A patient acuity and staffing tool for stroke rehabilitation inpatients based on the FIM instrument.

We undertook to develop a tool based on the FIM instrument to predict the number of nursing hours required to care for stroke patients in an acute inpatient rehabilitation program. The initial study to evaluate the feasibility of using the FIM instrument revealed that the total FIM score had a strong inverse relation to the level of care indicated by the Patient Care Index (PCI) at days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = -.76 to -.87). The results warranted continued investigation of the FIM instrument as a guide for nurse staffing decisions. Based on data from the initial study, five categories of FIM score ranges were designated that demonstrated the most accuracy of placing patients at the correct level of care. Special care considerations unique to institutional settings were identified and incorporated into the tool's final format, as were the calculations to determine the amount of assistance needed. The study reported here was undertaken to evaluate the level of care indicated by the adapted tool, compared with that of the PCI, in a sample of 67 stroke admissions. Spearman correlations revealed a moderate relationship (rs = .49 to .54) between the amount of care determined by the Patient Acuity and Staffing tool and through the PCI at the first, second, and third team meetings. We conclude that the system is an effective, efficient guide for scheduling nurse staffing on the stroke rehabilitation unit.

Determining stroke rehabilitation inpatients' level of nursing care.

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 (r(s) = -. 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.

Urinary incontinence and stroke outcomes.

OBJECTIVE: To examine the relation of urinary incontinence to functional status and discharge destination in stroke rehabilitation patients. DESIGN: Historical cohort. SETTING: Freestanding, not-for-profit rehabilitation hospital. PARTICIPANTS: Nonrandom sampling. The charts of all admissions to the stroke rehabilitation unit were screened to identify patients with a medical diagnosis of completed stroke occurring 2 to 4 weeks before admission to rehabilitation, documented evidence of urinary incontinence at least daily the first 2 days after admission, and Functional Independence Measure (FIM) bladder sphincter score of 5 or less. Ninety patients met the inclusion criteria. MAIN OUTCOME MEASURES: FIM, change in FIM scores from admission to discharge, weekly FIM gains, and discharge destination. RESULTS: Continence status at discharge was not associated with discharge destination, but did predict total FIM score at discharge and the change in FIM scores from admission to discharge. Subjects who regained continence had higher weekly FIM gains on all subscales except Communication. A critical area of difference between the groups was in Social Cognition scores. The time interval from stroke greatly influenced the findings; in patients evaluated 14 to 18 days after stroke differences between continent and incontinent subjects were found only in Social Cognition scores, whereas in patients evaluated 27 to 30 days after stroke differences were found in Self-Care and Sphincter Control scores. CONCLUSION: Further investigation into cognitive characteristics should be undertaken with a more comprehensive tool appropriate for an impaired population.

A comparison of the characteristics of incontinent and continent stroke patients in a rehabilitation program.

The characteristics of incontinent stroke patients who regained continence by the time of their discharge from an acute rehabilitation program were compared with those of patients who remained incontinent. Of the 90 patients who met the inclusion criteria on admission to the program, 45 were continent at discharge. Compared with those who regained continence, the subjects who remained incontinent at discharge took longer to be transferred to the rehabilitation program after the onset of stroke, had lower total Functional Independence Measure (FIM) instrument scores at admission and discharge, had more episodes of urinary incontinence (UI) during the first 24 hours after their admission, and had smaller increases in functional scores during rehabilitation. When the time from the onset of stroke was controlled, a subsample of those who remained incontinent scored lower only on the social cognition subscale 14-18 days after the stroke, whereas 27-30 days after their stroke their scores on the sphincter control and self-care subscales were lower. UI was not associated with patients' destinations at discharge. The results of this study provide more information about UI after stroke and give direction for future research.

[Adrenoleukomyeloneuropathy presenting as a mental disorder]. / Adrénoleucomyéloneuropathie évoluant comme une maladie psychiatrique.

Troubles of cognitive functions are generally observed in the X-linked adrenoleucodystrophy. This disease can be revealed at late onset (adrenomyeloneuropathy) or contemporary of the demyelinisation in central nervous system (adrenoleucodystrophy). Cerebral variants with only psychic involvement remain uncommon, the lesions are located in the temporo-parieto-occipital areas. The diagnosis occurs by biological investigations and/or the familial history before any defect of neurological signs. Therapeutics hopes in this storage disorder lay by the earlier diagnosis. In this way, we found interest to investigate the adult forms.

Bladder dysfunction after stroke.

The effects of stroke are complex and diverse. Deficits experienced depend on the location of damage and vary in severity. Voiding problems resulting from a stroke include uninhibited neurogenic bladder, urgency and frequency, retention, urge incontinence, and overflow incontinence. Because a variety of causative and contributing factors are involved, comprehensive and ongoing evaluation is necessary. Although bladder dysfunction is common initially after stroke, evidence has shown that improvements in voiding occur after the first few weeks. Intermittent sterile catheterization, scheduled voiding, pelvic floor exercises, and relaxation techniques can be effective, especially if other stroke deficit considerations are incorporated into the management plan.

Bladder dysfunction after a stroke--it's not always inevitable.

Bladder dysfunction frequently accompanies a stroke but, with appropriate management, is not necessarily a permanent deficit. Voiding problems most often experienced after a stroke include urgency, frequency, incontinence, and urinary retention. A clamping routine prior to indwelling urinary catheter removal did not affect the incidence of voiding dysfunction after a stroke. Checking consecutive post-voided residual urine volumes after a stroke is indicated to evaluate the effectiveness of bladder emptying; intermittent sterile catheterization is recommended if there is a problem.

A true experiment evaluating adult skill training for severely mentally retarded secondary students.

Skill acquisition by secondary-level severely mentally retarded students was assessed on functional community and living skills task analyses. Students were trained in natural settings according to a behavioral analysis of the curriculum into systematic teaching and error-correction procedures. Classroom training in the district high school supported the teaching that occurred in the community. The evaluation of student performance on specific skills was done using random assignment to training and control conditions in a cross-over design. Students showed significantly greater gains on those tasks for which they were trained than on those for which they were not. In addition to this specific skill training, a daily checklist showed significant progress by all students on a broad array of skill sequences. Discussion stressed the contribution of the project to ideologically appropriate public school programs for severely mentally retarded students, to behaviorally based instructional technology, and to evaluation using true experimental designs.