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CURRENT DIAGNOSIS AND TREATMENT PHYSICAL MEDICINE AND REHABILITATION PDF

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Address correspondence and reprint request to: Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. This article has been cited by other articles in PMC. Abstract Stroke is a major cause of death and other complications worldwide. The components of stroke rehabilitation The primary goals of stroke rehabilitation are to regain independence and improve quality of life by minimizing the limitations of activities of daily living ADL.

Open in a separate window. Figure 1. Table 1 Stroke rehabilitation team members and their responsibilities. The effectiveness of stroke rehabilitation In this section, we aim to briefly summarize recent studies on the effectiveness of stroke rehabilitation programs in different settings. Stroke rehabilitation in the outpatient setting Outpatient stroke rehabilitation is defined as a type of treatment where patients go to a clinic or hospital to attend sessions and then return home the same day.

Stroke rehabilitation in the inpatient setting An inpatient stroke rehabilitation facility is defined as a multidisciplinary team that exclusively oversees stroke patients in a ward at least one week after stroke. Stroke rehabilitation in a nursing facility A nursing facility NF is defined as a facility where a client is admitted, and services are provided by a multidisciplinary professional team, aimed at restoring function.

Stroke rehabilitation in the home-based setting Home-based stroke rehabilitation is characterized as a complex package of care provided by a clinician or nurse aiming at either avoiding the need for admission to hospital, or empowering timely and more virtual discharge and follow-up at home. The role of telerehabilitation and technology for patients with stroke Telerehabilitation is defined as the delivery of rehabilitation services including clinical assessment and clinical therapy over telecom systems, and the web.

Stroke rehabilitation outcome measures using the International Classification of Functioning, Disability, and Health model There are many outcome measures to be used in stroke rehabilitation. Figure 2. Table 2 A selection of outcome measures that have demonstrated construct validity in stroke rehabilitation by using the International Classification of Functioning, Disability, and Health domains. Dynamic Gait Index. General recommendations to improve stroke rehabilitation programs in Saudi Arabia From this review, the optimal stroke rehabilitation parameters frequency, type, duration, intensity could not be established.

However, many components of the stroke burden can be prevented and managed, including implementing the following recommendations for rehabilitation professionals, policy makers, and for future research: Recommendations for policy makers Policy makers can play a major role toward translating science into practice in the field of stroke care.

Recommendations for future research For future research, we believe there is a need to improve the quality of conduct and reporting of national studies on stroke rehabilitation programs. Future research in Saudi Arabia on stroke rehabilitation topics should address some of the following questions: What is the current status of stroke rehabilitation services and needs?

What role do environmental factors play on disability among patients with stroke? Appendix Appendix 1 Difference between the uses of outcome measures in stroke rehabilitation,. Testing is engaged around a solitary, twofold sided jolt card delineating a riverside scene on one side and geometric shapes on the other and 5 composed sentences. Scores from every test territory are summed to obtain an aggregate score out of Ten points are accessible for each of the cognizance and verbal expression; 5 each for perusing and composing Interpretability: FAST is short and straightforward, requiring less than 10 minutes of management.

FAST is easy to regulate notwithstanding during a bedside assessment. Test materials are straightforward and portable The specificity of FAST appears, by all accounts, to be antagonistically influenced by the vicinity of visual field shortfalls, visual disregard or distractedness, lack of education, deafness, poor focus or confusion Fugl-Meyer Assessment of Motor Recovery after Stroke FMA 53 The FMA is intended to evaluate motor function, balance, sensation qualities, and joint function in hemiplegic post-stroke patients The scale consists of 5 areas; motor function, sensory function, balance, joint range of motion and joint pain.

The total possible scale score is for engine capacity; 24 for sensation; 14 for parity; 44 for scope of movement; and 44 for joint pain Interpretability: It is broadly utilized and globally acknowledged. Administration of the entire test can be a long process; it takes minutes. The FMA should be regulated by a prepared physical or occupational therapist. Particular equipment is not required; it is managed over an assortment of settings and can be used in longitudinal assessments Need a prepared specialist.

