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Patients with severe coronavirus disease 2019 (COVID-19) have poor prognosis, with many cases being difficult to treat and many reports of neurological complications in patients who have been in the intensive care unit for a long time. Rehabilitation of patients with severe COVID-19 is important；however, no rehabilitation program has shown effectiveness. Thus, this study aimed to investigate the effects of a rehabilitation program developed and used at our hospital for patients with severe COVID-19. We enrolled 28 patients with severe COVID-19 (age 61［23-88］years；female/male, 9/19, body mass index, 25.0［18.0-33.6］kg/m2). We assessed the medical research council scoring (MRC) of the patients at the time of entry and exit from the ordinary ward using Wilcoxon signed-rank tests. MRC was significantly improved after exiting the ordinary ward compared with that on entering the ordinary ward (43 vs. 50 points；P＜.001). Moreover, Barthel index improved significantly after exiting the ordinary (32.5 vs. 77.5 points, P＜.001). Therefore, our acute rehabilitation treatment for patients with severe COVID-19 may be effective in improving their muscle strength and daily living.
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Objective To evaluate the effect of intravenous lidocaine on postoperative pain and acute rehabilitation after laparoscopic hysterectomy.Methods Ninety-six patients scheduled for lapa-roscopic hysterectomy under general anesthesia were randomized into 2 groups (n = 48 ).In test group,lidocaine 1.5 mg/kg was administered at induction,then with a continously infusing rate of 2 mg·kg-1 ·h-1 until the end of surgery.In control group,saline was instead.Record the resting and coughing pain scores at 6,12,24 and 48 h after surgery,morphine consumption during the first 48 h, time to first flatus,6 min walk test (6MWT)result,and side effects such as dizzy,nausea and vomi-ting.Results Resting VAS scores at 6,12 and 24 h postoperatively were lower in test group than in control group (P <0.05).Coughing VAS scores in test group were lower than in control group at all time points (P <0.05).The morphine consumption was lower in test group than in control group (P<0.05).Time to first flatus was earlier in test group than in control group (P <0.05 ).6MWT at day 4 and 5 were significantly enhanced in test group (P <0.05 ).Conclusion Intravenous lidocaine can reduce postoperative pain scores and morphine consumption,as well as improve early rehabilita-tion after laparoscopic hysterectomy.
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OBJECTIVE: To evaluate the feasibility of the ICF for initial comprehensive evaluation of early post-acute spinal cord injury. METHOD: A comprehensive evaluation of 62 early post-acute spinal cord injury (SCI) patients was conducted by rehabilitation team members, such as physicians, physical therapists, occupational therapists, nutritionists, medical social-workers, and nurses. They recorded each of their evaluation according to the ICF first level classification. The contents of the comprehensive evaluation were linked to the ICF second level categories, retrospectively. The linked codes were analyzed descriptively and were also compared with the brief ICF core set for early post-acute SCI. RESULTS: In the evaluation of early post-acute SCI patients based on the ICF first level categories, 19 items from the body functions domain, such as muscle power functions (b730) and urination functions (b620), 15 items from the body structures domain, including spinal cord and related structures (s120), 11 items from the activities and participation domain, such as transferring oneself (d420) and walking (d450), and 9 items from the environmental factors domain, e.g., health professionals (e355), were linked to the ICF second level categories. In total, 82.4% of all contents were linked to the brief ICF core set. Prognosis insight, a personal factor not linkable to an ICF code, was mentioned in 29.0% of all patients. CONCLUSION: First level ICF categories can provide a structural base for a comprehensive evaluation in early post-acute spinal cord injury. However, frequently linked items, including the brief core set, as well as personal factors should be considered via a checklist in order to prevent the omission of significant contents.
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Humans , Checklist , Health Occupations , Muscles , Physical Therapists , Prognosis , Retrospective Studies , Spinal Cord , Spinal Cord Injuries , Urination , WalkingABSTRACT
Lately, much progress was present in stroke prevention, treatment and rehabilitation. Mechanism called brain plasticity is enhanced from relatively early stage after the stroke’s onset by rehabilitation, and it is known to lead to functional recovery. Acute phase rehabilitation needs to be started as early as possible, after the onset of stroke, while the patient is still in the bedridden. The primary goals of such acute rehabilitation are prevention of disuse syndrome, early improvement of ADL, and to make someone is independent as possible and promotion of social reintegration. Many evidences prove that promotion of acute care and rehabilitation of stroke, carried out in the stroke unit or stroke rehabilitation unit, and early supported discharge, reduced the duration of hospitalization and improves ADL and QOL, as it gives long-term outcome. The result shows that stroke patients, who were admitted to a special ward carrying out organized multidisciplinary rehabilitation such as a stroke unit or stroke rehabilitation, had lower mortality and a higher home return rather than those treated in the ordinary unit, still after 10 years of their strokes. While care and service of rehabilitation system is at low level in our country, we need to introduce and establish such an effective system of acute care and rehabilitation of stroke, based at those evidences.
