Minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis.

[Purpose] To estimate the minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity by using anchor-based methods in stroke patients with moderate to severe hemiparesis. [Participants and Methods] Fourteen patients who were hospitalized in a convalescent phase rehabilitation ward were included in this study. Fugl-Meyer assessment of the upper extremity was used to assess the impairment prior to intervention and at follow-up (six weeks later). Participants were asked to evaluate the degree of improvement of paresis of the upper extremity using the global rating of change scale at follow-up. The mean change in Fugl-Meyer assessment scores in the group of patients who answered "a little better, meaningful in daily life" in the global rating of change scale was considered as the minimal clinically important difference. [Results] The mean post-onset period of participants for analysis was 49.4 days. The minimal clinically important difference of the Fugl-Meyer assessment scores were 12.4 (upper extremity), 5.6 (upper arm), and 4.9 (wrist/hand). [Conclusion] A score of 12.4 in the Fugl-Meyer assessment of the upper extremity is likely to be perceived as meaningful in stroke patients with moderate to severe hemiparesis.

Effectiveness of Family-Engaged Multidimensional Team Planning and Management for Recovery in Patients With Severe Stroke and Low Functional Status.

OBJECTIVE: To evaluate the effectiveness of family-engaged multidimensional team planning and management for patients with severe stroke and low functional status and to identify factors predictive of improved outcome at 1 month after admission. METHODS: We retrospectively evaluated 50 patients who underwent family-engaged multidimensional rehabilitation for recovery from severe stroke due to primary unilateral cerebral lesions. The rehabilitation consisted of three phases: comprehensive multidimensional assessment, intensive rehabilitation, and evaluation. Functional Independence Measure (FIM) scores were calculated and used to predict the patients' status at discharge. RESULTS: Although all FIM scores significantly improved after 1 month of rehabilitation, the motor FIM (mFIM) score improved the most (from 20.5±1.0 to 32.6±2.0). The total FIM (tFIM) and mFIM scores continued to improve from the first month to discharge (mean mFIM efficiency, 0.33). The high-efficiency patient group (mFIM efficiency ≥0.19) had a significantly higher discharge-to-home rate (44% vs. 13%), lower frequency of hemispatial neglect, and more severe finger numbness than the low-efficiency patient group (mFIM efficiency <0.19). The regression analyses revealed that besides lower mFIM and cognitive FIM scores at admission, unilateral spatial neglect, systemic comorbidities, and age were predictive of worse 1-month outcomes and tFIM scores (conformity, R2=0.78; predictive power, Akaike information criterion value=202). CONCLUSION: Family-engaged multidimensional team planning and management are useful for patients with severe stroke and low functional status. Furthermore, FIM scores at admission, age, unilateral spatial neglect, and systemic comorbidities should be considered by rehabilitation teams when advising caregivers on the probability of favorable outcomes after rehabilitation.

Lower garment-lifting postural control characteristics during toilet-related activities in healthy individuals and a post-stroke hemiplegic patient undergoing rehabilitation.

[Purpose] This study compared lower garment-lifting postural control characteristics during toilet-related activities between healthy participants and a post-stroke patient, and studied changes in the stroke patient's characteristics during rehabilitation. [Participants and Methods] Six healthy individuals and one stroke participant with right hemiparesis were asked to lift a pair of pants with the left arm while on the toilet. During the process, we measured the mean percentage of body weight (%BW) on each leg and the foot center of pressure (COP) using portable force plates. Measurements were conducted twice for the stroke participant during rehabilitation. [Results] In healthy participants, the %BW and respective COP indices for both legs were not different during lifting, but the COP sway velocity and excursion were greater in the anterior-posterior (AP) than the lateral axis in both legs. In the stroke participant, no marked change was seen in the high %BW of the non-paretic leg while lifting during rehabilitation, but both legs' COP positional asymmetry improved on the AP axis and the COP sway velocity and excursion of the non-paretic leg increased. [Conclusion] Facilitating selective COP mobility on the AP axis of the non-paretic leg during lower garment lifting could become an effective intervention for stroke patients.

A Process of Multidisciplinary Team Communication to Individualize Stroke Rehabilitation of an 84-Year-Old Stroke Patient.

Previously, we have used a multidisciplinary team (MDT) approach to individualize rehabilitation of very old stroke patients as a means to establish intervention points for addressing impaired activities of daily living (ADL). However, this previous study was limited because of a lack in describing the communication process over time. This case study characterized the MDT communication process in the rehabilitation of an 84-year-old patient over the course of 15 weeks. The MDT consisted of 3 nurses, 1 doctor, 6 therapists, and the patient/families. Meetings (15 minutes each) were held at 4, 6, 8, and 15 weeks following the patient's admission. To individualize the rehabilitation, the communication process involved gaining knowledge about ADL impairments, sharing assessments, providing treatment options, and reflecting on desired treatment outcomes-a process termed KATR. The knowledge, assessment, treatment, and reflection (KATR) process established intervention points focusing on specific ADL impairments. The team members focused the interventions on the impaired ADL identified in the KATR process, and individualized rehabilitation was generated from the MDT information-sharing knowledge. In the initial meeting (Week 4), intervention points derived from the KATR process focused on rehabilitation of self-care impairments. These impairments improved by Week 15. By the last meeting, the MDT intervention points focused on mobility impairments. Having an organized communication process (i.e., KATR) facilitates individualization of rehabilitation without lengthy and frequent MDT meetings and enhances the quality of rehabilitation after a stroke.