Measurement Properties of the High-Level Mobility Assessment Tool for Mild Traumatic Brain Injury.

Measurement Properties of the High-Level Mobility Assessment Tool for Mild Traumatic Brain Injury.

Phys Ther. 2013 Mar 15;
Kleffelgaard I, Roe C, Sandvik L, Hellstrom T, Soberg HL

BACKGROUND:: The High-Level Mobility Assessment Tool (HiMAT) was developed to quantify balance and mobility problems after traumatic brain injury (TBI). Measurement properties of HiMAT have not been tested in a mild TBI (MTBI) population. OBJECTIVE:: To examine the reliability, validity and responsiveness of the HiMAT in a MTBI population. DESIGN:: A cohort, pretest-posttest, comparison study. METHODS:: 92 patients, 69% men, mean age 37.1 (SD 13.8) and Glascow Coma Scale score 14.7 (SD 0.7), were recruited from Oslo University Hospital. HiMAT (range 0-54, worst-best) was tested at 3 months post-injury. 51 patients were retested at 6-months. A subgroup of 25 patients was selected for the reliability testing. Balance function reported on the Rivermead Post Concussion Questionnaire was chosen as criterion and anchor. Criterion related validity was studied with correlation analysis. Intra-class correlation coefficient (ICC) was used for assessing inter- and intrarater reliability. Minimal detectable change (MDC) for the HiMAT was estimated. Responsiveness was assessed with ROC curve analyses. RESULTS:: Mean HiMAT sumscore was 46.2 (CI 44.4 – 48.1). HiMAT had a ceiling effect of 22.8%. The correlation between HiMAT and self-reported balance problems were large (r = -0.63, p <0.001). Inter- and intra-rater reliability for HiMAT sumscore was high (Interrater ICC= 0.99, intrarater ICC= 0.95). The MDC was -3 to +4 points. Responsiveness was good, and HiMAT discriminated well between patients with self- perceived improved versus unchanged balance function (AUC= 0.86). LIMITATIONS:: Low sample size, ceiling effect and lack of gold standard. CONCLUSIONS:: The HiMAT demonstrated satisfactory measurement properties for patients with MTBI. The HiMAT can be used as an outcome measurement of balance and mobility problems in patients with MTBI. HubMed – rehab


The Effect of Poststroke Delirium on Short-Term Outcomes of Elderly Patients Undergoing Rehabilitation.

J Geriatr Psychiatry Neurol. 2013 Mar 15;
Turco R, Bellelli G, Morandi A, Gentile S, Trabucchi M

Objectives: Delirium is a common poststroke complication, but its prevalence and effect in rehabilitation settings is unknown. We retrospectively assessed the prevalence of delirium in elderly patients undergoing poststroke rehabilitation and its association with short-term outcomes. Methods: All patients (aged ?65 years) admitted to the Department of Rehabilitation between November 2007 and October 2011 after a recent stroke were screened for delirium. Delirium was diagnosed using the confusion assessment method. Multiple logistic regressions were used to evaluate the association between delirium, institutionalization, and inhospital death, while multiple linear regressions were used for the association between delirium and functional recovery, defined in 3 different ways which include (1) measuring the relative functional gain of the Barthel index (BI-RFG); (2) the change in Barthel index (BI) walking subscore from admission to discharge; and (3) the change in Tinetti score from admission to discharge. Results: In all, 58 (33%) patients of the total 176 patients were consecutively admitted to our department with delirium. After adjustment for potential confounders, poststroke delirium (PSD) was an independent predictor of institutionalization (odds ratio [OR] = 7.23; 95% confidence interval [CI] = 4.79 to 10.91; P ? .0003) and inhospital death (OR = 4.26; 95% CI = 1.15 to 15.81; P = .03); PSD was not a predictor of functional recovery at discharge, neither using the BI-RFG (P = .96) nor using the change from admission to discharge of both the BI walking subscore (P = .57) and the Tinetti score (P = .61) as outcome measures. Conclusions: In elderly patients undergoing poststroke rehabilitation, delirium is an independent predictor of institutionalization and inhospital death, but it does not affect functional recovery. HubMed – rehab


Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Fatigue. 2013 Jan 14; 1(1-2): 27-42
Jason LA, Brown M, Brown A, Evans M, Flores S, Grant-Holler E, Sunnquist M

Treatment approaches for patients with Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been controversial. This paper provides the theoretical and conceptual background for the Energy Envelope Theory to assist patients with ME/CFS and reviews evidence of its treatment efficacy.Over a 15-year period, efforts were directed to develop a non-pharmacologic intervention that endeavored to help patients with ME/CFS self-monitor and self-regulate energy expenditures and learn to pace activities and stay within their energy envelope.Studies show that the energy envelope approach, which involves rehabilitation methods, helps patients with ME/CFS pace activities and manage symptoms and can significantly improve their quality of life. HubMed – rehab


The Effects of Training on Recognition of Musical Instruments by Adults with Cochlear Implants.

Semin Hear. 2012 Nov; 33(4): 410-418
Driscoll VD

This study examines the efficiency and effectiveness of three types of training on recognition of musical instruments by adults with cochlear implants (CI). Seventy-one adults with CIs were randomly assigned to one of three training conditions: feedback on response accuracy, feedback-plus (response accuracy plus correct answer), and direct instruction. Each participant completed three training sessions per week over a five-week time period in which they listened to recorded excerpts of eight different musical instruments. Results showed significant pre-to-posttest improvement in music instrument recognition accuracy for all three training conditions (22.9-25.7%, p< 0.0001). Time when tested (week), bilateral CI use, and age were significant predictors of performance. Participants who wore bilateral implants scored significantly higher than participants with unilateral implants at all three time points; hearing aid use was not a significant predictor. These results may have practical implications for numerous types of auditory rehabilitation for persons who use CIs. HubMed – rehab