Daily life consequences, cognitive impairment, and fatigue after transient ischemic attack.

OBJECTIVES: Studies suggest that fatigue and cognitive impairment may be present after transient ischemic attack (TIA), but little is known about consequences in daily life. The main aim was to longitudinally explore the presence of fatigue, cognitive impairment, and consequences in daily life including communication after clinically diagnosed TIA at 1 and 9 months after the event. MATERIAL AND METHODS: A consecutive sample of 46 patients (23 women, 69 ± 12.3 years) was assessed at discharge from hospital and at 1 and 9 months after TIA regarding cognition, mental fatigue, tiredness, and activities of daily life. This served as basis for an interview concerning experienced changes related to the TIA. RESULTS: Problems in daily life with probable association with the TIA were experienced by 37% (n = 45) of participants 9 months after the TIA event. Cognitive impairment was present in 40% (n = 44) after 1 month and 30% (n = 23) after 9 months. Mental fatigue was experienced by 26% (n = 42) after 1 month and 17% (n = 39) after 9 months. Communication problems were reported and increased from 7 to 14 participants between the two time points. CONCLUSIONS: A third of the TIA patients experienced problems in performance of complex activities in daily life and often communication problems within the first 9 months. Cognitive impairment and mental fatigue could be factors influencing performance in daily life and at work, but this needs to be verified in a larger sample. The risk of activity limitations indicates need for multiprofessional support and systematic routines for TIA follow-up.

Functioning of the upper extremity in persons with late polio.

BACKGROUND: There are a number of people living with late effects of polio, but the extent of engagement with the upper extremity is unclear. The objective is to describe the polio involvement in persons attending the polio clinic and to assess the perceived problems in self-reported arm/hand function. MATERIAL AND METHODS: A 1-year sample of consecutively examined community-dwelling people at the polio clinic. Electromyography and muscle strength were assessed as part of the clinical examination. A questionnaire regarding perceived problems in different activities involving arm/hand function was sent out prior to appointment and brought to the clinic. RESULTS: A total of 186 persons were seen, and the majority was women (65%). The average age at examination was 60 years (SD 14), and the acute polio illness had occurred at 5 years of age (SD 7). Post-polio syndrome was present in 96%. Polio involvement in the upper extremities was seen in the majority, and this was often clinically unstable. Perceptions of problems in arm/hand activities did not always correlate with having had polio in the upper extremity or with mode of mobility. However, the grip force correlated significantly with the number of perceived problems. Bi-manual activities were more often perceived problematic. CONCLUSIONS: Polio involvement in the upper extremity is very common. There were no obvious correlations with the objective findings of polio and perceived problems. The polio survivors' adaptation requires more questions and assessments from the professional team to identify those with a possible need for intervention.

Two years after cardiac arrest; cognitive status, ADL function and living situation.

PURPOSE: To describe cognitive function, activities of daily living (ADL), housing and return to work after cardiac arrest (CA) and examine the prognostic value of early assessments. METHOD: Two years after CA 22 persons were assessed with the Barrow Neurological Screen for Higher Cerebral Functions (BNIS) and the Functional Independence Measure (FIM). Data on early assessments of neurological status (The National Institute of Health Stroke Scale, NIHSS), mental status (the Mini Mental State Examination, MMSE) and ADL ability (FIM) were retrieved. RESULTS: Sixty-four per cent were living in their own home, 36% lived in sheltered accommodation and 29% of those of working age had returned to work. Cognitive dysfunction was noted in 95% according to neuropsychological screen. Four persons living in own homes were in need of assistance in social-cognitive ADL. All those in sheltered accommodation needed help in ADL; one was independent in motor functions. This need for assistance was reflected at initial assessments by a higher degree of neurological deficits, cognitive dysfunctions and dependency in ADL activities. CONCLUSION: The majority had persistent cognitive dysfunctions. Persons in sheltered accommodation were dependent for ADL. Early evaluation is important for understanding and planning for future need for assistance and care, having realistic goals.

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.

Cross-diagnostic validity in a generic instrument: an example from the Functional Independence Measure in Scandinavia.

BACKGROUND: To analyse the cross-diagnostic validity of the Functional Independence Measure (FIM) motor items in patients with spinal cord injury, stroke and traumatic brain injury and the comparability of summed scores between these diagnoses. METHODS: Data from 471 patients on FIM motor items at admission (stroke 157, spinal cord injury 157 and traumatic brain injury 157), age range 11-90 years and 70 % male in nine rehabilitation facilities in Scandinavia, were fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM motor items was made prior to testing fit to the model. Categories were re-scored where necessary. Fit to the model was assessed initially within diagnosis and then in the pooled data. Analysis of Differential Item Functioning (DIF) was undertaken in the pooled data for the FIM motor scale. Comparability of sum scores between diagnoses was tested by Test Equating. RESULTS: The present seven category scoring system for the FIM motor items was found to be invalid, necessitating extensive rescoring. Despite rescoring, the item-trait interaction fit statistic was significant and two individual items showed misfit to the model, Eating and Bladder management. DIF was also found for Spinal Cord Injury, compared with the other two diagnoses. After adjustment, it was possible to make appropriate comparisons of sum scores between the three diagnoses. CONCLUSION: The seven-category response function is a problem for the FIM instrument, and a reduction of responses might increase the validity of the instrument. Likewise, the removal of items that do not fit the underlying trait would improve the validity of the scale in these groups. Cross-diagnostic DIF is also a problem but for clinical use sum scores on group data in a generic instrument such as the FIM can be compared with appropriate adjustments. Thus, when planning interventions (group or individual), developing rehabilitation programs or comparing patient achievements in individual items, cross-diagnostic DIF must be taken into account.

Cross-cultural validity of FIM in spinal cord injury.

OBJECTIVE: To analyse cross-culture validity of the Functional Independence Measure (FIM) in patients with a spinal cord injury using a modern psychometric approach. SETTINGS: A total of 19 rehabilitation facilities from four countries in Europe. PARTICIPANTS: A total of 647 patients at admission, median age 46 years, 69% male. METHODS: Data from the FIM, collected on inpatient admission, was fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM items was undertaken before to testing fit to the model. Categories were rescored where necessary. Fit to the model was assessed initially within country, and then in the pooled data. Analysis of differential item functioning (DIF) was undertaken in the pooled data for each of the FIM motor and social cognitive scales, respectively. Final fit to the model was tested for breach of local independence by principle components analysis (PCA). RESULTS: The present scoring system for the FIM motor and cognitive scales, that is a seven category scale, was found to be invalid, necessitating extensive rescoring. Following this, DIF was found in a number of items within the motor scale, requiring a complex solution of splitting items by country to allow for the valid pooling of data. Five country-specific items could not be retained within this solution. The FIM cognitive scale fitted the Rasch model after rescoring, but there was a substantial ceiling effect. CONCLUSIONS: Data from the FIM motor scale for patients with spinal cord injury should not be pooled in its raw form, or compared from country to country. Only after fit to the Rasch model and necessary adjustments could such a comparison be made, but with a loss of clinical important items. The FIM cognitive scale works well following rescoring, and data may be pooled, but many patients were at the maximum score.