Is the Activity Measure for Postacute Care "6-Clicks" Tool Associated With Discharge Destination Postacute Stroke?

Objective: To investigate the association of poststroke physical function, measured within 24 hours prior to discharge from the acute care hospital using Activity Measure for Postacute Care (AM-PAC) Inpatient "6-Clicks" scores and discharge destination (home vs facility and inpatient rehabilitation facility [IRF] vs skilled nursing facility [SNF]). Design: Retrospective cross-sectional cohort study. Setting: Acute care, University Hospital. Participants: Individuals post acute ischemic stroke, N=721, 51.3% male, mean age 63.6±16.4 years. Interventions: Not applicable. Main Outcome Measures: AM-PAC "6-Clicks" 3 domains: basic mobility, daily activity, and applied cognition. Results: AM-PAC basic mobility and daily activity were significant predictors of discharge. Those in the home discharge group had AM-PAC basic mobility mean t scale score of 48.5 compared with a score of 34.8 for individuals sent to a facility and daily activity score of 47.2 compared with 32.7 for individuals sent to a facility. The AM-PAC variables accounted for an additional 24% of the variance in the discharge destination, with basic mobility and daily activity accounting for most of the variance.The AM-PAC scores were not statistically different and were not able to discriminate between placement in an IRF vs SNF. The mean basic mobility t scale score for individuals going to an IRF was 34.9 compared with 34.6 for those going to an SNF. The daily activity score for IRF was 32.8 compared with 32.6 for SNF. The AM-PAC accounted for no additional variance in discharge destination to an IRF or SNF. Conclusions: The AM-PAC Inpatient "6-Clicks" 3 domains are able to distinguish individuals with stroke being discharged to home from postacute care (PAC) but not for differentiating between PAC facilities (IRF vs SNF) in this cohort of individuals post stroke.

Comparison of driving capacity among patients with amyotrophic lateral sclerosis and healthy controls using the lane change task.

OBJECTIVE: Compare driving capacity of individuals with Amyotrophic Lateral Sclerosis (ALS) and healthy controls (HC) using a driving simulation program. METHODS: A prospective study was performed on individuals with ALS who reported they were still driving, and a group of HCs. Demographic data included age and gender. Assessment included cognitive assessments (Montreal cognitive assessment [MoCA] and ALS Cognitive Behavioral Scale [ALS-CBS]); gait speed (m/s); ALS Functional Rating Scale-revised total score (ALSFRS-R); and simulated driving assessment (Lane Change Task [LCT]). The LCT is a simple assessment tool which simulates the visual, cognitive, and motor demands of driving to detect at-risk drivers and uses distractions (secondary tasks) to quantify the performance loss on the primary task (lane changes). RESULTS: Twenty-eight individuals with ALS (22 males, mean age 64 years) and 20 HCs (7 males, mean age 59 years) were studied. Individuals with mild to moderate ALS (ALSFRS-R mean 36.2) were older, had mild cognitive difficulty (MoCA 24 vs 27; ALS-CBS 14.19 [SD 3.85]) and mobility decline (gait speed 1.1 vs 1.4 m/s) compared to HC. Driving assessment using the LCT found no differences in baseline scores or during motor, cognitive, or visually distracting conditions. CONCLUSIONS: Individuals with ALS with mild to moderate disease progression, with cognitive and motor weakness still demonstrate similar driving capacity to HCs using a driving simulation task. Driving assessment needs to be expanded longitudinally and perhaps with more robust measures to more precisely identify types of driving challenges that lead to cessation of driving in individuals with ALS.

Increased practice of a standing motor sequence task in healthy young and healthy elders: Short communication.

BACKGROUND: Sequence-specific learning (SSL); the ability to implicitly integrate repeated sequences compared to random sequences during a motor sequence paradigm, is impaired in healthy elders (HE) compared to healthy young (HY). Prior studies have provided limited practice (small repetitions and only 1 to 3 days). RESEARCH QUESTION: Using a standing, postural control task we sought to assess if more practice (7 days) would remediate the differences observed in SSL for HE. METHODS: We used a continuous tracking task following a sinusoidal path of randomly presented random and repeated patterns. Root mean square error (RMSE) was the primary dependent variable, and the difference in RMSE between the random and repeated sequences was calculated to determine if SSL occurred. RESULTS: Improvement in SSL was documented as a decreasing value of the mean repeated sequence and less or no change in the random sequence. Eight HY and 8 HE practiced the repeated sequences 420 times over 7 days. No differences were observed between the groups on cognition, balance, and mobility. HE did not demonstrate the ability to integrate the repeated sequence on day 1, but with increased practice, they integrated the repeated sequence similar to HY by the end of practice. The results of this study suggest that sustained practice over 7 days remediated differences in performance of a standing, implicit, sequence-specific task between HY and HE. SIGNIFICANCE: Clinically, it is important to provide individuals with sufficient practice amount to achieve integration of a standing task. Results suggest that older adults need more practice to demonstrate SSL.

Does Dopamine Replacement Medication Affect Postural Sequence Learning in Parkinson's Disease?

Deficits in sequence-specific learning (SSL) may be a product of Parkinson's disease (PD) but this deficit could also be related to dopamine replacement. The purpose of this study was to determine whether dopamine replacement affected acquisition and retention of a standing Continuous Tracking Task in individuals with PD. SSL (difference between random/repeated Root Mean Square Error across trials) was calculated over 2 days of practice and 1 day of retention for 4 groups; 10 healthy young (HY), 10 healthy elders, 10 individuals with PD on, 9 individuals with PD off their usual dosage of dopamine replacement. Improvements in acquisition were observed for all groups; however, only the HY demonstrated retention. Therefore, age appeared to have the largest effect on SSL with no significant effect of medication. Additional research is needed to understand the influence of factors such as practice amount, task difficulty, and dopamine replacement status on SSL deficits during postural tasks.