Biomedical subjects

Haim Ring

Publications and source records attributed to Haim Ring.

23 records · Page 2Linked to original sources

PubMed2002

Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome.

OBJECTIVE: To assess whether, and to what extent, cognitive outcome relates to overall functional outcome among elderly stroke patients. DESIGN: Nonconcurrent prospective study. SETTING: Geriatric rehabilitation division at a large, urban, academic, freestanding hospital in Israel. PARTICIPANTS: Three hundred thirty-six patients aged 60 years and older admitted consecutively for rehabilitation after first acute stroke. Inclusion criteria were met by 315 patients, who were included in the final analysis. Average age was 75.3 years. The stroke was right sided in 44.1%. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The motor subscale of the FIM instrument assessed functional status. Absolute functional gain was determined by the FIM motor gain. Relative functional gain was calculated according to the Montebello Rehabilitation Factor Score. Cognitive status was assessed with the Mini-Mental State Examination (MMSE) and the FIM cognitive subscale. RESULTS: FIM scores increased significantly during rehabilitation, mainly due to improvement in motor functioning. A strong association was found between the cognitive scales (r=.853, P<.001). Better rehabilitation outcomes were observed in patients with higher admission cognitive status, adjusting for the effect of age, sex, onset to admission interval, length of stay, and severity of stroke (odds ratio = 2.0; 95% confidence interval, 1.5-2.5). CONCLUSIONS: Impaired cognitive status at admission negatively affects the rehabilitation outcome of elderly stroke patients. The utility of routinely using a cognitive test for all patients before admission to rehabilitation, preferably the MMSE, is emphasized. The time, cost, and effort involved in performing such a test are negligible, and the potential benefits are considerable.

Activities of Daily Living↗

PubMed2002

Awareness of deficits in stroke rehabilitation.

The aim of this study was to evaluate the awareness of deficit profiles of stroke patients undergoing rehabilitation, and examine the impact of unawareness on rehabilitation functional outcomes. Sixty first-event stroke patients, 36 after right hemisphere damage and 24 after left hemispheric damage were included. The Awareness Interview was administered at admission to rehabilitation, and patients' responses were compared with standardized cognitive and neurological evaluations. The FIM motor scale and a safety rating were used to measure functional outcomes at discharge from rehabilitation and at 1-year follow up. The frequency of unawareness for motor and sensory deficits was low, whereas unawareness of cognitive deficits was much higher. Unawareness was not associated with a specific lesion site, however a significant association was found with cortical involvement, and with lesion size. In the right hemispheric damage group a significant negative correlation was found between total unawareness scores and discharge functional outcomes. Multiple regression revealed that unawareness at admission was a significant predictor of discharge FIM motor scores in the right hemispheric damage group, beyond the contribution of cognitive and demographic variables. Findings delineate the multifaceted nature of unawareness phenomenon, and highlight the significance of unawareness in post-stroke rehabilitation.

Analysis of Variance↗

PubMed2002

Disability assessment by a single rater or a team: a comparative study with the Catz-Itzkovich spinal cord independence measure.

The Catz-Itzkovich Spinal Cord Independence Measure was found to be reliable and more sensitive than the FIM to functional changes, when used by a multidisciplinary team. This study was performed to find out whether assessment may be similar when done by a single rater. Twenty-eight patients with spinal cord lesions participated in the study, in which examinations performed within a week by a single nurse or a team were compared for correlation, differences and agreement. The team members scored their relevant fields. A significant correlation was found between the nurse's scoring and that of physiotherapists and occupational therapists (r = 0.82-0.94; p < 0.0001), and the differences between the mean scores were small. The agreement between raters was modest, however (total agreement 38-90%, Kappa 0.17-0.73). It was concluded that although disability assessment performed by a single nurse may not be as accurate as by a multidisciplinary team, it could be reliable and valid.

Activities of Daily Living↗

PubMed2002

Dynamic cardiophysiologic variables correlate with lesion location and FIMTM in patients with ischemic stroke.

OBJECTIVE: To examine the correlation between a clinical measure of function in patients undergoing rehabilitation who had recently had an ischemic stroke and to examine cardiophysiologic measures registered during effort. DESIGN: A cohort study comprising a sample of consecutive patients, without a history of cardiac disease or rhythm disturbances, admitted for rehabilitation after an ischemic supratentorial stroke. All patients were examined for the FIM trade mark score and dynamic cardiophysiologic variables. Results were analyzed in relation to stroke location. Thirty-eight patients participated in the study. Ten patients had a superficial lesion, 20 had a deep brain lesion, and eight had no noticeable lesion by computed tomographic imaging. Function was measured with the FIM instrument 48-72 hr after admission and repeated at 1 wk before discharge. Electrocardiographic activity was recorded during physiotherapy treatment. The relationship between the RR and QT intervals in the electrocardiographic waveforms was found to estimate two cardiophysiologic variables, the constant (a) and the slope (b) values, reflecting the dynamic change of QT during physiotherapy effort. RESULTS: Only for the subgroup of patients who sustained a deep brain lesion did the motor items in the FIM instrument on admission and discharge scores have a statistically significant relationship with the slope variable (b) and an inverse statistically significant relationship with the constant variable (a). CONCLUSIONS: Deep brain infarction seems to result in a significant dysfunction of the autonomic nervous system, manifesting itself as distorted dynamic behavior of the QT interval and with impaired functional performance.

Aged↗

PubMed2002

[SCIM--spinal cord independence measure (version II): sensitivity to functional changes].

Until recently, the functional ability of patients with spinal cord lesions (SCL) was assessed by standardized scales designed for various disabilities. However, these scales have either a relatively low sensitivity to changes in the functions that are most important for SCL patients or a limited suitability for a specific SCL subgroup. To counter this problem the team of the Spinal Department of Loewenstein Rehabilitation Hospital developed the Spinal Cord Independence Measure (SCIM), which is specific for SCL patients, adjusts for disadvantages of earlier scales, and is user-friendly. It was found to be reliable and more sensitive to functional changes in SCL patients than the Functional Independence Measure (FIM), the most often used disability scale today. A second version (SCIM II) was constructed with improved phrasing of some of the components. It too, was found reliable, even more than the original version for certain functions. The present study examined the sensitivity of the SCIM II to changes in function in SCL patients compared to the FIM. Twenty-six patients with SCL underwent sequential SCIM II and FIM examinations during hospitalization for rehabilitation. A high correlation was found between the total scores of the two scales (r = 0.915; p < 0.0001). The mean change in function score from the first to the last examination was significantly larger with the SCIM II than with the FIM (p < 0.04), and the rate of detection of functional change was usually higher with the SCIM II. The advantage of the SCIM II over the FIM in detecting functional changes was evident in areas in which the two scales differ substantially. These results support the validity of the SCIM II. Studies with larger groups in different countries and cultures are still needed before the scale can be applied on an international basis.

Activities of Daily Living↗