SYMPTOMS OF PSYCHOPATHOLOGY IN MOTHERS WITH MENTAL HANDICAP

The primary purpose of this study was to examine how mothers with or without mental handicap ascribed to those symptoms of psychopathology included in the self-report version of the Psychopathology Instrument for Mentally Retarded Adults (PIMRA). A secondary purpose was to examine the psychometric properties of the PIMRA. Mothers with mental handicap scored significantly higher than did the contrast mothers on all a priori pre-constructed subscales except on psychosexual disorders where they scored lower. These subscale differences were largely as a result of differences on a few items within each scale. Scores for mothers with mental handicap on the Adjustment and Anxiety subscales were related to whether they had been abused or neglected as children while Adjustment scores were related to a report of abusing their own child. Results with some similarity to those previously reported were found regarding the psychometric properties of the PIMRA. Suggestions are made regarding the need for examination of the purpose and construction of the PIMRA as well as for the further study of the expression of symptoms of psychopathology in persons with mental handicap.     

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.     

Validity of the PULSES profile compared with the Functional Independence Measure for measuring disability in a stroke rehabilitation setting.

OBJECTIVES: To test the validity of the PULSES profile for measuring the disability of stroke rehabilitation patients and to compare it with the Functional Independence Measure (FIM); and to determine the ability of the PULSES score to predict discharge home from a stroke rehabilitation setting. STUDY DESIGN: Retrospective cohort. SETTING: A tertiary stroke rehabilitation unit. PATIENTS: One hundred ninety-seven patients admitted consecutively to a stroke rehabilitation unit from September 1992 to April 1995. METHODS: The PULSES profile was tested for internal consistency. Criterion validity was evaluated by comparing with the FIM. Construct validity was tested using the multimethod-multitrait matrix method and by performing logistic regression to determine if admission PULSES score was predictive of discharge home. RESULTS: Internal consistency of the PULSES profile was supported with a Cronbach's alpha of .74. There was a high correlation between the PULSES and FIM admission and discharge scores of -.82 and -.88, respectively. The multimethod-multitrait matrix correlations demonstrated good convergent and divergent validity for the correlation of the PULSES profile items and the FIM subcategories. Multivariate logistic regression determined the admission PULSES total score to be an independent variable in the model to predict discharge home. CONCLUSIONS: The PULSES profile is a valid measure for assessing disability in the stroke rehabilitation setting. The PULSES profile correlates highly with the FIM. The admission PULSES total score is predictive of discharge home from a stroke rehabilitation program.     

Correlation between upper limb function and oral health impact in stroke survivors

[Purpose] The aim of the present study was to evaluate the relationship between upper limb impairment and oral health impact in individuals with hemiparesis stemming from a stroke. [Subjects and Methods] The study subjects were conducted with a sample of 27 stroke survivors with complete or partial hemiparesis with brachial or crural predominance. The 14-item short version of the Oral Health Impact Profile was used to evaluate perceptions of oral health. The Brazilian version of the Stroke Specific Quality of Life Scale was used to evaluate perceptions regarding quality of life. [Results] A statistically significant association was found between the upper extremity function subscale of the SSQOL-Brazil and the impact of oral health evaluated using the OHIP-14, with a strong correlation found for the physical pain subscale, moderate correlations with the functional limitation, psychological discomfort, physical disability, social disability and social handicap subscales as well as a weak correlation with the psychological disability subscale. Analyzing the OHIP-14 scores with regard to the impact of oral health on quality of life, the most frequent classification was weak impact, with small rates of moderate and strong impact. [Conclusion] Compromised upper limb function and self-perceived poor oral health, whether due to cultural resignation or functional disability, exert a negative impact on the quality of life of individuals with hemiparesis stemming from a stroke.Key words: Quality of life, Oral Health, Stroke     

Quality of life in patients with oral lichen planus

Background  Oral lichen planus (OLP) can seriously affect the quality of life of patients because it has a strong impact on social relations, psychological status and daily activities.
Objective  To study the quality of life using the Oral Health Impact Profile (OHIP-49) (validated Spanish version) in patients with OLP.
Patients and methods  A total of 74 patients with a minimum age of 18 years who had lichen planus were recruited into the study, along with 74 'healthy' subjects matched by sex and age who acted as control. Both groups completed the OHIP-49.
Results  Higher scores were obtained on the OHIP-49 index in patients with OLP for all the subgroups and for the overall total than in the control group. Furthermore, there were statistically significant differences in the items concerning psychological discomfort, social disability and handicap in patients with OLP.
Conclusions  The study shows that the quality of life in patients with OLP is reduced and that patient-centred measures should be considered in the management of patients with OLP.     

