Aphasia Rehabilitation Service Delivery in a Stroke Rehabilitation Unit in Australia: A Clinical Audit of Speech Pathology Practices

Purpose: To investigate service delivery of aphasia rehabilitation in a metropolitan rehabilitation hospital by speech pathologists and assess adherence to both the National Stroke Foundation (NSF) Clinical Guidelines and the Australasian Rehabilitation Outcomes Centre (AROC) database of benchmarks. Method: A retrospective audit of 34 discharged patients was conducted within a dedicated stroke rehabilitation unit from March 2012 to July 2013 in Australia. Discharge reports, Functional Independence Measure (FIM) scores and clinical time statistics derived from the organization’s electronic database were studied and compared with NSF’s Clinical Guidelines for best practice recommendations and AROC benchmarks. Results: Patients with aphasia were admitted to inpatient rehabilitation at an average of 21 days post stroke, 2 days beyond the AROC benchmark for inpatient rehabilitation. The mean length of stay of patients with aphasia was 60 days, significantly longer than the average AROC benchmark of 32.8 days. Patients received an average of 4.25 hours of speech pathology therapy per week, more than twice the minimum amount of therapy time recommended by the NSF Guidelines. Conclusion: The current clinical audit is the first known speech pathology audit investigating adherence to stroke and aphasia rehabilitation guidelines set forth by the NSF clinical guidelines and AROC benchmarks in Australia. By comparing current care with advocated best practice, strengths were identified in service delivery, as well as priority areas for quality improvement.

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Abstract TP137: Robotic Upper Limb Therapy by a Trained Volunteer on an Inpatient Stroke Rehabilitation Unit

Stroke ◽

10.1161/str.48.suppl_1.tp137 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lisa Spinelli ◽

Christine Trudell ◽

Lisa Edelstein ◽

Mike Reding

Keyword(s):

Upper Limb ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Functional Independence ◽

Rehabilitation Unit ◽

Software Applications ◽

Upper Limb Function ◽

Straight Line ◽

One Step ◽

Safety Considerations

Introduction: Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer. Methods: The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses. Results: A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000. Conclusions: Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.

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Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

Clinical Nursing Research ◽

10.1177/c10n1r5 ◽

2001 ◽

Vol 10 (1) ◽

pp. 40-51 ◽

Cited By ~ 3

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.

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Length of Stay in In-Patient Rehabilitation after Stroke in Qatar

The Scientific World JOURNAL ◽

10.1100/tsw.2008.81 ◽

2008 ◽

Vol 8 ◽

pp. 547-555

Author(s):

Loganathan Venkatachalm ◽

Ana Bobinac Georgievski ◽

Wafaa Al Yazeedi ◽

Rajvir Singh ◽

Hilda Uribazo Garrido

Keyword(s):

Length Of Stay ◽

Hemorrhagic Stroke ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Significant Negative Correlation ◽

Multivariate Regression Analysis ◽

Functional Independence ◽

Medical Rehabilitation ◽

Rehabilitation Unit ◽

Disability Scale

The objective of this study was to analyze the factors predicting length of stay in a stroke patient rehabilitation unit at Hamad Medical Corporation (HMC) in Qatar. The medical rehabilitation data of 100 stroke patients discharged from a 15-bed inpatient rehabilitation unit (IPRU) were collected retrospectively from medical records during the period from September 2004 to April 2007. A questionnaire was developed, and variables included in the study were age of the patient, length of stay in acute care (LOSa), length of stay in rehabilitation (LOSr), functional independence measure on admission and discharge (FIMa and FIMd), modified disability scale, and modified mobility scale. Patients were grouped by impairments defined by cause as ischemic or hemorrhagic stroke, and right or left body side deficit. A significant negative correlation was observed between LOSr and FIMa (r= −0.44,p= 0.00), and positive correlation between LOSr and LOSa (r= 0.37,p= 0.00). There was no correlation between LOSr and FIMd (r= −0.03,p= 0.76). We observed that low admission FIMa and FIMd were related to extended LOS in both acute and IPRU. Multivariate regression analysis was performed by taking age, LOSa, cause of hemorrhage or ischemia, and FIMa as independent variables, and LOSr as dependent variable. The model could explain only 26% variation for LOSr. This study supports the hypothesis of an association between LOSr, LOSa, and FIMa. Further research is needed to confirm the results of this and other similar studies.