Takes significantly more time for evaluations Hospital Anxiety and Depression Scale HADS 54 A bi-dimensional scale was developed specifically to recognize instances of depression and anxiety disorders among physically sick patients The HADS consists of 14 items isolated into 2 subscales of 7 items each: The respondent rates every item on a 4-point scale extending from 0 absence — 3 extreme presence.

Five of the 14 items were coded in reverse.

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The aggregate scale score is out of 42 or 21 for each of the subscales. Higher scores showed more noteworthy levels of anxiety or depression Interpretability: No standards are accessible in English.

Stroke rehabilitation

The scale is convenient and simple to utilize minutes. Cut-off focuses utilized are not specifically well established Modified Ashworth Scale 55 To evaluate the adequacy of hostile to spastic medication in patients experiencing different sclerosis The unique Ashworth scale consists of 5 evaluations from The first Ashworth and Adjusted Ashworth scales are essential clinical measures of tone. No particular equipment is required Lower levels of unwavering quality.

The largest amounts of between spectator and intra-observer assertion are noted among patients with a 0 rating Mini-Mental State Examination MMSE 56 The MMSE was created as a brief screening instrument to provide a quantitative appraisal of intellectual disability and to record subjective changes after some time The MMSE consists of 11 basic inquiries or errands. These are assembled into 7 cognitive spaces; introduction to time, introduction to place, enrollment of 3 words, consideration and computation, review of 3 words, language, and visual development.

The MMSE is broadly utilized and the most acknowledged part was the cut-off scores, which were demonstrative of cognitive impairment. The test is brief, requiring approximately 10 minutes to complete. The test requires no specific equipment, requires little time and is inexpensive It is unrealistic to distinguish adequate cut-off scores for visual or verbal memory issues Low reported levels of affectability among stroke patients Functional Independence Measure FIM 57 Measures the level of understanding the disability and demonstrates the amount of help required for the person to complete the movement of activity of daily living ADL Consists of 18 items: Tasks are evaluated on a 7 point ordinal scale that ranges in total assistance or complete dependence to complete independence.

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Scores range from 18 least to most elevated demonstrating level of function. FIM is utilized to assess mind damage, geriatrics, various sclerosis; orthopedic conditions including low back pain, spinal cord harm and stroke persistent individuals.

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Excellent test-retest dependability. FIM has high inward consistency and satisfactory discriminative abilities for rehabilitation patients Standard error of estimationn mean SEM and insignificant recognizable. Change not built up. There is no cut-off scores. FIM is not freely accessible Bathel Index BI 58 Evaluates the capacity of a person with a neuromuscular or musculoskeletal disorder to standard care 10 ADL exercises including feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation, stair climbing.

Items are appraised based on the measure of help required to complete every activity Area of evaluation incorporates ADL; functional mobility; gait. It sets aside less time to complete the evaluation. It is an execution based measure.

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All items are evaluated on a 4-point ordinal scale going from 0 to 3 where 0 represents no movement possible, and 3 represents normal performance of the task Interpretability: As a Guttman scale, level of execution is effortlessly comprehended and contemplated. Not proper for use with proxy; negligible weight for patients. A broad gathering of items and a particular table are required.

Testing must be completed in a formal setting In patients with serious disabilities or close typical function, the scale may not be sufficiently delicate to identify changes in execution Motor Assessment Scale MAS 60 The MAS was created to obtain a substantial and solid method for evaluating regular motor function following stroke The MAS consists of 8 items relating to 8 regions of motor function recumbent to side lying, prostrate to sitting over the edge of a bed, adjusted sitting, sitting to standing, walking, upper-arm function, hand developments and propelled hand exercises.

Each parameter, except for general tonus, is evaluated utilizing a 7-point pecking order of useful criteria. Score extending from 0 most basic to 6 generally complex Interpretability: Scores mirror a task-oriented approach to assessment. The test is generally straightforward and brief to manage. The MAS is freely accessible in Carr et al. Patients select their own power of activity and are permitted to stop and rest during the test, at their own particular pace.

Performance on the 6MWT is measured by aggregate separation strolled in feet or meters within the 6 minutes.

The 6MWT is a broadly utilized apparatus that gives a quantitative measure of sub-maximal activity limit. It is concurred that age, stature, weight, and gender all freely affect the 6MWT in healthy adults. The 6MWT is moderately concise and heavily endured by patients; however, its utilization may be complicated by issues of continuance.