Life satisfaction and spinal cord injury: the patient perspective

Spinal cord injury is a high-cost disability requiring numerous personal life-style changes. As a result of advanced medical and nursing care, life expectancy of the spinal cord-injured (SCI) individual has greatly increased. Economic impact and changes in life expectancy have led to assumptions about life satisfaction in SCI individuals. Those assumptions are: (1) spinal cord-injured individuals have less life satisfaction than the general population, and (2) since these individuals cannot lead "normal" lives, they may be better off not living. This study attempted to disprove those assumptions by determining whether correlation existed between life satisfaction and physical functioning in SCI individuals. Telephone interviews were conducted with 31 individuals who had suffered spinal cord injury. Data were collected through the use of the Life Satisfaction in the Elderly Scale (LSES) and the Barthel Index. A correlation was found to exist between LSES scores and Barthel scores, but Barthel scores and the LSES subscale scores for goals, mood and finance had low correlations. The data suggest nurses may enhance life satisfaction in the SCI individual by focusing on adaptation in the three subscales of goals, mood and finance.     

A retrospective analysis of outcome in severe Guillain-Barre syndrome following combined neurological and rehabilitation management

Purpose : To determine the outcome in severe Guillain-Barre syndrome following combined neurological and rehabilitation management using standardized disability and handicap measures and to identify the factors which affect this outcome. Methods : A retrospective study was performed of 24 patients with Guillain-Barre Syndrome admitted over a 3 year period to the neurological rehabilitation unit of the National Hospital for Neurology and Neurosurgery, Queen Square, London. Disability and handicap on admission and discharge were measured using the modified Barthel Index (BI), Functional Independence Measure (FIM), Environmental Status Scale (ESS) and Handicap Assessment Scale (HAS). Data was collected to identify any factors affecting outcome; age at onset, time to nadir, duration of ventilation, total in-patient stay, duration of stay at the neurological rehabilitation unit, symptoms, signs and electrophysiological findings. Results : The majority of patients had multiple problems. Outcome was related to the duration of rehabilitation. The mean modified BI score and the FIM score increased whereas ESS scores and HAS scores decreased, these changes were compatible with a reduction in disability and handicap. Conclusions : Significant improvement in function occurred during rehabilitation. These changes can be demonstrated using standardized outcome measures.     

Use of the Barthel Index and the Functional Independence Measure during early inpatient rehabilitation after single incident brain injury

OBJECTIVE: To compare the appropriateness and responsiveness of the Barthel Index and the Functional Independence Measure (FIM) during early inpatient rehabilitation after single incident brain injury. DESIGN: Cohort study. SETTING: A regional neurological rehabilitation unit. PATIENTS: Two hundred and fifty-nine consecutive patients undergoing inpatient comprehensive neurological rehabilitation following a vascular brain injury due to single cerebral infarction (n = 75), spontaneous intracerebral haemorrhage (n = 34) and subarachnoid haemorrhage (n = 43), and 107 patients who had sustained traumatic brain injury. MEASUREMENTS: Admission and discharge FIM total, physical and cognitive scores and the Barthel Index were recorded. Appropriateness and responsiveness in the study samples were determined by examining score distributions and floor and ceiling effects, and by an effect size calculation respectively. Non-parametric statistical analysis was used to calculate the significance of the change in scores. RESULTS: In all patient groups there was a significant improvement (Wilcoxon's rank sum, P<0.0001) in the Barthel Index (mean change score: vascular 3.9, traumatic 3.95) and FIM (mean change score: vascular 17.3, traumatic 17.4) scores during rehabilitation, and similar effect sizes were found for the Barthel Index (effect size: vascular 0.65, traumatic 0.55) and FIM total (effect size: vascular 0.59, traumatic 0.48) and physical scores in all patient groups. In each patient group the cognitive component of the FIM had the smallest effect size (0.35-0.43). CONCLUSIONS: All measures were appropriate for younger (less than 65 years of age) patients undergoing early inpatient rehabilitation after single incident vascular or traumatic brain injury. The Barthel Index and the total and physical FIM scores showed similar responsiveness, whilst the cognitive FIM score was least responsive. These findings suggest that none of the FIM scores have any advantage over the Barthel Index in evaluating change in these circumstances.     