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Effect of hyponatremia on cancer patients' in-patient rehabilitation length of stay.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20626 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20626-e20626

Author(s):

Megan Nelson ◽

J. Lynn Palmer ◽

Jack Brian Fu ◽

Janet L. Williams ◽

Rajesh R. Yadav ◽

...

Keyword(s):

Length Of Stay ◽

Cancer Patients ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Cancer Rehabilitation ◽

Cancer Center ◽

Rehabilitation Unit ◽

Increased Risk ◽

Patient Groups

e20626 Background: The incidence of hyponatremia in cancer patients has been reported as high as 47%. Hyponatremia is associated with gait and attention impairments, increased falls, increased risk of fractures, and osteoporosis. Our aim is to determine if hyponatremia impact cancer patients’ rehabilitation length of stay, functional outcome, and survival. Methods: Retrospective study was conducted in a tertiary cancer center on two hundreds and ninty-five patients who underwent inpatient cancer rehabilitation between January 27, 2009 through July, 31, 2010. Hyponatremia incidence, rehabilitation length of stay (LOS), functional independence measure (FIM) for ambulation and transfers, and survival information were collected. Results: The incidence of hyponatremia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na<130 mEq/L) hyponatremia was 11 and 15 days, respectively, which was significantly longer than patients with eunatremia (10 days; P = .03). FIM change for ambulation and transfers during inpatient rehabilitation stay was not significantly different, nor was survival significantly different, between different patient groups. Conclusions: A high percentage of patients have hyponatremia upon admission to our inpatient cancer rehabilitation unit, and this is associated with a prolonged rehabilitation LOS.

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Severe Disability After Stroke: Outcome After Inpatient Rehabilitation

Neurorehabilitation and Neural Repair ◽

10.1177/154596839901300310 ◽

1999 ◽

Vol 13 (3) ◽

pp. 199-203 ◽

Cited By ~ 9

Author(s):

John G. Schmidt ◽

Jessie Drew-Cates ◽

Mary L. Dombovy

Keyword(s):

Functional Outcome ◽

Hemorrhagic Stroke ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Efficiency Score ◽

Poor Functional Outcome ◽

Rehabilitation Unit ◽

Home Setting ◽

Severe Stroke ◽

Acute Rehabilitation

Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.

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Embedding EBVM into Practice

Veterinary Evidence ◽

10.18849/ve.v2i1.95 ◽

2017 ◽

Vol 2 (1) ◽

Author(s):

Bradley Viner

Keyword(s):

Open Access ◽

Patient Care ◽

Practice Guidelines ◽

Clinical Guidelines ◽

Best Practice ◽

Clinical Performance ◽

Clinical Audit ◽

Clinical Effectiveness ◽

Pros And Cons ◽

Audit Cycle

Embracing EBVM as a concept is an important first step, but is of little value unless it is translated into an improvement in patient care. This session will discuss how EBVM can be incorporated into clinical guidelines at a practice level, using a team-based approach to maximise concordance. The pros and cons of using practice guidelines as a means of improving clinical effectiveness will be discussed, followed by an illustration of how the clinical audit cycle can be used as a tool to ensure that Best Practice as a established by practice guidelines is applied to produce an improvement in clinical performance. <a href="/index.php/ve/article/view/95/128"><img src="/public/site/images/bridget/Bradley_twitte_image.PNG" alt="" /></a> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

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Abstract TMP40: Sociodemographic Predictors of Return to Home after Inpatient Stroke Rehabilitation

Stroke ◽

10.1161/str.48.suppl_1.tmp40 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nneka L Ifejika ◽

Chunyan C Cai ◽

Elizabeth A Noser ◽

James C Grotta ◽

Sean I Savitz

Keyword(s):

