Are your patients safe to mobilize alone in their room? The Johns Hopkins Hospital In-Room Independence Scale (JH-IRIS).

OBJECTIVE: Given the stigma of falls while hospitalized, inpatient rehabilitation facilities (IRF) often restrict the independent room mobility of their patients. We assessed the psychometric properties of a new tool, the Johns Hopkins In-Room Independence Scale (JH-IRIS), to evaluate its effectiveness at identifying independence for in-room mobility. DESIGN: Construct validity was assessed by comparing the JH-IRIS to its "gold standard" counterparts, The Johns Hopkins Falls Risk Assessment Tool (JHFRAT), the Activity Measure for Post-Acute Care (AM-PAC) Mobility and Activity, and the Centers for Medicare Quality Indicators (QI). Reliability was assessed via Cronbach's Alpha. RESULTS: 197 episodes were included. Construct validity: JH-IRIS had significantly negative low correlation to the JHFRAT (Spearman's Rho -0.281), and a significant moderate correlation to the AM-PAC Activity and AM-PAC Mobility (Spearman's Rho, 0.678 and 0.530, respectively). The JH-IRIS was moderately positively correlated to the QIs for mobility and activity (Spearman's Rho 0.577 and 0.643, respectively). All two tailed, alpha level 0.01. JH-IRIS' reliability was strong (Cronbach's Alpha 0.822, 15 items). Sensitivity and specificity were both 100%. CONCLUSION: Given the moderate validity, strong reliability, and high sensitivity/specificity, our study suggests the JH-IRIS can be used to identify patients who have the capacity to mobilize independently in their room.

The Scale for Assessment and Rating of Ataxia Is Reliable and Valid in the Telehealth Setting for Patients With Cerebellar Ataxia.

OBJECTIVE: Health care has increasingly expanded into a hybrid in-person/telehealth model. Patients with a variety of health conditions, including cerebellar ataxia, have received virtual health evaluations; however, it remains unknown whether some outcome measures that clinicians utilize in the telehealth setting are reliable and valid. The goal of this project is to evaluate the psychometric properties of the Scale for Assessment and Rating of Ataxia (SARA) for patients with cerebellar ataxia in the telehealth setting. METHODS: Nineteen individuals with cerebellar impairments were recruited on a voluntary basis. Participants completed 2 30-minute testing sessions during which a clinical examination and the SARA were performed. One session was performed in person, and the other session was assessed remotely. Outcome measure performance was video recorded in both environments and independently scored by 4 additional raters with varying levels of clinical experience (ranging from 6 months to 29 years). Concurrent validity was assessed with the Spearman rank order correlation coefficient (α < .05), comparing the virtual SARA scores to their gold standard in-person scores. Interrater reliability was evaluated with the intraclass correlation coefficient (ICC) (2,4) (α < .05). RESULTS: Fourteen of the 19 participants completed both in-person and telehealth SARA evaluations. We found that the in-person SARA and the telehealth SARA have large concurrent validity (Spearman rho significant at the 2-tailed α of .01 = 0.90; n = 14). Additionally, raters of varying years of experience had excellent interrater reliability for both the in-person SARA (ICC [2,4] = 0.97; n = 19) and the telehealth SARA (ICC [2,4] = 0.98; n = 14). CONCLUSION: Our results show that the telehealth SARA is comparable to the in-person SARA. Additionally, raters of varying years of clinical experience were found to have excellent interrater reliability scores for both remote and in-person SARA evaluations. IMPACT: Our study shows that the SARA can be used in the telehealth setting for patients with ataxia.

Is the dynamic gait index a useful outcome to measure balance and ambulation in patients with cerebellar ataxia?

BACKGROUND: Ataxia can adversely affect balance and gait and increase the incidence of falls, which puts individuals at greater risk for injury. Thus, interventions focused on balance and gait are integral in rehabilitation training. In order to determine if rehabilitation interventions are effective, we need an outcome measure to detect change. To our knowledge, no activity level outcome measures have been established for balance and gait in cerebellar ataxia. OBJECTIVE: The aim of the current study is to determine the reliability and validity of the Dynamic Gait Index (DGI) for ataxia. DESIGN: Twenty adult participants (23-84 years) with ataxia were evaluated to assess construct validity, inter-rater reliability, and same day test-retest reliability of the DGI. METHODS: Participants completed ataxia-specific impairment level outcome measures, as well as the DGI. In addition to the in-person rater, three additional physical therapists scored video recordings of DGI test and retests. Construct validity was assessed via Spearman's rank order correlation coefficient (Spearman's rho) between the impairment measures (Scale for Assessment and Rating of Ataxia (SARA), International Cooperative of Ataxia Rating Scale (ICARS) and the DGI. Reliability was assessed by Spearman's rho and Intraclass Correlation Coefficient ICC (2,1). RESULTS: In terms of construct validity, we found significant correlations between the activity level DGI and impairment level outcome measures (-0.81 for SARA; -0.88 with ICARS). The interrater reliability of the DGI applied to participants with ataxia was high (Spearman rho: range 0.71-0.98; ICC (2,1) 0.98) as was test-retest reliability (Spearman rho: 0.95; ICC (2,1) 0.98). CONCLUSION: We showed that the DGI is a reliable and valid outcome measure to be used in the clinic for individuals with cerebellar ataxia. The DGI had excellent inter-rater and test-retest reliability for raters with varying years of clinical experience. Therefore, the DGI can be a useful clinical outcome measure for assessing balance and ambulation for individuals with cerebellar ataxia.