A retrospective analysis of outcome in severe Guillain-Barre syndrome following combined neurological and rehabilitation management

Purpose: To determine the outcome in severe Guillain-Barre syndrome following combined neurological and rehabilitation management using standardized disability and handicap measures and to identify the factors which affect this outcome. Methods: A retrospective study was performed of 24 patients with Guillain-Barre Syndrome admitted over a 3 year period to the neurological rehabilitation unit of the National Hospital for Neurology and Neurosurgery, Queen Square, London. Disability and handicap on admission and discharge were measured using the modified Barthel Index (BI), Functional Independence Measure (FIM), Environmental Status Scale (ESS) and Handicap Assessment Scale (HAS). Data was collected to identify any factors affecting outcome; age at onset, time to nadir, duration of ventilation, total in-patient stay, duration of stay at the neurological rehabilitation unit, symptoms, signs and electrophysiological findings. Results: The majority of patients had multiple problems. Outcome was related to the duration of rehabilitation. The mean modified BI score and the FIM score increased whereas ESS scores and HAS scores decreased, these changes were compatible with a reduction in disability and handicap. Conclusions: Significant improvement in function occurred during rehabilitation. These changes can be demonstrated using standardized outcome measures.     

Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study.

OBJECTIVE: To quantify the differences in physical disability and handicap experienced by patients with lower extremity sarcoma who required amputation for their primary tumor as compared with those treated by limb-sparing surgery. DESIGN: Matched case-control study. Twelve patients with amputation were matched with 24 patients treated by limb-sparing surgery on the following variables: age, gender, length of follow-up, bone versus soft-tissue tumor, anatomic site, and treatment with adjuvant chemotherapy. PATIENTS: Patients who underwent above-knee amputation (AKA) or below-knee amputation (BKA) for primary soft-tissue or bone sarcoma, who had not developed local or systemic recurrence, and who had been followed up for at least 1 year since surgery. MAIN OUTCOME MEASURES: The Toronto Extremity Salvage Score (TESS), a measure of physical disability; the Shortform-36 (SF-36), a generic health status measure; and the Reintegration to Normal Living (RNL), a measure of handicap. RESULTS: Mean TESS score for the patients with amputations was 74.5 versus 85.1 for the limb-sparing patients. (p = .15). Only the physical function subscale of the SF-36 showed statistically significant differences, with means of 45 and 71.1 for the amputation versus limb-sparing groups, respectively (p = .03). The RNL for the amputation group was 84.4 versus 97 for the limb-sparing group (p = .05). Seven of the 12 patients with amputations experienced ongoing difficulty with the soft tissues overlying their stumps. CONCLUSIONS: There was a trend toward increased disability for those in the amputation group versus those in the limb-sparing group, with the amputation group showing significantly higher levels of handicap. These data suggest that the differences in disability between amputation and limb-sparing patients are smaller than anticipated. The differences may be more notable in measuring handicap.     

互联网管理下的手工作业训练对脑卒中患者感觉障碍及心理状态的影响

目的:探讨互联网康复平台管理下的手工作业训练对脑卒中后遗症期患者感觉障碍、心理状态及生活质量的影响。方法:75例卒中后遗症期伴感觉障碍患者按随机数字表信封法分为普通训练组(26例)、手工训练组(26例)、互联网+手工训练组(23例)三组,研究过程中普通训练组脱落2例,手工训练组脱落1例。普通训练组给予常规康复治疗和传统...     

Multidimensional measurement of fatigue in advanced cancer patients in palliative care: an application of the multidimensional fatigue inventory

To investigate the level, dimensionality, and correlates associated with fatigue in patients receiving specialist palliative care, 278 advanced cancer patients referred to a department of palliative medicine during a 2-year period were asked to complete the Multidimensional Fatigue Inventory (MFI-20), a self-assessment questionnaire measuring five dimensions of fatigue, and the Hospital Anxiety and Depression Scale. Of 267 eligible patients, 130 (49%) participated. Mean fatigue scores (0–100 scale) were very high, especially for general fatigue (81), physical fatigue (87), and reduced activity (85). Only some of the MFI-20 subscales were significantly correlated. Fatigue was not correlated with sociodemographic factors. Depressed patients had higher scores on all five subscales except physical fatigue. Anxious patients had higher levels on the mental fatigue subscale only. The variation in fatigue explained by depression varied markedly (4%–31%) among subscales. Fatigue levels were very high in this population. The lack of significant correlation between some subscales indicates that they measure different aspects of fatigue. This is also supported by the differences in associations between fatigue subscales and depression and anxiety.     

