ABSTRACT
The study describes the development of a rating scale for assessment of mobility after stroke. It was based on 74 first-stroke patients, 40 men and 34 women, each assessed three times during rehabilitation. Their median age was 69 years, and they represented all degrees of severity of paresis. Content, construct, criterion and convergent validity were examined, as well as the inter-rater reliability. The final rating scale has three special characteristics: 1) it reflects the regularity in the recovery of mobility after stroke; 2) the sum of item scores comprises the information contained in the 10-item subscores; 3) the score sum is independent of age, side of hemiparesis, and gender of the patient. Latent trait analysis (Rasch) was found to be an ideal model for statistical investigation of these properties.
Subject(s)
Cerebrovascular Disorders/diagnosis , Hemiplegia/diagnosis , Neurologic Examination/statistics & numerical data , Activities of Daily Living/classification , Adult , Aged , Aged, 80 and over , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/rehabilitation , Cerebral Infarction/diagnosis , Cerebral Infarction/rehabilitation , Cerebrovascular Disorders/rehabilitation , Disability Evaluation , Dominance, Cerebral/physiology , Female , Hemiplegia/rehabilitation , Humans , Locomotion , Male , Middle Aged , Observer VariationABSTRACT
The aim of the present study was to investigate the predictive power of ratings of Barthel Index at Day 40 post stroke, compared with and/or combined with simultaneous ratings from a mobility scale (EG motor index) and a rather simple cognitive test scale (CT50). The parameter to be individually predicted was the need for special living facilities and support at discharge from a rehabilitation hospital, as well as six months later; 53 stroke patients with age median 68 years were included in this prospective study. It was shown that a combination of Barthel Index and CT50 had a stronger predictive power than Barthel Index alone. A combination of EG motor index and CT50 had at least the same predictive power as the combination of Barthel Index and CT50. The usefulness of a simple diagram for individual prognostication was demonstrated.
Subject(s)
Cerebrovascular Disorders/complications , Cerebrovascular Disorders/rehabilitation , Cognition Disorders/etiology , Movement Disorders/etiology , Severity of Illness Index , Activities of Daily Living , Adult , Aged , Brain/physiopathology , Cerebrovascular Disorders/physiopathology , Cognition Disorders/diagnosis , Cognition Disorders/physiopathology , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Movement Disorders/therapy , Occupational Therapy , Physical Therapy Modalities , Prognosis , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
Overnight gastric aspiration was performed on 15 fasting asymptomatic adults in the erect and supine positions. The pH of the gastric aspirates was not directly related to the bile acid concentration, which ranged from 0 to 1116 mumol/l. The total bile acid content of the 12-hour aspirates varied from 0 to 122 mumol. A change in posture had no significant effect on the duodenogastric reflux of bile when subjects were fasting or when gallbladder contraction was stimulated by intravenous pancreozymin. The clinical relevance of these findings is discussed.
Subject(s)
Bile Acids and Salts/analysis , Duodenogastric Reflux/metabolism , Gastric Juice/analysis , Adult , Aged , Female , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Posture , Time FactorsABSTRACT
The clinical progress, histological state of the gastric mucosa, gastric emptying of a liquid meal and duodenogastric reflux were studied postoperatively in 15 patients with a vagotomized intrathoracic stomach without a drainage procedure. The intact though denervated pylorus did not impede the emptying of liquids. Bile reflux into the thoracic stomach in both the erect and supine positions was significantly greater than that measured in control subjects. While posture did not affect duodenogastric reflux in the normal adult, bile reflux across the denervated pylorus was significantly increased in the supine position. Chronic active gastritis was noted in 12 patients but could not be correlated with the degree of bile reflux. Nine patients had evidence of pulmonary aspiration and gastric food residue was a common finding at endoscopy. The vagotomized intrathoracic stomach may need a drainage procedure to facilitate solid emptying.
Subject(s)
Bile Reflux/etiology , Biliary Tract Diseases/etiology , Gastric Emptying , Gastric Mucosa/pathology , Stomach/surgery , Adult , Drainage , Esophageal Neoplasms/surgery , Female , Gastritis/pathology , Humans , Male , Middle Aged , Postoperative Complications/pathology , Posture , ThoraxABSTRACT
Domperidone (Motilium) speeds the emptying rate of the smallest particle size of a digestible solid (radioactive cubed liver) but has no effect on the emptying rate of 400 ml of 5% dextrose in the normal canine stomach. Conversely, metoclopramide (Maxolon) speeds the emptying of the liquid, but slows the emptying rate of the digestible solid. The effect of domperidone on canine gastric electrical activity is to increase the frequency and strength of action potentials in the stomach after fasting and to slow the rate of discharge of the pacesetter potential, an effect similar to that seen after feeding.
