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Hoensbroek, Netherlands

Van Der Zwaluw C.S.,Radboud University Nijmegen | Valentijn S.A.M.,Catharina Hospital | Nieuwenhuis-Mark R.,University of Tilburg | Rasquin S.M.C.,Rehabilitation Center Adelante | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2011

Cognitive dysfunction occurs in more than half of stroke survivors and can have far-reaching consequences for functioning in daily life. Assessment of cognitive function can play a major role in determining the appropriate discharge destination after a hospital stay. The present study aimed to determine the feasibility of cognitive screening in the acute phase poststroke and to investigate whether this cognitive screening can accurately predict discharge destination to either a dependent or an independent living situation. A total of 287 patients with a first-ever cerebral stroke consecutively admitted to a stroke unit of a general hospital were eligible for the study. All patients underwent neuropsychological screening, consisting of the Mini-Mental State Examination (MMSE), Cognitive Screening Test (CST), and Clock-Drawing Test, within 7 days poststroke. Screening was feasible in 73.2% of the patients. Logistic regression analysis showed that the Barthel Index (BI) score (ie, ability to perform activities of daily living) could predict the discharge destination with 47% explained variance when age and BI score were taken into account. Adding the 3 cognitive tests to the model with age and BI improved the explained variance substantially (53%), with a significant contribution of BI and CST. Cognitive screening in the acute phase poststroke appeared to be feasible and capable of supporting the decision of whether to discharge a patient to home or to a dependent living situation. Functional status improved the predictive value of the model; the MMSE was not suitable for prediction. A comprehensive set of various predictors, including cognition, is recommended to support discharge planning. © 2011 by National Stroke Association. Source

Geubbels H.J.B.,Maastricht University | Nusselein B.A.M.,Catharina Hospital | Van Heugten C.M.,Maastricht University | Valentijn S.A.M.,Catharina Hospital | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Background To decide on an appropriate discharge destination for stroke survivors from hospital, factors such as activities of daily living and age are often taken into account as predictors. Cognition has been found to support the decision whether to send a patient home or to a dependent living situation. The Montreal Cognitive Assessment (MOCA) has been proven to be a suitable cognitive screening instrument in the acute phase after stroke. However, its predictive value in the determination of discharge destination is unknown. The aim of the present study was to examine whether cognitive functioning, as measured with the MOCA, in the acute phase after stroke could predict discharge destination. Methods The study involved 211 patients with a first-ever cerebral stroke within the first week after stroke. Demographic and stroke-specific data, cognitive functioning (MOCA), and level of functional disability (Barthel Index [BI]) were collected. Multivariate logistic regression analyses were used to predict discharge destination (dependent versus independent living situation). Results Both age (B = -.05; P <.01) and BI score (B =.33; P <.001) were found to be significantly related to discharge destination with explained variance of 43%. Adding MOCA score as a predictor variable to the model resulted in a nonsignificant improvement of the model, explaining 44% of the variance. Conclusions Cognitive functioning, as measured by a single screening instrument such as the MOCA, in the acute phase after stroke is not predictive for discharge destination. © 2015 National Stroke Association. Source

Rianne Ravensbergen H.J.,Simon Fraser University | Rianne Ravensbergen H.J.,VU University Amsterdam | de Groot S.,University of Groningen | Post M.W.,University of Groningen | And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2016

Objectives: To determine whether physical activity and participation 1 and 5 years after discharge are associated with measures of cardiovascular autonomic function: prevalence of hypotension and reduced peak heart rate at discharge from initial inpatient spinal cord injury (SCI) rehabilitation. Design: Prospective cohort study. Setting: Rehabilitation centers. Participants: Individuals with SCI (N=146). Interventions: Not applicable. Main Outcome Measures: We recorded markers of cardiovascular autonomic dysfunction (resting blood pressure and peak heart rate) and personal and lesion characteristics at the time of discharge from rehabilitation. Parameters for participation (social health status dimension of the Sickness Impact Profile) and physical activity (Physical Activity Scale for Individuals with Physical Disabilities [PASIPD]) were measured 1 and 5 years after discharge. Effects of prevalence of cardiovascular autonomic dysfunction were analyzed using linear regression analysis while correcting for possible confounders. Results: We found no significant association between hypotension and social health status dimension of the Sickness Impact Profile or PASIPD, either at 1 or at 5 years after discharge. A significant association between peak heart rate and social health status dimension of the Sickness Impact Profile was found at 1 year after discharge, showing poorer participation in individuals with low peak heart rate (ie, cardiovascular autonomic dysfunction). The unadjusted relation between peak heart rate and the social health status dimension of the Sickness Impact Profile was significant at 5 years, but not when adjusted for confounders. We found associations between peak heart rate and PASIPD for both 1 and 5 years after discharge; however, these were not significant after correction for potential confounding factors. Conclusions: Autonomic dysfunction after SCI is a crucial factor influencing quality of life. We found that cardiovascular autonomic impairment, assessed from low peak heart rate, was associated with reduced participation after 1 year. The results suggest that peak heart rate at discharge from rehabilitation after SCI should be used to identify those needing additional support to facilitate physical activity and participation after discharge. © 2016 American Congress of Rehabilitation Medicine. Source

Schrijnemaekers A.-C.,Rehabilitation Center Adelante | Smeets S.M.J.,Maastricht University | Ponds R.W.H.M.,Rehabilitation Center Adelante | Ponds R.W.H.M.,Maastricht University | And 3 more authors.
Journal of Head Trauma Rehabilitation | Year: 2014

Objective: To review and evaluate the effectiveness and methodological quality of available treatment methods for unawareness of deficits after acquired brain injury (ABI). Methods: Systematic literature search for treatment studies for unawareness of deficits after ABI. Information concerning study content and reported effectiveness was extracted. Quality of the study reports and methods were evaluated. Results: A total of 471 articles were identified; 25 met inclusion criteria. 16 were uncontrolled or single-case studies. Nine were of higher quality: 2 randomized controlled trials, 5 single case experimental designs, 1 single-case design with pre- and posttreatment measurement, and 1 quasi-experimental controlled design. Overall, interventions consisted of multiple components including education and multimodal feedback on performance. Five of the 9 high-quality studies reported a positive effect of the intervention on unawareness in patients with some knowledge of their impairments. Effect sizes ranged from questionable to large. Conclusion: Patients with ABI may improve their awareness of their disabilities and possibly attain a level at which they personally experience problems when they occur. At present, because of lack of evidence, no recommendation can be made for treatment approaches for persons with severe impairment of self-awareness in the chronic phase of ABI. We recommended developing and evaluating theory-driven interventions specifically focused on disentangling the components of treatment that are successful in improving awareness. High-quality intervention studies are urgently needed using controlled designs (eg, single-case experimental designs, randomized controlled trials) based on a theoretic perspective with a detailed description of the content of the intervention and suitable outcome measures. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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