Measuring participation across impairment groups using the Craig Handicap Assessment Reporting Technique

OBJECTIVE: To assess the efficacy, across a range of disability groups, of the Craig Handicap Assessment and Reporting Technique (CHART), a measure of societal participation. DESIGN: Cross-sectional analysis survey methodology. A total of 1110 community-based, nonhospitalized Coloradans with spinal cord injury, traumatic brain injury, multiple sclerosis, stroke, burn, or amputation were interviewed twice, 2 wks apart, using the CHART and a single administration of the FIM. RESULTS: Across all impairment groups, the intraclass correlation for the total score and the subscales of CHART-R were high. In addition, the CHART-R discriminated among the impairment categories in a direction that parallels increasing disability. CONCLUSIONS: CHART may be an appropriate measure of handicap for a range of physical or cognitive impairments.     

The relationship of chronic pain, mental illness and organic disorders

One hundred and six consecutive new attenders at a regional pain relief clinic were assessed using ratings of pain, standardized psychiatric interviews and physical examination by independent assessors. Approximately half the subjects had diagnosed mental illness and two-thirds had diagnosed organic disease. Pain ratings were higher in those with mental illness but were not related to the presence of organic pathology. The distribution of mental illnesses was not related to the organic status and those without physical disease had the lowest ratings on psychiatric assessments. All major findings were confirmed at a follow-up assessment. There is no evidence that these subjects can be divided into a simple dichotomy of those with physical or mental illnesses, or that pain measures can discriminate between them. It is concluded that all chronic pain patients require both physical and mental state assessment.     

Psycho-Social Characteristics of Children with Prenatal Alcohol Exposure,Compared to Children with Down Syndrome and Typical Children

The aim of this study was to extend the literature on cognitive and psychosocial adjustment and on facial processing in children with Prenatal Alcohol Exposure (PAE). Twenty-five children with PAE, 23 neurotypical children, and 13 children with Down syndrome matched on sex and mental age participated. Parents or guardians completed the Conners Comprehensive Behavior Rating Scale for Parents and the Social Responsiveness Scale; participants completed facial processing tasks. Using MANOVAs, the PAE group had substantially higher standard scores on all CBRS-P and SRS subscales compared with the typical group, and on almost all of them compared with the Down syndrome group. A large portion of individuals in the PAE group had clinically significant scores on the CBRS-P subscales, including ADHD, conduct and oppositional/defiant disorder, autism spectrum disorder, major depression, manic episodes, generalized and separation anxiety and phobias. Using a MANCOVA, no group differences were found in facial processing between the PAE and the neurotypical groups. Many children with PAE had scores that exceeded cut-offs for autism spectrum disorders, ADHD, conduct disorder, oppositional/defiant disorder, major depression, manic episodes, generalized and separation anxiety, and phobias. In addition, academic, language and mathematics problems were noted relative to typical children. Finally, children with PAE performed just as well on the facial processing tasks as a group of younger typical children of equal mental age. That means that facial processing by children with PAE was corresponded with their mental age.     

医院-社区-家庭多维护理在脑卒中康复中的应用效果

目的：探讨医院-社区-家庭多维护理在脑卒中康复中的应用效果,拓宽延续护理模式,为脑卒中患者康复开辟更经济、有效、实用的途径。方法选取2013年11月至2014年12月在某三甲医院住院的脑卒中患者522例,将出院后于该医院所在社区街道居住的患者258例纳入实验组,不在该医院社区街道居住的患者264例纳入对照组。医院责任护士、社区护士和家庭共同为实验组患者实施医院-社区-家庭多维护理干预模式,而对照组只采用常规康复护理模式,对522例患者均分别在出院时及出院后6个月进行 ADL 即日常生活活动能力(Barthel 指数)评分、心理 HAMD(汉密顿抑郁量表)评分和患者对护理满意度评分。结果干预后两组患者ADL、HAMD 及满意度评分与干预前比较差异均有统计学意义(P<0.05),且采用医院-社区-家庭多维护理的实验组改善更为明显(P<0.05)。结论医院-社区-家庭多维护理能促进脑卒中患者身心整体康复。     

院外延续护理对全膝关节置换术后患者生活能力的影响

目的探讨院外延续护理对全膝关节置换术后患者日常生活能力的影响。方法将70例行全膝关节置换术的患者按入院时间分为研究组和对照组。两组均给予常规护理;研究组患者出院后,责任护士电话随访1~2次/周,门诊随访1次/2周,3个月后根据患者情况酌情增减随访次数,随访时间为12个月。比较两组患者出院时及术后3、6、12个月的Bar-thel指数评分。结果两组患者出院时Barthel指数评分差异无统计学意义,出院后3、6、12个月时Barthel指数评分差异有统计学意义（P〈0.05）。结论对全膝关节置换术后患者实施院外延续护理,能够促进患者肢体功能的康复、提高生活质量,而且还有助于提高患者及家属的自我护理能力。     

