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Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.
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Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.
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Objective：To clarify the effect of exclusion items on the KRW achievement index (KRW-AI) in the outcome evaluation of a convalescent rehabilitation ward.Methods：The subjects were 812 inpatients in a convalescent rehabilitation ward. The objective variable was the KRW-AI of 40 or less, and the explanatory variables were the items excluded from the KRW-AI and their combination for a total of eight categories, such as (1) low motor FIM, (2) high motor FIM, (3) low cognitive FIM, (4) elderly, (5) (1)＋(3), (6) (1)＋(4), (7) (3)＋(4), (8) (1)＋(3)＋(4). The adjusted variables were sex, rehabilitation calculation category, and time from onset to admission to the ward. Poisson regression analysis was performed. The Incidence Rate Ratio (IRR) and 95％ confidence interval (CI) were calculated.Results：Five of the eight exclusion categories were significantly associated with low-KRW-AI scores. The highest IRR was 2.29 (95％ CI：1.41-3.69, p＜0.001) for (2).Conclusion：High motor FIM are associated with a higher relative risk of falling below the KRW-AI of 40. Conversely, being older and the presence of cognitive disorder did not interfere with low-KRW-AI scores.
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Objective：To clarify the effect of exclusion items on the KRW achievement index (KRW-AI) in the outcome evaluation of a convalescent rehabilitation ward.Methods：The subjects were 812 inpatients in a convalescent rehabilitation ward. The objective variable was the KRW-AI of 40 or less, and the explanatory variables were the items excluded from the KRW-AI and their combination for a total of eight categories, such as (1) low motor FIM, (2) high motor FIM, (3) low cognitive FIM, (4) elderly, (5) (1)＋(3), (6) (1)＋(4), (7) (3)＋(4), (8) (1)＋(3)＋(4). The adjusted variables were sex, rehabilitation calculation category, and time from onset to admission to the ward. Poisson regression analysis was performed. The Incidence Rate Ratio (IRR) and 95％ confidence interval (CI) were calculated.Results：Five of the eight exclusion categories were significantly associated with low-KRW-AI scores. The highest IRR was 2.29 (95％ CI：1.41-3.69, p＜0.001) for (2).Conclusion：High motor FIM are associated with a higher relative risk of falling below the KRW-AI of 40. Conversely, being older and the presence of cognitive disorder did not interfere with low-KRW-AI scores.
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Objective: To examine the trajectory of activities of daily living (ADL) in cancer patients from 6 weeks before death using the Functional Independence Measure (FIM). Method: This study was a retrospective observational study. The participants were cancer patients aged 18 years or older who died and were discharged from the palliative care unit in Tsurumaki-onsen Hospital. Six weeks of FIM data were collected from the patients’ medical records from 6 weeks before death to the time immediately before death (week 0). Results: Fifty-five participants were included in the study. FIM scores declined from 55 points at 6 weeks before death to 25 points immediately before death. Functional independence was higher for cognitive items on the FIM than for motor items, and both cognitive and motor functioning significantly declined just before death. Within the motor subscale, the patients were more independent with regard to eating, grooming, and bladder management compared to other activities until just before death. Within the cognitive subscale, the patients showed greater independence with regard to expression and social interaction. Discussion: A support for ADL needs to be considered to assist out-of bed activities in a safe and comfort manner until two weeks before death. Patients’ activities on the bed can also be continued for independence until just before death.
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Purpose: Approximately 30% of the patients who received intervention from a palliative care team for problematic symptoms (e.g., pain, nausea, depression) also underwent rehabilitation at our acute hospital. We investigated their changes in activities of daily living (ADLs) and outcomes (i.e., death, changing hospitals, or being discharged to their homes). Method: We retrospectively analyzed the patients’ medical records data to examine patient training content, Barthel Index (B.I.) scores, and outcomes. Results: For one year, 86 patients received rehabilitation and 42 (48%) underwent anticancer therapy. B.I. scores increased for 35% of the patients, were stable for 20%, and decreased for 45%; 95% of the patients with decreased B.I. scores could not be discharged home. Conclusion: Advanced cancer patients are likely to experience a decline in ADLs and require longer rehabilitation periods to improve. A team approach is important for preventing disuse syndromes within a palliative care setting.
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Children with developmental disabilities may need extra care due to delayed development of self-care skills and/or a need for special care. Delayed self-care skills mean that care needs that are expected to diminish in typically developing children, persist. Whether a child is independent in an aspect of self-care would be dependent on his chronological and developmental age, developmental disability and the associated impairments, as well as cultural and other environmental factors, such as the child’s gender, the presence of a domestic helper, early attendance at preschool. Family circumstances should also be taken into consideration. The functional assessment of ADL in infants and children with developmental disabilities has been distilled into the domains of Washing/Bathing, Dressing, Feeding, Toileting, Transferring and Mobility. They reflect the activities that occur in the typical day in the life of a child. Common developmental disabilities and possible effects on acquisition of independent ADL are discussed.
