Rehab Centers: Physical, Cognitive and Social Activity Levels of Stroke Patients Undergoing Rehabilitation Within a Mixed Rehabilitation Unit.

Physical, cognitive and social activity levels of stroke patients undergoing rehabilitation within a mixed rehabilitation unit.

Filed under: Rehab Centers

Clin Rehabil. 2012 Nov 28;
Janssen H, Ada L, Bernhardt J, McElduff P, Pollack M, Nilsson M, Spratt N

Objective:To determine physical, cognitive and social activity levels of stroke patients undergoing rehabilitation, and whether these changed over time.Design:Observational study using behavioural mapping techniques to record patient activity over 12 hours on one weekday and one weekend day at baseline (week 1) and again two weeks later (week 2).Setting:A 20-bed mixed rehabilitation unit.Subjects:Fourteen stroke patients.Interventions:None.Main measures:Percentage of day spent in any activity or physical, cognitive and social activities. Level of independence using the Functional Independence Measure (FIM) and mood using the Patient Health Questionniare-9 (PHQ-9).Results:The stroke patients performed any activity for 49%, social activity for 32%, physical activity for 23% and cognitive activity for 4% of the day. Two weeks later, physical activity levels had increased by 4% (95% confidence interval (CI) 1 to 8), but levels of any activity or social and cognitive activities had not changed significantly. There was a significant: (i) positive correlation between change in physical activity and change in FIM score (r = 0.80), and (ii) negative correlation between change in social activity and change in PHQ-9 score (r = -0.72). The majority of activity was performed by the bedside (37%), and most physical (47%) and cognitive (54%) activities performed when alone. Patients undertook 5% (95% CI 2 to 9) less physical activity on the weekends compared with the weekdays.Conclusions:Levels of physical, cognitive and social activity of stroke patients were low and remained so even though level of independence and mood improved. These findings suggest the need to explore strategies to stimulate activity within rehabilitation environments.
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Offender patients’ opinions on placement in a forensic hospital.

Filed under: Rehab Centers

Crim Behav Ment Health. 2012 Dec; 22(5): 360-8
Margeti? B, Ivanec D, Zarkovi? Palijan T, Kova?evi? D

People who become patients in secure hospitals may not understand their situation and have different opinions about the nature of institutionalisation from each other and from staff and the authorities. More knowledge of patient perspectives could improve treatment outcomes.Our aim was to evaluate patients’ beliefs about whether placement in an institution should be mainly punitive, therapeutic or a mixture of both and whether offence type should have any influence on the nature of the institutionalisation.Inpatients with schizophrenia or schizoaffective disorder, from the Department of Forensic Psychiatry in Popova?a, Croatia, were asked to report their personal opinions about appropriateness of placements according to three case vignettes related to psychotically motivated offences of (1) homicide; (2) property damage; and (3) arson.A total of 52 patients were eligible for participation and consenting. Their average age was 44 (±9.56) years and the mean duration of treatment in the specialist hospital was 7.7 (±5.59) years; just over a third of them (20 patients) had committed or attempted homicide. They were more likely than not to favour at least 5?years of detention in a secure hospital for a person with psychosis who had killed another, regardless of mental state, but that for minor property damage, improvement in mental state should be the key determinant of discharge. They were more equivocal about arsonists.Perceptions of male offenders with psychosis on determinants of length of stay in a secure hospital appear to have much in common with what one would expect in the wider community. The fact that in spite of generally having poor insight into their own situation, these men could make judgments about fictitious but similar patients that appeared so unremarkable raised the possibility of building on this vignette study towards an educationally therapeutic module in preparation for rehabilitation. Copyright © 2012 John Wiley & Sons, Ltd.
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Neurophysiological characteristics of human leg muscle action potentials evoked by transcutaneous magnetic stimulation of the spine.

Filed under: Rehab Centers

Bioelectromagnetics. 2012 Nov 28;
Knikou M

The objectives of this study were to establish the neurophysiological properties of the compound muscle action potentials (CMAPs) evoked by transcutaneous magnetic stimulation of the spine (tsMSS) and the effects of tsMSS on the soleus H-reflex. In semi-prone seated subjects with trunk semi-flexed, the epicenter of a figure-of-eight magnetic coil was placed at Thoracic 10 with the handle on the midline of the vertebral column. The magnetic stimulator was triggered by monophasic single pulses of 1?ms, and the intensity ranged from 90% to 100% of the stimulator output across subjects. CMAPs were recorded bilaterally from ankle and knee muscles at the interstimulus intervals of 1, 3, 5, 8, and 10?s. The CMAPs evoked were also conditioned by posterior tibial and common peroneal nerve stimulation at a conditioning-test (C-T) interval of 50?ms. The soleus H-reflex was conditioned by tsMSS at the C-T intervals of 50, 20, -20, and -50?ms. The amplitude of the CMAPs was not decreased when evoked at low stimulation frequencies, excitation of group I afferents from mixed peripheral nerves in the leg affected the CMAPs in a non-somatotopical neural organization pattern, and tsMSS depressed soleus H-reflex excitability. These CMAPs are likely due to orthodromic excitation of nerve motor fibers and antidromic depolarization of different types of afferents. The latency of these CMAPs may be utilized to establish the spine-to-muscle conduction time in central and peripheral nervous system disorders in humans. tsMSS may constitute a non-invasive modality to decrease spinal reflex hyperexcitability and treat hypertonia in neurological disorders. Bioelectromagnetics. © 2012 Wiley Periodicals, Inc.
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