Physical function and health-related quality of life of community-dwelling older adults with locomotive syndrome and pre-frailty

[Purpose] To consider the effective rehabilitation approaches for locomotive syndrome (LS) and pre-frailty, we examined the characteristics of physical function and health-related quality of life (HRQoL) in community-dwelling older adults. [Participants and Methods] Eighty-three individuals (age 71.8 ± 5.5 years, 29 males and 54 females) were divided into robust (R), LS, and locomotive syndrome with pre-frailty (LSP) groups. We compared the subscale and summary scores of the 36-Item Short-Form Health Survey (SF-36) as HRQoL indices. The grip strength, five-chair stand up test (SS-5), and normal walking speed were the physical function indices. [Results] The LS group had lower two-step scores and normal walking speed but there was no significant difference in the SF-36. The two-step score and 25-question geriatric locomotive function scale, SS-5, seven SF-36 subscales, and mental component summary (MCS) scores were lower in the LSP group. Compared to that of the LS group, the LSP group did not show significant difference in physical function but showed lower values in overall health, vitality, mental health, and MCS in the SF-36 subscales. [Conclusion] The subjective evaluation of one’s health was lower than that of the deterioration of physical function as a characteristic of the LSP.     

Discriminative, predictive and evaluative properties of the simplified stroke rehabilitation assessment of movement instrument in patients with stroke.

OBJECTIVE: To justify the utility of the Simplified Stroke Rehabilitation Assessment of Movement Instrument (S-STREAM), we examined the discriminative, predictive and evaluative properties of the 3 subscales of the S-STREAM (i.e. upper-limb movements, lower-limb movements and mobility) in patients after stroke. SUBJECTS: A total of 388 patients after stroke participated in this study. To examine the discriminative property, the patients were divided into 3 groups according to their Barthel Index scores. A comprehensive measure of activities of daily living was administered at 6 months after hospital discharge as an external criterion to examine the predictive property. Changes in the S-STREAM scores from the time of admission for rehabilitation, to hospital discharge, were used to examine the evaluative property. RESULTS: All pair-wise comparisons of mean scores among the 3 groups on the 3 subscales of the S-STREAM were significant. The scores of the S-STREAM showed moderate to good correlations with the comprehensive activities of daily living scores. There were large changes in the 3 subscales of the S-STREAM. CONCLUSION: All 3 subscales of the S-STREAM demonstrate good discriminative, predictive and evaluative properties in patients after stroke. These findings provide strong evidence that the S-STREAM is useful in measuring motor and mobility function in patients after stroke.     

Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers

OBJECTIVE: To develop and test a new instrument to assess environmental barriers encountered by people with and without disabilities by using a questionnaire format. DESIGN: New instrument development. SETTING: A rehabilitation hospital and community. PARTICIPANTS: Two convenience samples: (1) 97 subjects, 50 with disabilities and 47 without disability, and (2) 409 subjects with disabilities from spinal cord injury, traumatic brain injury, multiple sclerosis, amputation, or auditory or visual impairments. In addition, a population-based sample in Colorado of 2269 people (mean age, 44 y; 57% men) with and without disabilities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Item development; factor structure; test-retest, subject-proxy and internal consistency reliability; content, construct, and discriminant validity; and subscale and abbreviated version development. RESULTS: Panels of experts on disability developed items for the Craig Hospital Inventory of Environmental Factors (CHIEF). The instrument measured the frequency and magnitude of environmental barriers reported by individuals. Five subscales were derived from factor analysis measuring (1) attitudes and support, (2) services and assistance, (3) physical and structural, (4) policy, and (5) work and school environmental barriers. The CHIEF total score had high test-retest reliability (intraclass correlation coefficient [ICC]=.93) and high internal consistency (Cronbach alpha=.93), but lower participant-proxy agreement (ICC=.62). Significant differences were found in CHIEF scores among groups of people with known differences in disability levels and disability categories. CONCLUSIONS: The CHIEF has good test-retest and internal consistency reliability with evidence of content, construct, and discriminant validity resulting from its development strategy and psychometric assessments in samples of the general population and among people with a variety of disabilities.