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The common types of disabilities in adults are those of the locomotor system which affects mobility, those affecting activities of daily living (ADL), hearing and sight. These disabilities may be caused by a variety of diseases. Diseases of musculoskeletal, neurological, eye, ear, and psychiatric origin, as well as cancers, may lead to impairments which when severe lead to disability in mobility as well as in performing essential self-care activities. Important impairments to consider with regards to mobility and dependency are lower and upper extremity impairments, visual/ hearing impairment, affective disorders and poor balance. Ambulation is not only affected by impairments to lower limb but also by compromised cardiopulmonary status.
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Children with developmental disabilities may need extra care due to delayed development of self-care skills and/or a need for special care. Delayed self-care skills mean that care needs that are expected to diminish in typically developing children, persist. Whether a child is independent in an aspect of self-care would be dependent on his chronological and developmental age, developmental disability and the associated impairments, as well as cultural and other environmental factors, such as the child’s gender, the presence of a domestic helper, early attendance at preschool. Family circumstances should also be taken into consideration. The functional assessment of ADL in infants and children with developmental disabilities has been distilled into the domains of Washing/Bathing, Dressing, Feeding, Toileting, Transferring and Mobility. They reflect the activities that occur in the typical day in the life of a child. Common developmental disabilities and possible effects on acquisition of independent ADL are discussed.
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@#ObjectiveTo observe occupational therapy combing with physical therapy on the upper limb movement function and the activities of daily living for the old stroke patient.Methods62 stroke patients with hemiplegia were divided into the observation group (occupational therapy with physical therapy) and control group (physical therapy). All patients were evaluated with Bathel Index (BI) and Fugl-Meyer Assessment (FMA) before and 3 months after treatment.ResultsThe scores of BI and FMA increased significantly in the observation group compared with the control group after the treatment (P<0.01).ConclusionOccupational therapy combing with physical therapy can obviously improve the upper limb movement function and the activities of daily living for the old stroke patient.
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@# ObjectiveTo observe the effect of Integrated Chinese-western three-stage rehabilitation on activities of daily living (ADL) in stroke patients. Methods60 stroke patients were randomly divided into the trial group and control group with 30 cases in each group. Patients of control group were treated with routine neurological interventions and three-stage rehabilitation, while those of trial group were administered resuscitating acupuncture therapy, scalp and body acupuncture in addition. All the patients were assessed with modified Barthel index (MBI) at the beginning, 1 month, 3 months, 6 months respectively after stroke. ResultsThere was no significant difference in ADL between the trial and control groups at the beginning, and both improved at the following period (P<0.01). At each of the following period, either the ADL scores (P<0.05) or the increase of the ADL scores (P<0.05) of the trial group were significant higher than those of the control group. ConclusionIntegrated Chinese-western three-stage rehabilitation could improve the ADL further for the stroke patients.
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Purposes<br> The purposes of this study were to analyze the relationship between the discharge destinations of patients with cerebrovascular diseases (CVD) in our convalescent rehabilitation ward and their levels of activities of daily living (ADL), and also to consider the factors causing those patients difficulties upon discharge. <br>Methods<br> The subjects were 114 CVD patients in our Convalescent Rehabilitation Ward. <br> The investigation was conducted to examine their ADL score, both at hospitalization and at discharge, and to analyze the relationship between changes in their ADL scores and their discharge destinations. <br>Discussion<br> It was suggested that reduction of the ADL score from above 8 points at hospitalization, to less than 4 at discharge, contributed to improvement of the rate of discharge to the patients' own homes, and that four items in the ADL assessment scale, such as ‘transfer’, ‘ability to communicate’, ‘locomotion’ and ‘oral care’, had an effect on their discharge destinations.
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@#Objective To investigate the effects of rehabilitation intervening in different stage on activities of daily living of old stroke patients. Methods 74 old cases were divided into 3 group according to the time from onset of stroke to rehabilitation intervention: group A (＜3 months), group B (3～6 months), and group C (>6 months). They were treated with routine rehabilitation for 2 months and assessed with Barthel Index before and after rehabilitation. Results All the patients improved their ADL significantly after rehabilitation (P=0.000), and those in group A improved more than in group C (P<0.05). There was no significant difference between group A and B, and group B and C (P>0.05). Conclusion The rehabilitation can effectively improve the ADL of old stroke patients. The early the rehabilitation intervenes, the better the ADL is.
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@#Chronic obstructive pulmonary disease (COPD) influenced the activities of daily living (ADL) of COPD patients. The six-minute walking test is considered as a good marker of functional capacity to perform ADLs. However, it does not identify the activities roundly. A good ADL scale can be used to assess functional incapacity of ADL in patients with COPD, and present sensitivity to changes following pulmonary rehabilitation.
