Public policy issues in geriatric rehabilitation.

As geriatric rehabilitation confronts major changes in health care funding, investigators and practitioners must identify and validate best practices in the field. Consistent, convincing outcomes research is lacking in several important areas of practice. Lack of scientific support for geriatric rehabilitation approaches is a common criticism at present, and may further jeopardize the availability of reimbursement in the future. It is, therefore, essential that geriatric rehabilitation investigators follow the lead of such influential groups as the Institute of Medicine and the Robert Wood Johnson Foundation in developing and defining a public policy-oriented research agenda.

Recurrent traumatic brain injury.

This article reviews, analyses and provides commentary on the most recent literature concerning recurrent traumatic brain injury (RTBI) case histories. It is revealed that a significant proportion of TBI sufferers survive and recover most of the functions of daily living. However, relatively little is known about the epidemiology, effects, or causes of a new phenomenon: recurrent TBI.

Restraint use in inpatient rehabilitation: incidence, predictors, and implications.

The use of mechanical restraints in rehabilitation facilities focuses attention on the conflict between patient safety and independent physical function. To evaluate restraint use, we reviewed records of 323 inpatient rehabilitation admissions. Restraint orders were written for 78.3% of admissions, but used in only 32.2% of cases (mean duration of use was 16 days). Posey vests were most commonly used (78.2%). Reasons for restraint were previous fall (26.8%), impulsivity (23.7%), and inappropriate self-transfers (19.6%). Male sex, decreased mental status, low admission functional independence measure (FIM) score, stroke, or traumatic brain injury were closely associated with restraint use. Falls occurred in 25% of restrained and 10.1% of unrestrained patients. Conclusions are as follows: (1) although physician orders are required to apply restraints, nursing staff initiate, monitor, and discontinue restraint use independently; (2) traumatic brain injury or stroke, decreased admission mental status, lower FIM scores, and male sex are indicators of restraint use; (3) age is not associated with restraint use; and (4) restraints may not prevent falls.

Thermographic observations in unilateral carpal tunnel syndrome: report of 61 cases.

This study was undertaken to assess the sensitivity and specificity of thermographic diagnosis of unilateral carpal tunnel syndrome in a patient population large enough to permit meaningful statistical analysis. Sixty-one persons with clinical diagnoses of unilateral carpal tunnel syndrome confirmed by electrodiagnostic examination and 40 symptom-free volunteers underwent standard thermographic examinations. The thermographic images were then randomly sorted and interpreted by an experienced physician thermographer. Fifty-seven of the 61 patients with carpal tunnel syndrome were found to have thermographic abnormalities, while only one of the control group was found to have such an abnormality. Individual area sensitivity was highest in the dorsal area, but addition of other regions increased this measure; specificity ranged between 98% and 100%. These findings would appear to confirm the value of thermography in the diagnosis of unilateral carpal tunnel syndrome.

Bladder emptying assessment in stroke patients.

The bladder-emptying status of 85 stroke patients admitted to a comprehensive rehabilitation center was evaluated by postvoid residual (PVR) sequential catheterizations. Those patients with incomplete bladder emptying were assessed by scheduled PVRs throughout their hospitalization. Incomplete bladder emptying occurred initially in 48 of the 85 patients and was sustained in 28. Of this group, 22 were able to void voluntarily and 15 were continent. The incomplete emptying group also demonstrated a significantly higher rate of urinary tract infections. Incomplete bladder emptying or urinary retention in stroke patients with apparently normal bladders is a frequent problem which should be addressed as part of the routine rehabilitation management.

Recurrent severe traumatic brain injury. Series of six cases.

Six of 141 persons treated for severe traumatic brain injury at the Medical College of Virginia were found to have a history of similar previous injury. These cases are presented in the context of the phenomenon of recurrent severe traumatic brain injury, which has received no systematic attention in epidemiologic studies of trauma.