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Biomedical subjects

C V Granger

Publications and source records attributed to C V Granger.

At least 19 recordsLinked to original sources
PubMed1992

Hypothyroidism producing reversible dementia. A challenge for medical rehabilitation.

The evaluation of dementia for reversible causes should not be overlooked. Hypothyroidism is a reversible cause for dementia. Mental status is one of the important factors to be assessed prospectively to determine whether a patient is likely to benefit from intensive inpatient rehabilitation. Because of the negative effect of dementia on the learning process during intensive inpatient medical rehabilitation, it alone may be a sufficient reason to consider alternatives to intensive inpatient rehabilitation. On our rehabilitation unit, hypothyroidism causing confusion was recognized and corrected in two patients. The thyroid-stimulating hormone test is suggested as a screening tool.

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PubMed1992

Discharge outcome after stroke rehabilitation.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the relations between host characteristics (age and side of body affected) and program variables (lengths of stay in acute care and rehabilitation, levels of functional ability at admission and discharge, and rates of community discharge). METHODS: A sample of 7,905 patients was drawn from medical rehabilitation facilities enrolled in the Uniform Data System for Medical Rehabilitation who were admitted and discharged for the first time between January 1988 and June 1989. Data were analyzed using either chi 2 tests or z normal tests of proportions, and analyses of variance (ANOVA) and/or t tests. Significance was set at p less than 0.05, and statistically significant F ratios were examined using Student-Newman-Keuls tests. RESULTS: The average age of patients was 70.7 years (24% less than 65 years, 53% 65-79 years, and 23% greater than 79 years). Lengths of stay in acute care and rehabilitation, admission and discharge functional independence ratings, and rates of community discharge were generally inversely related to patient age. Patients with bilateral paresis had lower rates of community discharge than those with unilateral paresis, although this distinction was not evident in the older group. CONCLUSIONS: Results showed that older age and bilateral paresis are negatively associated with levels of independence at admission and discharge and with rates of community discharge.

Activities of Daily Living↗
PubMed1990

Symptomatic atlantoaxial instability associated with medical and rehabilitative procedures in children with Down syndrome.

The Canadian College of Medical Genetics recently questioned the rationale for radiographic screening for atlantoaxial instability in Down syndrome. We report a case series of four children with Down syndrome with symptomatic atlantoaxial instability and followed for more than 5 years. In all cases a medical or rehabilitational procedure was associated with significant apnea, cardiopulmonary compromise, or severe neurological impairments. None of these patients were screened radiographically. The need for protocols to detect atlantoaxial instability in children with Down syndrome undergoing medical and rehabilitational procedures is highlighted by these cases.

Atlanto-Axial Joint↗
PubMed1990

Functional assessment scales: a study of persons with multiple sclerosis.

The purpose of this study was to investigate disability in persons with multiple sclerosis (MS) by using combinations of functional assessment scales and subscales to predict (1) the burden of care measured in minutes of assistance provided per day by another person in the home, and (2) the subject's level of satisfaction with life in general. The Functional Independence Measure (FIM), Incapacity Status Scale, Environmental Status Scale, and the Barthel Index had high intercorrelations with each other. Although each was predictive of the MS subject's physical care needs, the FIM was the most useful. A change in total FIM score of one point was equivalent to an average of 3.38 minutes of help from another person per day. With the Brief Symptom Inventory and the Environmental Status Scale, the FIM contributed to predicting the patient's general satisfaction as well. We propose that burden of care and subjective satisfaction with life be the standards by which functional assessment instruments are compared to reflect, in pragmatic terms, the impact of disability on the lives of individuals and on the human and economic resources of the community.

Activities of Daily Living↗
PubMed1989

The stroke rehabilitation outcome study: Part II. Relative merits of the total Barthel index score and a four-item subscore in predicting patient outcomes.

