Patterns of participation in school-related activities and settings in children with spina bifida.

PURPOSE: To evaluate how children with spina bifida (SB) participate in school-related activities and to explore if their motor and process skills in task performance were related to their level of active participation in school. METHOD: Fifty children from a geographical cohort of children with SB (aged 6-14 years) and their teachers rated the children's frequency of participation in school-related activities using a Swedish adaptation of the Availability and Participation Scale. The teachers also rated each child's level of active participation with the School Function Assessment, part one. Each child's motor and process skills were evaluated with the Assessment of Motor and Process Skills. The relation between levels of active participation and motor and process skills was subjected to binary logistic regression analysis. RESULTS: The children participated very frequently in school activities, but their level of active participation was restricted, particularly in the recess/playground setting. There was a highly significant relation between full active participation in most school settings and the children's motor and process skills. CONCLUSION: Children with SB need support to become more actively involved, particularly in unstructured peer activities. The school staff need to be informed that not only the motor skills but also the process skills have an impact on the children's active participation. IMPLICATIONS FOR REHABILITATION: The children with spina bifida (SB) showed a low level of active participation and involvement in school settings even though their frequency of participation was high. It is of highest importance to enable children with SB to be actively involved in peer-related and unstructured activities and to encourage them to participate in both academic and societal learning. To achieve active participation, it is important to inform the school staff about how this issue is affected not only by the level of the child's motor skills but also, and probably even more so, by the level of his/her process skills. From this knowledge, individual strategies can be worked out.

Recovery in personal care related to cognitive impairment before and after stroke - a 1-year follow-up.

OBJECTIVE: To examine whether there were any differences in the recovery in performance of personal activities of daily living (P-ADL) in elderly persons in relation to cognitive impairments pre- and post-stroke from discharge to 6 and 12 months in elderly persons. METHODS: Forty-five elderly persons after stroke were assessed at discharge from hospital and at 6 and at 12 months after stroke onset. A questionnaire posed to the next of kin was used to evaluate the person's pre- and post-stroke cognitive status. P-ADL was assessed with the Barthel Index. The Mini Mental State Examination and neuropsychological tests were used to measure cognitive functions after stroke. The National Institute of Health Stroke Scale was used to measure neurological deficits. RESULTS: Persons with cognitive impairments before and after stroke did not improve in P-ADL from the acute phase until 6 and 12 months, while persons with intact cognition pre- and post-stroke did. CONCLUSION: Since cognitive problems pre- and post-stroke hinder recovery in P-ADL, it is important to understand the connection between cognitive impairment and activity limitations when planning the optimal rehabilitation, which could include special compensation strategies, learnt by the patients, cognitive assistive devices and/or appropriate personal support trained in meaningful activities in daily life in their natural environment.

Quality of performance of everyday activities in children with spina bifida: a population-based study.

AIM: The aim of this study was to evaluate the quality of the performance of everyday activities in children with spina bifida. METHODS: Fifty children with spina bifida (of 65 children in a geographic cohort), aged 6 to 14 years, were evaluated with Assessment of Motor and Process Skills. RESULTS: Compared with age-normative values, 60% of the children with spina bifida were found to have motor ability measures below 2 SD and 48% process ability measures below 2 SD. Most of the children with spina bifida had difficulties performing well-known everyday activities in an effortless, efficient and independent way, relating to both motor and process skills. The motor skills hardest to accomplish involved motor planning and the process skills hardest to accomplish were adaptation of performance and initiations of new steps, thus actually getting the task done. CONCLUSION: To reach autonomy in life, children with spina bifida may need particular guidance to learn not only how to do things but also how to get things done.

Influence of cognition on personal activities of daily living (P-ADL) in the acute phase: the Gothenburg Cognitive Stroke Study in Elderly.

This study examines how prestroke dementia and cognitive dysfunction after stroke influence the personal activities of daily living (P-ADL) in elderly patients in the acute phase after stroke. Elderly stroke patients (n=60) referred to geriatric rehabilitation were included. Assessments were carried out at admission and evaluated at discharge from the geriatric ward. The median age of the group was 77 years. Astrand's questionnaire was used to interview a close relative about the patient's prestroke cognitive status. P-ADL was assessed with the Barthel Index (BI). The Mini Mental State Examination (MMSE) and a neuropsychological test battery were used to measure cognitive functions. Analyses were made using non-parametrical methods. In the acute phase after stroke, neither the presence of prestroke dementia nor the cognitive status after stroke onset among these elderly patients influenced P-ADL at admission or at discharge. Prestroke dementia and cognitive dysfunction's were found to be common after stroke onset, however this did not have any impact on dependence in P-ADL in these elderly patients at admission or at discharge.