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OBJECTIVE: To determine whether the rehabilitation desire of patients with spinal cord injury (SCI) in post-acute rehabilitation hospitals be suitable to objective parameters, and to figure out the discharge plan after post-acute rehabilitation hospitals. METHOD: 98 patients with SCI in post-acute rehabilitation hospitals were included. In order to identify rehabilitation desire, interviews were conducted among patients or their family members in a direct line. Discharge plans of patients after post-acute rehabilitation hospitals were surveyed. All participants completed demographic measures, Korean Modified Barthel Index (K-MBI) and International Classification of Functioning, Disability and Health (ICF) core-set for patients with neurological problems in post-acute rehabilitation facilities to determine the influences on rehabilitation desire. RESULTS: Most (80.6%) of patients desired more intensive rehabilitation services and 47 patients (48.0%) purposed to get physical therapy focused on motor recovery. Only 15 patients (15.3%) planned to discharge to home. Patients who planned to discharge to home had higher K-MBI score and lower numbers of decreased body functioning, activities and participation in ICF core-set than patients who would admit to another rehabilitation hospitals after discharge. CONCLUSION: Appropriate and intensive educations after spinal cord injury on the recovery process and goal of rehabilitation are required to supply adequate rehabilitation services and to avoid unnecessary admission to rehabilitation hospitals. And the rehabilitation program focusing on functional recovery should be emphasized in patients with SCI.
Subject(s)
Humans , Spinal Cord , Spinal Cord InjuriesABSTRACT
OBJECTIVE: To determine whether the rehabilitation desire of stroke patients in post-acute rehabilitation facilities was suitable to objective parameters, and to figure out the discharge plan after post-acute rehabilitation facilities. METHOD: 107 stroke patients in post-acute rehabilitation facilities were included. In order to identify rehabilitation desire, interviews were conducted among patients or their family members in a direct line. Discharge plans of patients after post-acute rehabilitation facilities were surveyed. All participants completed demographic measures, Mini Mental Status Examination (MMSE), Korean Modified Barthel Index (K-MBI) and International Classification of Functioning, Disability and Health (ICF) core set for patients with neurological problems in post-acute rehabilitation facilities to determine the influences on rehabilitation desire. RESULTS: Most (81.3%) of the patients desired more intensive rehabilitation service and 65 patients (60.7%) purposed to get physical therapy focused on motor recovery. Only 24 patients (22.4%) planned home discharge, most (67.3%) of them did re-admission. CONCLUSION: The desire of patients in post-acute rehabilitation facilities would have a tendency of hospital staying for motor recovery in large percentage of patients. Rehabilitation desire and goal were not affected by the affected side and onset duration. Social support and extended educational program for rehabilitation for the patients and their relatives should be performed to overcome these problems.
Subject(s)
Humans , International Classification of Functioning, Disability and Health , Rehabilitation , StrokeABSTRACT
To assess the extent of functional gains measured before and after inpatient rehabilitation in patients who have brain tumors, and to identify whether the tumor type, tumor laterality, side of hemiparesis, postoperative addition therapy, cognitive dysfunction, and impairment of consciousness influences outcome. We reviewed the Barthel index(BI)of patients admitted to our hospital from Feb. 2004 to Jan. 2006. Participants numbered 133 persons, aged 52.2±15.4 years old and comprised 57 males and 76 females. All participants had functional impairments resulting from their brain tumors, and patient data was collected from their medical records retrospectively. The numbers of the patients by tumor pathology were 68 gliomas(16 Grade I·II, 52 Grade III·IV), 19 meningiomas, 15 metastatic brain tumors and 31 others. Significant improvements were found between admission and discharge BI scores for all patients, including the glioma group, meningioma group and metastatic tumor group. A significant change of BI improvement was noted between the glioma group and the meningioma group. Length of rehabilitation stay for the glioma group was significantly longer than for the meningioma and metastatic tumor groups. The highest percentage of patients discharged to home was in the glioma group(77.9%). Tumor laterality, side of hemiparesis and postoperative addition therapy all affected functional improvement. We concluded that acute inpatient rehabilitation is an effective treatment for patients with brain tumors that can help them to regain functional ability and to improve their quality of life.