Part I of this series described the background of the study; the characteristics of the patient population; and their functional status before onset of stroke, at rehabilitation admission, at discharge, and at six months after discharge. Results at follow-up showed that patients with higher Barthel index scores living in the community were more likely to be satisfied with life in general, to have more person-to-person contacts, and to be more active in community affairs. Part II describes the utility of two sets of data derived from the admission Barthel index (combinations of independent performance of four basic items of the index vs the total score) in predicting the likely range of Barthel index scores at discharge and functional outcomes at six-month follow-up.

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PubMed1988

Stroke rehabilitation outcome studies: comparison of a Japanese facility with 17 U.S. facilities.

A Japanese university hospital collaborated with a mixed group of 17 American hospitals in using common measures of functional status and outcomes for patients undergoing rehabilitation after stroke. Management protocols were similar for all facilities. Philosophies and operational factors concerning length of stay and discharge destinations varied among facilities. In Japan there was little pressure for discharge of rehabilitation patients. Japanese patients were kept in the hospital as long as they improved in their functional scores. The Japanese sample had fewer patients with bilateral involvement, patients were younger, were admitted after a longer period of time following the onset of the stroke, had less severe disability on admission, and had longer lengths of stay, and this may have accounted for higher Barthel score gains for the Japanese sample. These factors may have worked together with the family support system in Japan to account for higher discharge rate to the community for the Japanese sample.

Activities of Daily Living↗
PubMed1988

The stroke rehabilitation outcome study--Part I: General description.

Part I describes the background of the study, the characteristics of the patient population, and their functional status before onset of stroke, at rehabilitation admission, and at discharge, and the outcomes six months after discharge. Results showed that the average age was 69; 40% had right hemiparesis, 43% left, and 17% bilateral deficits. Medical complications during rehabilitation hospitalization were more common in patients who, at follow-up, were either living in a long-term care facility or had died. Average length of medical rehabilitation stay was 37 days, with mean admission and discharge Barthel Index scores of 37 and 66, respectively. Seventy percent of patients were discharged to the community and 68% were in the community six months after discharge. Patients with higher Barthel Index scores at discharge were more likely to be living in the community at follow-up. Patients living in the community at follow-up, with higher Barthel Index scores, were more likely to be satisfied with life in general, have more person-to-person contacts, and be more active in community affairs.

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PubMed1979

Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index.

In view of current emphasis on evaluation of benefits derived from rehabilitation programs, it is important that there be easily replicated measures for demonstrating the efficiency and effectiveness of services provided, as well as for transmitting information on patient functional status when transferring service responsibilities from one agency or facility to another. The authors used the PULSES profile and the Barthel index to measure severity of disability and to monitor rehabilitation progress in a heterogeneous sample of 307 severely disabled persons in 10 comprehensive medical rehabilitation centers, geographically selected. Gains in functional independence were registered for up to 2 years after admission. Cutting points of PULSES score totals or Barthel score totals distinguished the degree of severity of disability. The 2 scoring modalities appear valid, reliable, and sensitive for describing functional abilities and change over a period of time. They can be applied both to medical records and direct observations, and staff of medical facilities can readily be trained in their use.

Activities of Daily Living↗
PubMed1979

Stroke rehabilitation: analysis of repeated Barthel index measures.

Functional abilities of stroke patients in a rehabilitation hospital are recorded every 2 weeks using the Barthel index. For purposes of this study, data were collected retrospectively and prospectively from consecutive records according to predetermined criteria on forms coded for computer analysis. Total scores of 110 patients were correlated with length of stay, placement at discharge and scores in individual functional abilities. Analysis of the data reveals that an initial score over 40 on the Barthel index defines a population with a greater proportion of discharges to home and that patients with initial scores over 60 have a shorter length of stay. Further analysis indicates a predictable progression in the development of functional skills in this population so that with a Barthel score below 40, no one was independent in the mobility skills and fewer than 50% were independent in the very basic skills, such as feeding, grooming and sphincter control. A score of 60 appears to be a pivotal score where patients move from dependency to assisted independence.

Activities of Daily Living↗