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@#Objective To investigate the effect of simple rehabilitation technique for community on activities of daily living (ADL) and balance function in stroke patients with hemiplegia. Methods 48 patients were subdivided into two groups: treatment group (n=26) and control group (n=22), who received simple rehabilitation combining with routine or routine only. All patients were assessed with the Barthel index (BI) and Fugl-Meyer balance assessment (FMA-B) at the enrollment time, and 1 month, 3 months after treatment. Results 3 months after treatment, the scores of BI and FMA-B improved more significantly in the treatment group than those in the control group (P<0.05).Conclusion Simple rehabilitation technique for community is effective to improve activities of daily living and balance function of stroke patients with hemiplegia.
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@# Objective To investigate the effect of hyperbaric oxygen (HBO) on basic activities of daily living (B-ADL) of patients with unilateral spatial neglect (USN) after stroke.Methods 72 patients with USN after stroke were divided into the experimental group (group A1, 36 cases), who received the training for USN and HBO, and observation group (group A2, 36 cases), who received the training for USN alone. Other 90 stroke inpatients without USN at the same time were as control (group B). All of them received routine rehabilitation, and were assessed with Modified Barthel Index (MBI) before and after treatment. Results Before treatment, the scores of MBI in the patients with USN (groups A1 and A2) were significantly lower than those in the control group (B) (P<0.05). The scores of MBI in all groups improved 6 weeks after treatments (P<0.001). While, the scores in the group A2 were lower than that of the group A1, but both were not significantly different from control (P>0.05). Conclusion USN would significantly impair the ADL of stroke patients, and the rehabilitation for USN may improve their ADL. HBO may improve the outcome.
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@#Objective To study the effects of the staging acupuncture combined with physical therapy on the neural function, motor function and activities of daily living in stroke patients. Methods 166 cases were divided into two groups: 83 cases in the treatment group were treated with staging acupuncture combined with physical therapy; 83 cases in the control group were treated with traditional acupuncture combined with physical therapy. They were evaluated with modified Edinburgh-Scandinavia Stroke Scale (MESSS)，Fugl-Meyer Assessment (FMA), and Bathel Index (BI) before and 2 months after treatment. Results There was no significant difference between these 2 groups before treatment (P>0.05), but were significant differences in MESSS, FMA and BI (P<0.05) after treatment. The incidence of recovery after treatment was 90.36% in treatment group, significantly better than that of the control group (74.49%, P<0.05). Conclusion In comparison with the traditional acupuncture, the staging acupuncture can significantly improve the effect on stroke based on the physical therapy.
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@#Objective To identify the risk factors for osteoporosis in patients with hemiplegia. Methods The total body bone mineral density (BMD) of 366 patients with hemiplegia in the stage of rehabilitation was measured with dual-energy X-ray absorptiometry. The data of the patients were analyzed with multiple logistic regressions. Results The incidence of osteoporosis was 15.3 % (56/366) in the cohort. ≥60 years old (OR=5.434, 95% CI:2.734～10.801), duration of disease (OR=1.046, 95% CI:1.013～1.080), body mass index (BMI) (OR=0.746,95% CI:0.622～0.840),ADL level (OR=0.618, 95% CI: 0.444～0.858) were independently correlated with osteoporosis in patients with hemiplegia. Conclusion Patients with hemiplegia in the stage of rehabilitation were at a high risk of osteoporosis. Aged over 60 years old, lower BMI, longer duration of disease and ADL level were independent risk factors for osteoporosis, which called for supervision and prophylaxis on osteoporosis.
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@#Objective To observe the effect of supervised rehabilitation on functional recovery in hemiplegia patients after stroke.Methods 65 patients with acute stroke were divided into supervised rehabilitation group and no-supervised rehabilitation group. They were assessed with Ueda Test and Barthel Index before and after treatment. Results The scores of the Barthel Index in supervised rehabilitation group were significantly superior to those of the not supervised rehabilitation group (P <0.05), while the scores of Ueda Test between these two groups were not significantly different (P>0.05). Conclusion Supervised rehabilitation can improve the function recovery, especially in activities of daily living.
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@#Objective To explore the effect of acupuncture combined with facilitated technique on lower limb function and activities of daily living of stroke patients.Methods 120 stroke patients with lower limb palsy were divided into the group Ⅰ (treated with acupuncture combined with facilitated technique), group Ⅱ (treated with acupuncture), third group Ⅲ (treated with facilitated technique) and the group Ⅳ (treated with medicine). The lower limb function and ADL of four groups were evaluated with Functional Ambulation Classification (FAC), Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI) before and 10 weeks after treatment.Results The scores of FAC, FMA and MBI of all the groups improved significantly, but it was more significantly in the first group than the in other groups (P<0.01), in group Ⅰ, Ⅱ, Ⅲ than in group Ⅳ (P<0.01). The difference between the group Ⅱ and Ⅲ was insignificantly(P>0.05).Conclusion Acupuncture combined with facilitated technique can improve the lower limb function and activities of daily living of stroke patients more effectively.