Interpersonal Relationships ◽

Stroke Rehabilitation ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Caregiver Training ◽

Term Care ◽

Caregiver Support ◽

Stroke Treatment ◽

Returning Home ◽

Return Home

Background: Interpersonal relationships are understudied components of the stroke treatment paradigm, which become important when patients require long-term care. In this study, we analyzed sociodemographic factors that impact return to home after inpatient rehabilitation (IR). Methods: Stroke patients were identified by ICD9/10 code from a prospective multicenter rehabilitation registry between Jan 2005 & July 2016 (n=6447). Patients were analyzed based upon "Home" vs "Not Home" or "Married" vs "Not Married" groups. Descriptive statistics were provided for all patients. Marital status was used as a proxy for caregiver support. We hypothesized that increased discharge functional independence measure (FIM), ambulation and no insurance predicted return to home. A “return home model” was developed using multivariable regression with a stepwise approach. Odds ratio & 95% CI were calculated. Results: 5378 patients returned Home, 1069 did not return Home. Home patients tended to be younger, married, ambulatory and minorities, with a discharge FIM>75 (p<0.0001). Aphasia, dysphagia and UTI were significantly higher in the “Not Home” group (p<0.0001). Married patients had more stroke risk factors and impairments, indicating increased caregiver needs (Figure). In the model, being a minority and being a woman increased the odds of returning home. Advancing age, being widowed, divorced, separated or never married decreased the odds of returning home. We confirmed that ambulation, increasing discharge FIM and no insurance predicted return to home (Figure). Conclusions: Being married, a woman or a minority increases the odds of returning home after inpatient rehabilitation. Caregiver training and social support for unmarried and male patients are important areas of improvement. Strategies to ensure the successful transition of stroke rehabilitation patients to home are needed, including prospective studies of non-spousal caregiver support.

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Inpatient Rehabilitation Outcomes in Patients With Stroke Aged 85 Years or Older

Physical Therapy ◽

10.2522/ptj.20150364 ◽

2016 ◽

Vol 96 (9) ◽

pp. 1381-1388 ◽

Cited By ~ 5

Author(s):

Suzanne R. O'Brien ◽

Ying Xue

Keyword(s):

Outcome Measures ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

The United States ◽

Functional Independence ◽

Assessment Instrument ◽

Age Group ◽

Cross Sectional ◽

Discharge Outcomes

Abstract Background In the United States, people 85 years of age or older have a growing number of strokes each year, and this age group is most at risk for disability. Inpatient rehabilitation facilities (IRFs) adhere closest to post-acute stroke rehabilitation guidelines and have the most desirable outcomes compared with skilled nursing facilities. As stroke is one of the leading causes of disability, knowledge of postrehabilitation outcomes is needed for this age group, although at present such information is limited. Objective The purpose of this study was to describe functional and discharge outcomes after IRF rehabilitation in people with stroke aged 85 years or older. Design A serial, cross-sectional design was used. Methods Inpatient Rehabilitation Facility–Patient Assessment Instrument data were analyzed beginning in 2002 for the first 5.5 years after implementation of the prospective payment system and included 71,652 cases. Discharge function, measured using the Functional Independence Measure (FIM), and community discharge were the discharge outcome measures. Sample description used frequencies and means. Generalized estimating equations (GEEs) with post hoc testing were used to analyze the annual trends for discharge FIM and community discharge by age group (85–89, 90–94, 95–99, and ≥100 years). Risk-adjusted linear and logistic GEE models, with control for cluster, were used to analyze the association between both outcome measures and age group. Results Over 5.5 years, mean discharge FIM scores decreased by 3.6 points, and mean achievement of community discharge decreased 5.5%. Approximately 54% of the sample achieved community discharge. Continuous and logistic GEEs revealed factors associated with discharge outcomes. Limitations Results obtained using an observational design should not be viewed as indicating causation. The lack of control for a caregiver may have altered results. Conclusions The very elderly people admitted to IRF stroke rehabilitation made functional gains, and most were able to return to the community.

