ObjectiveTo assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke.MethodsForty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into 'good status' and 'poor status' according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis.ResultsThe z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS.ConclusionImpairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome.

Older age was associated with increased level of apoptosis, but older muscle was not more vulnerable to the effect of denervation. Muscle Nerve 55: 262-269, 2017.

Background This study evaluated functional outcomes using newly established clinical pathways after hip fracture surgery in older adults and analyzed the major determinants of successful functional outcomes in rehabilitation programs using standardized clinical pathways. Methods This was a retrospective cohort study performed in a tertiary rehabilitation facility. A total of 220 patients who had received unilateral hip fracture surgery were followed up from immediately after surgery to 6 months postoperatively. Clinical pathways for rehabilitation included early, individualized rehabilitation, education for activities of daily living, review of general medical conditions, and arrangement of discharge settings. One rehabilitation specialist consecutively checked ambulatory function using 3-level grading, and patients were classified into good recovery and poor recovery groups based on ambulatory function at 6 months postoperatively. Logistic regression analysis was performed using 7 representative variables (age, sex, bone mineral density, Mini-Mental Status Examination [MMSE], Berg Balance Scale [BBS], premorbid ambulatory function, and length of hospital stay). Results A total of 86.8% of patients could walk with or without assistance at 6 months after surgery and 75.5% of patients involved in the rehabilitation program were classified into the good recovery group in this study. the good recovery group showed higher mmse and bbs scores compared with the poor recovery group. the factors in the model most strongly correlated with recovery were mmse and bbs. Conclusion This study showed that a well-designed rehabilitation program could improve ambulatory function in older patients after hip fracture surgery and that cognitive impairment and poor balance control may inhibit the recovery of ambulatory function.

Background This study examined how meeting the medical needs of injured workers after initial treatment may affect their return to work, using data from the Panel Study of Workers’ Compensation Insurance. Methods This study was designed as a longitudinal study, which used data from the second-year, follow-up survey conducted in the secondary cohort of the Panel Study of Workers’ Compensation Insurance. The odds ratio (OR) and 95% confidence interval were estimated through binomial and multinomial logistic regression analyses to examine the effects of unmet medical needs on workers’ return to original work and return to work overall (including reemployment). Results The returned to original work OR of workers whose rehabilitation needs were met was 1.35 (1.12–1.63) while the return to work OR was 1.20 (1.03–1.41). The returned to original work OR of workers whose medical needs were met was 1.64 (1.18–2.27) while the return to work OR was 1.39 (1.07–1.80). In terms of disability rating, the return to work ORs of workers with mild disabilities whose medical/rehabilitation needs were not met and those of workers without disabilities were 1.71 (1.17–2.49) and 1.97 (1.27–3.08), respectively. In the case of regular/temporary workers, the returned-to-work ORs of workers whose medical/rehabilitation needs were not met were 1.54 (1.12–2.13) and 1.27 (1.03–1.56), respectively. Conclusions For workers who sustained work-related injuries, providing medical accessibility and meeting rehabilitation needs were found to be important predictors of return to work after initial treatment.