The test is brief, modest and easy to assess It is highly recommended that 6MWT combined with other measures for a better estimate Stroke Impact Scale SIS 62 Surveys health status after stroke A 59 item measure, 8 domains are assessed: Each item is rated on a 5-point Likert scale in terms of the difficulty the patient has experienced in completing each item. Cumulative scores are obtained for every space, scores range from SIS assessment including ADL; cognition; communication; depression; functional mobility; gait; general health; life participation; quality of life; social relationships; social support; upper extremity function SIS assessment is patient reported outcomes Medical Outcomes Study Short-Form SF 63 The SF is a non-specific health survey developed to survey health status in the all inclusive community The SF consists of 8 measurements or subscales: Each of the 8 summed scores is directly changed onto a scale structure to obtain a score for every scale.

Utilization of the scale scores and synopsis part scores represents lost data and reduction in potential clinical interpretability. Fruition time is approximately 10 minutes for either the self-finished or interview managed questionnaires. It has been used as a mail survey with reasonably high completion rates reported Higher rates of missing information have been accounted for among older patients when utilizing the self-finished type of organization.

The SF does not fit the era of a general synopsis score. The level of test-retest unwavering quality reported in the stroke population demonstrates that the SF may not be sufficient for serial correlations of individual patients Nottingham Health Profile NHP 64 The NHP was intended to be a brief, subjective measure of wellbeing incorporating the social and belongings of illness The NHP consists of 2 sections.

Part I consists of 38 parameters grouped into 6 subsections: All parameters are weighted and given an aggregate score of Part II consist of 7 items: These parameters are not weighted.

A score out of a total of 7 is obtained by including the quantity of positive reactions. Higher scores correlate to poorer wellbeing status.

The NHP has been generally utilized in many countries. The NHP is short and basic form and requires little time to complete. The test can be managed as either a self-report or verbal postal overview The NHP to some degree is a constrained measure. Each of these announcements is appraised by the respondent on a 10 cm visual analogue scale VAS: Individual item scores are summed to obtain an aggregate score out of , which focuses on the relative changes over time to obtain a score out of Interpretability: There are no generally accepted standards for understanding.

A short and straightforward assessment of the RNLI represents negligible patient weight. The RNLI is accessible for free. It can be utilized to evaluate longitudinal studies The perfect composition of the subscales is questionable. Reliability and legitimacy have not been significantly studied within the stroke population EuroQoL Quality of Life Scale EQ5D 66 The EQ5D is a non-specific recorded instrument, created by a multi-nation, multi-disciplinary group, used to depict well-being and esteem.

The EQ5D is a self-reported survey, consisting of 2 sections. Part I consists of 5 measurements: Each measurement is represented by 3 articulations comparing to 3 levels: Part II consists of a VAS in which respondents rate their present condition of wellbeing from 0 worst imaginable to best possible Interpretability: EQ5D utilizes population base utility weights to obtain a standard arrangement of utility qualities for the 5-digit wellbeing state from the 5-domain index.

Short and straightforward, reports of missing information are blended. It is a self-reported questionnaire that may be regulated as a postal or phone survey or in a face-to-face interview Not suitable for use in serial evaluations of individual patients.

Footnotes Disclosure. References 1. Stroke in Saudi Arabia: Pan Afr Med J. Stroke Rehabilitation. Belval B, Lebowitz H, editors. Columbus OH: McGraw-Hill Global Education; Benamer HT, Grosset D.

Stroke in Arab countries: J Neurol Sci. The status of acute stroke care in Saudi Arabia: Int J Stroke. Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: J Phys Ther Sci. Outcome after mobilization within 24 hours of acute stroke: Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: Eur J Phys Rehabil Med. Physical rehabilitation. Philadelphia PA: Davis Co; Stroke unit care combined with early supported discharge improves 5-year outcome: Stroke unit care benefits patients with intracerebral hemorrhage: Hydrotherapy vs.

Clin Rehabil. Clarke DJ, Forster A. Improving post-stroke recovery: View Contributor Index. Add Item s to: An Existing Folder. A New Folder. The item s has been successfully added to " ". Thanks for registering!

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