Can the ARAT Be Used to Measure Arm Function in People With Cerebellar Ataxia?

OBJECTIVE: For people with ataxia, there are validated outcome measures to address body function and structure (BFS) impairments and participation; however, no outcome measure exists for upper extremity (UE) activity level in this population. The purpose of this study was to determine whether the action research arm test (ARAT), a measure of UE activity validated for other neurological conditions, might be a useful outcome measure for capturing UE activity limitations in ataxia. METHODS: A total of 22 participants with ataxia were evaluated to assess construct validity of the ARAT; 19 of the participants were included in the interrater reliability assessment. Participants received a neurologic examination and completed a battery of outcome measures, including the ARAT. ARAT performance was video recorded and scored by 4 additional raters. RESULTS: For construct validity, Spearman rho showed a significant moderate relationship between the ARAT and BSF outcome measures. A small, nonsignificant relationship was noted for the ARAT and the participation measure. For interrater reliability, Spearman rho showed a large, significant relationship among all raters for the ARAT (range = .87-.94). High reliability was demonstrated using the intraclass correlation coefficient ([2,1] = .97). CONCLUSION: The ARAT is moderately correlated with ataxia BFS outcome measures, but not with participation scores. The ARAT is a measure of UE activity, which is different from BFS and participation outcome measures. The ARAT was identified to have strong interrater reliability among raters with varying amounts of experience administering the ARAT. Thus, for the ataxic population, the ARAT may be useful for assessing UE activity limitations. IMPACT: Ataxia can negatively affect reaching tasks; therefore, it is important to assess UE activity level in people with ataxia. Until this study, no outcome measure had been identified for this purpose. LAY SUMMARY: People with ataxia may have difficulty with daily tasks that require reaching. The ARAT is an outcome measure that clinicians can use to assess UE activity limitations to help design a treatment program.

Mild Perceptual Categorization Deficits Follow Bilateral Removal of Anterior Inferior Temporal Cortex in Rhesus Monkeys.

In primates, visual recognition of complex objects depends on the inferior temporal lobe. By extension, categorizing visual stimuli based on similarity ought to depend on the integrity of the same area. We tested three monkeys before and after bilateral anterior inferior temporal cortex (area TE) removal. Although mildly impaired after the removals, they retained the ability to assign stimuli to previously learned categories, e.g., cats versus dogs, and human versus monkey faces, even with trial-unique exemplars. After the TE removals, they learned in one session to classify members from a new pair of categories, cars versus trucks, as quickly as they had learned the cats versus dogs before the removals. As with the dogs and cats, they generalized across trial-unique exemplars of cars and trucks. However, as seen in earlier studies, these monkeys with TE removals had difficulty learning to discriminate between two simple black and white stimuli. These results raise the possibility that TE is needed for memory of simple conjunctions of basic features, but that it plays only a small role in generalizing overall configural similarity across a large set of stimuli, such as would be needed for perceptual categorical assignment. SIGNIFICANCE STATEMENT: The process of seeing and recognizing objects is attributed to a set of sequentially connected brain regions stretching forward from the primary visual cortex through the temporal lobe to the anterior inferior temporal cortex, a region designated area TE. Area TE is considered the final stage for recognizing complex visual objects, e.g., faces. It has been assumed, but not tested directly, that this area would be critical for visual generalization, i.e., the ability to place objects such as cats and dogs into their correct categories. Here, we demonstrate that monkeys rapidly and seemingly effortlessly categorize large sets of complex images (cats vs dogs, cars vs trucks), surprisingly, even after removal of area TE, leaving a puzzle about how this generalization is done.

Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach.

BACKGROUND AND PURPOSE: Sacroiliac joint pain and dysfunction affect 15-25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. CASE DESCRIPTION: A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. OUTCOMES: The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient's Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient's rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. DISCUSSION: A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up.