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Abstract T P119: Challenges Associated with Access to Stroke Rehabilitation for Patients with Cognitive Impairment in Toronto

Stroke ◽

10.1161/str.46.suppl_1.tp119 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Elizabeth Linkewich ◽

Nicola Tahair ◽

Michelle Donald ◽

Sylvia Quant

Keyword(s):

Cognitive Impairment ◽

Cognitive Rehabilitation ◽

Stroke Rehabilitation ◽

Best Practice ◽

Inpatient Rehabilitation ◽

Rehabilitation Services ◽

Cognitive Screening ◽

Stroke Patients ◽

Referral Decisions ◽

Rehabilitation Facilities

Background: Cognitive Impairment (CI) affects up to 60% of stroke survivors and is associated with poorer recovery and decreased function. Toronto clinicians report limited access to inpatient rehabilitation for stroke patients with CI. Purpose: To inform system planning that aligns with best practice for stroke patients with CI, the Toronto Stroke Networks examined: 1) access to inpatient rehabilitation services for stroke patients with CI; 2) facility differences with respect to referral decisions; and 3) the frequency of documented standardized cognitive screening (SCS) in inpatient rehabilitation referrals. Methods: Data were abstracted from the E-Stroke Rehab Referral System for fiscal years 2012-2014. Initial high intensity rehabilitation (HIR) referrals for 5 rehabilitation facilities in Toronto were analyzed to examine: percentage of referrals accepted, declined, and declined due to CI, and percentage of referrals reporting SCS in referral documentation. These data were further stratified by facility. A survey of cognitive rehabilitation was completed across 6 rehabilitation facilities. Results: There are no cognitive rehabilitation services that cater specifically to stroke patients reported in Toronto. Of the total number of HIR referrals (n=5005), 68.3% of initial referrals were accepted and 18.2% declined. Of the declined referrals (n=910), 17.5% were declined due to CI with variability across the 5 rehabilitation facilities ranging from 0.6 to 46.5%. Further, when examining referrals that were pending a decision or declined due to CI (n=508), 78.5% (range 48-100%) of these referrals across, 10 referring acute care facilities, had no documented SCS. Conclusions: Stroke patients with CI do not have adequate or consistent access to stroke rehabilitation across sites within Toronto. Additionally, there is a lack of documented SCS in rehabilitation referrals, which could impact access to rehabilitation. This work will further inform educational initiatives that support increased access to inpatient rehabilitation for persons with stroke and CI.

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A Case Report Exploring Activity Intensity in Inpatient Rehabilitation after Stroke

Case Reports in Medicine ◽

10.1155/2010/507476 ◽

2010 ◽

Vol 2010 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Kathryn Zalewski ◽

Julie Kerk ◽

Kristina Laundre ◽

Amber Wacek ◽

Melissa Wiedmeyer

Keyword(s):

Physical Activity ◽

Case Report ◽

Stroke Rehabilitation ◽

Inpatient Rehabilitation ◽

The United States ◽

Rehabilitation Unit ◽

Physical Demand ◽

Low Intensity ◽

Activity Intensity ◽

The Us

Background and Purpose. Inpatient rehabilitation in countries other than the United States (US) has been described as a time where patients are often not engaged in intensive physical activity. The purpose of this case report is to explore the amount and intensity of physical activity provided in inpatient rehabilitation after stroke in the US.Methods. This study presents a case report of a person admitted to an inpatient rehabilitation unit after sustaining a first stroke. A customized data collection tracked type of activity, activity intensity and social interaction every 5 minutes during the rehabilitation day.Results. 74 percent of the day was spent in low intensity, often seated, physical activity; 14% of the day was spent resting or sleeping. Only 2.91% the day was spent in moderate or high intensity activity with a mobility focus.Conclusions. Consistent with other studies, this case report suggests a relatively low physical demand to rehabilitation delivered in inpatient stroke rehabilitation. This case begins to raise questions about optimized rehabilitation parameters for acute stroke rehabilitation.

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