Parallel reliability of the functional independence measure and the Barthel ADL index.

PURPOSE: The aim of this study was to evaluate the concordance between the assessments of ADL according to the Functional Independence Measure (FIM) and the Barthel ADL index (BI) by means of a rank-invariant statistical method. METHOD: The construct validity, also called parallel reliability, of FIM and BI was assessed on the item level. Two different approaches to condensing the FIM assessments into 2-4 scale steps on the item level in order to calibrate the two ADL instruments were compared. One was determined by the theoretical operational definitions and the other defined by the empirical definitions. The 204 assessments of elderly persons were made three months after stroke by means of interviews. RESULTS: The parallel reliability of the FIM and the BI on the item level was strong, both according to the theoretical cut-off levels defined by the operational definitions and the empirical cut-off levels defined by the marginal distributions. CONCLUSIONS: The concordance between FIM and BI was high. There was a slight difference in favour of the operational definitions. The clinical key elements are to have a critical attitude towards ADL instruments; how they are constructed and operationalized. These are important elements in the quality assurance in the everyday work.

Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients: the Göteborg 70+ Stroke Study.

BACKGROUND AND PURPOSE: The aim of the present study was to examine resource utilization during a 12-month period after acute stroke in elderly patients randomized to care in an acute stroke unit integrated with a care continuum compared with conventional care in general medical wards. A secondary aim was to describe costs related to the severity of stroke. METHODS: Two hundred forty-nine consecutive patients aged >/=70 years with acute stroke within 7 days before admission, living in their own homes in Göteborg, Sweden, without recognized need of care were randomized to 2 groups: 166 patients were assigned to nonintensive stroke unit care with a care continuum, and 83 patients were assigned to conventional care. There was no difference in mortality or the proportion of patients living at home after 1 year. Main outcomes were costs from inpatient care, outpatient care, and informal care. RESULTS: Mean annual cost per patient was 170, 000 Swedish crowns (SEK) (equivalent to $25,373) and 191,000 SEK ($28,507) in the stroke unit and the general medical ward groups, respectively (P:=NS). Seventy percent of the total cost was for inpatient care, and 30% was for outpatient and informal care. For patients with mild, moderate, and severe stroke, the mean annual costs per patient were 107,000 SEK ($15,970), 263,000 SEK ($39, 254), and 220,000 SEK ($32,836), respectively (P:<0.001). There was no statistical difference in age or nonstroke diagnosis. CONCLUSIONS: The total costs the first year did not differ significantly between the treatment groups in this prospective study. The total annual cost per patient showed a very large variation, which was related to stroke severity at onset and not to age or nonstroke diagnoses. Costs other than those for hospital care constituted a substantial fraction of total costs and must be taken into account when organizing the management of stroke patients. The high variability in costs necessitates a larger study to assess long-term cost effectiveness.

Effect of acute stroke unit care integrated with care continuum versus conventional treatment: A randomized 1-year study of elderly patients: the Göteborg 70+ Stroke Study.

BACKGROUND AND PURPOSE: The aim of the study was to compare the effect of conventional treatment with the effect of acute stroke unit care integrated with geriatric stroke unit care continuum. METHODS: A 1-year study was undertaken with 2:1 randomization to stroke unit care or conventional care, with assessment by an independent team. The study was composed of 249 elderly patients (aged >/=70 years) hospitalized for acute stroke, without previous cerebral lesion and without recognized need of care. Main outcome measures were patients at home after 1 year, ability in daily living activities, health-related quality of life score according to questionnaire, death or institutional care, and death or dependence. RESULTS: One hundred two patients (61%) in the stroke unit and 49 patients (59%) in the general ward group were alive and at home after 1 year (95% CI -10% to 16%). There were no significant differences in daily life activities or quality of life. In patients with concomitant cardiac disease, there was a reduction in death or institutional care after 3 months in the stroke unit group compared with the group receiving conventional care (28% versus 49%, respectively; 95% CI -40% to -3%). This effect did not remain after 1 year. Patients seeking care after 24 hours often had mild stroke and lived alone. CONCLUSIONS: There was no effect on the number of patients living at home after 1 year, but after 3 months of stroke unit care, a beneficial effect was found on mortality and the need for institutional care among those with concomitant heart disease. This study involved patients who were considerably older than those investigated in previous randomized studies of acute stroke unit care; thus, these findings will contribute to the specialized register of controlled trials in stroke.

Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients.

BACKGROUND AND PURPOSE: A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. METHODS: One hundred four consecutive patients >40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. RESULTS: There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. CONCLUSIONS: The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services.

Different kinds of services and informal support in the daily life activities in a community-based elderly population.

As part of the well-known population study of 70-year olds in Gothenburg, 1239 persons at the age of 70 were invited to participate in an extensive investigation and Inter-Vention program of the Elderly in Gothenburg (IVEG). The probands were examined at the ages of 70, 73 and 76 years. The purpose of this study is to describe different kinds of services and informal support in the daily life activities among three large groups of people in their seventies. A cross-sectional study design was chosen in order to get as large groups as possible. A home call was made by an experienced occupational therapist, who interviewed and observed the probands' performance in the daily life activities. The probands and their relatives were asked about the extent of different services and informal support. Personal and home assistance care given by relatives almost doubled between the age of 70 and 76 years. Help organized by the Social Welfare Services only increased marginally. Of the personal activities of daily living (ADL), getting in/out of a bathtub was the activity that caused most problems. The most common walking aid was a stick or a crutch, while use of a wheelchair was quite uncommon. Between the age of 70 and 76 years, the use of the Handicap Transport Service more than doubled. This study shows that at the age of about 73 years the elderly should be offered formal support, such as the supply of assistive devices. What is noteworthy is that the help from relatives and friends increased much more than the help from the Social Welfare Services between the age of 70 and 76 years. At present, relatives and friends assist the elderly in their homes to a large extent, and frequently. Relatives are doing an important job for their elderly and for society, and should be given every possible kind of public support and relief in order to have the strength to continue.

Domestic activities and walking in the elderly: evaluation from a 30-hour heart rate recording.

The physical activity pattern among 43 subjects (25 women, 18 men) from the Intervention Study of Elderly in Gothenburg (IVEG) has been evaluated by means of heart rate monitoring, rating of perceived exertion and recording activities over a 30-hour period. These subjects had previously been interviewed about their activity pattern, including the duration of their daily walks. In 91% of the participants the average heart rate was below 100 beats/min during walking. Considerable individual variations were noted in the duration of domestic activities and of walks. Using heart rate levels equal to or above the average heart rate during walking as a criterion, it was found that 68% of the women, but only 17% of the men, spent more time on domestic activities than on walking. Nonetheless, it is suggested that in addition to walking, domestic activities, owing to their duration, are important in maintaining physical fitness in the elderly, especially among women. This should be taken into account when physical activity is being classified (to avoid bias in favour of men). A modified version of a previously published six-grade scale for the classification of physical activity has been suggested.

ADL-reduction and need for technical aids among 70-year-olds. From the population study of 70-year-olds in Göteborg.

Six hundred and nineteen persons from the population study of 70-year-olds "The intervention study of the elderly in Göteborg" (IVEG) were examined. They were interviewed in their home environment concerning their ability to manage activities of daily living (ADL), and the definition "ADL-reduction" is based on seven of these ADL-measurements. One third of the 70-year-old population had reduced ADL-capability, some only slightly. Joint disorders, paresis and congestive heart failure were the most common problems among the ADL-reduced subjects. Forty-three per cent of the ADL-reduced subjects (19% of total) received help with their personal care and/or housekeeping. One third had technical aid, mostly quite simple and inexpensive. Half were provided with new technical aids. The need for technical aids and home help service was noted and intervention undertaken as and when necessary. The needs were correlated to physical activity and performance in functional tests. The results do not illustrate the occurrence of handicap but are aimed at illustrating the special needs that elderly people may have in their normal surroundings.