Does postacute care site matter? A longitudinal study assessing functional recovery after a stroke

The main difficulty behind any comparison of stroke recovery is that there is no objective damage diagnosis and thus no starting point for comparison. But I bet the article does not mention that.
http://www.hubmed.org/display.cgi?uids=23453907
Patients with stroke may receive postacute rehabilitation services from one or more types of postacute care providers. An article in this issue of Archives of Physical Medicine and Rehabilitation compares the outcomes of patients who received rehabilitation care from an inpatient rehabilitation facility, a skilled nursing facility, a home health agency, or did not receive any postacute care. This commentary discusses challenges in conducting this type of observation study.

True functional ability of chronic stroke patients

I'm not sure how this is useful to us but your doctor will know.
http://www.jneuroengrehab.com/content/10/1/20/abstract

Abstract (provisional)

Background

There is a paucity of information regarding visuospatial (VS) and visuomotor (VM) task performance in patients with chronic right fronto-parietal lobe stroke, as the majority of knowledge to date in this realm has been gleaned from acute stroke patients. The goal of this paper is to determine how VS and VM performance in chronic stroke patients compare to the performance of healthy participants.

Methods

Nine patients with stroke involving the right fronto-parietal region were evaluated against match controls on neuropsychological tests and a computerized visuomotor assessment task.

Results

Initial evaluation indicated that performance between participant groups were relatively similar on all measures. However, an in-depth analysis of variability revealed observable differences between participant groups. In addition, large effect sizes were also observed supporting the theory that using only conventional examination (e.g., p-values) measures may result in miss-identifying crucial stroke-related differences.

Conclusion

Through conventional evaluation methods it would appear that the chronic stroke participants had made significant functional gains relatively to a control group many years post-stroke. It was shown that the type of evaluation used is essential to identifying group differences. Thus, supplementary methods of evaluation are required to unmask the true functional ability of individuals many years post-stroke.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

non-functional stroke therapy - swing

Diane of Pink House on the Corner was complaining about the functionality focus of therapists.I agree totally, its the way they have to write notes so they get paid. I have such diffuse deficits due to the pre-motor cortex dead area and white matter damage that I really only work on individual muscles and eventually will put them together in a coordinated pattern. This should be something our therapists should be able to explain to us but that would require some brainpower thinking outside of book larning.
My hamstring does not fire properly when walking so I sit on our grape arbor swing and push/pull the swing back and forth while reading a book (multitasking - hey And if I really want to challenge myself I'll put my left arm on the top of the bench and see how long I can hold it there. ). This would be an easy research project for any therapist to setup. To answer the question - How many repetitions does it take to get the hamstring working in concert when walking?

The flagstone at the bottom sticks out 1 inch so
I can hook my heel on it. Just think of the dangers of the woodpile falling. Don't self medicate.

Long-term outcome poststroke: Predictors of activity limitation and participation restriction

Every country should have this kind of followup. It seems to be the only way to get stroke rehabilitation needs in front of the public.
http://www.naric.com/research/rehab/record.cfm?search=2&type=all&criteria=J62305&phrase=no&rec=117021
NARIC Accession Number: J62305. What's this?
ISSN: 0003-9993.
Author(s): Gadidi, Vered; Katz-Leurer, Michal; Carmeli, Eli; Bornstein, Natan M..
Publication Year: 2011.
Number of Pages: 7.
Abstract: Study examined long-term activity limitation, participation restriction, and patients’ overall perception of recovery among stroke patients 4 years poststroke, and evaluated the association between these factors. In addition, the study investigated those factors present at the time of stroke onset that could predict the level of activity limitation and participation restriction at 4 years poststroke. All 139 first ever stroke patients admitted to the Sheba Medical Center in Israel between February and March 2004 were followed and reassessed for activity limitation and participation restrictions using the Barthel index and the Frenchay Activities Index, respectively. Perception of recovery was assessed by 2 simple questions. At 4 years poststroke, 9 patients (6.4 percent) were lost to follow-up, 71 (54.1 percent) patients had survived; 42.3 percent with activity limitation, 28.2 percent were classified as restricted in participation, and 78.1 percent felt they had not completely recovered. The most significant predictors of activity limitation at 4 years poststroke were age at stroke onset and disability in the acute phase. None of the demographic characteristics or baseline clinical features predicted participation restriction. A positive association was noted between activity limitation and participation restriction 4 years poststroke.
Descriptor Terms: DAILY LIVING, FUNCTIONAL LIMITATIONS, INTERNATIONAL REHABILITATION, LONGITUDINAL STUDIES, OUTCOMES, PREDICTION, STROKE.