swiss dataset, n = 662) and validate (US, n = 119, and Canadian datasets, n = 133) the crosswalks. Three different crosswalk methods (expert panel, equipercentile, and Rasch analysis) were employed. We used the correlation between observed scores on FIM® and SCIM III to crosswalked scores as the primary criterion to assess the strength of the crosswalk. Secondary criteria such as score distributions, Cohen’s effect size, point differences, and subgroup invariance were also evaluated. Results. All three methods resulted in strong correlation coefficients, exceeding the primary criterion value of r = .866 (.897–.972). Assessment of secondary criteria suggests the equipercentile and Rasch methods produced the strongest crosswalks. Conclusions. The Rasch FIM®/SCIM III crosswalk is recommended because it is based on co-calibration of linearized measures, allowing for more sophisticated parametric analyses. The crosswalk will allow comparisons of voluntary musculoskeletal functional recovery across international databases using different functional measures, as well as different systems of care and rehabilitation approaches.

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Evaluation of Functional Recovery by Motor Functional Independence Measure Test of Elderly After Hip Fracture in Serbia

Acta Médica Portuguesa ◽

10.20344/amp.4267 ◽

2014 ◽

Vol 27 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Natasa Radosavljevic ◽

Dejan Nikolic ◽

Milica Lazovic ◽

Zoran Radosavljevic ◽

Aleksandar Jeremic

Keyword(s):

Hip Fracture ◽

Functional Recovery ◽

Age Groups ◽

Functional Independence Measure ◽

Severity Index ◽

Functional Independence ◽

Post Discharge ◽

Third Age ◽

Period 2 ◽

Group 2

Introduction: The aim of the study was to evaluate motor functional status measured by motor Functional Independence Measure (mFIM) test in population above 65 years of age after the hip fracture. Material and Methods: We evaluated 203 patients after hip fracture by mFIM test on 3 occasions: at admission (Period-1), at discharge (Period-2) and 3 months after discharge (Period-3); 3 age groups: Group65-74, Group75-84 and Group85-up and 2 groups concerning Severity Index (SI): group 0-1.99 (SI1) and group ≥ 2 (SI2). Results: In same SI group there is significant increase in mFIM values for Period-2 and Period-3 for both genders and in first two age groups, while for those above 85 years of age with higher SI we found non-significant change in mFIM values between discharge and 3 months post discharge period. Discussion: The most significant improvement is obtained for women in first and third age groups and with higher SI. Conclusion: Gender is not significant predictor for motor functional recovery measured by mFIM test in patients with hip fracture, although the admittance mFIM is a good indicator for mFIM capacity recovery in women of certain age groups (first and third age groups).

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Adherence to Post-Acute Rehabilitation Guidelines Improves Functional Recovery in Stroke

Stroke ◽

10.1161/str.32.suppl_1.333-c ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 333-333

Author(s):

Pamela W Duncan ◽

Ronnie D Horner ◽

Dean M Reker ◽

VA Medical Ctr ◽

Kansas City ◽

...

Keyword(s):

Quality Of Care ◽

Acute Stroke ◽

Functional Recovery ◽

Stroke Rehabilitation ◽

Functional Independence ◽

Case Mix ◽

Stroke Patients ◽

Sf 36 ◽

Acute Rehabilitation

97 Purpose & Methods: To assess if compliance with post-stroke rehabilitation guidelines improves functional recovery. The design of the study was an inception cohort of stroke patients followed prospectively for 6 months. The setting was eleven Department of Veteran Affairs Medical Centers providing care to stroke patients. The subjects included 288 selected patients with stroke admitted between January 1998 - March 1999. Data were abstracted from medical records and telephone interviews. Primary outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and post-acute rehabilitation composite compliance scores (range 0–100) were derived from an algorithm. All outcomes were adjusted for case mix. Results: Average compliance scores in acute and post acute care settings were 68.2% (+ 14) and 69.5% (+ 14.4), respectively. After case-mix adjustment, level of compliance with post-acute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function scores and mortality were not affected by compliance with post-acute rehabilitation guidelines. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. Conclusion: Process of care in post-acute stroke rehabilitation affects 6-month functional recovery. Our findings support the use of guidelines as means of assessing quality of care and improving outcomes. These quality indicators are needed to ensure that quality of care is not comprised with new organizational and funding changes involving post-acute stroke care.

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