Shoulder pain after stroke is common, especially in patients with severe sensorimotor deficits, diabetics and those living at home. Appropriate management may reduce the rate of occurrence.
Walking speed was measured on admission and then weekly during treatment of 125 subjects admitted to a geriatric rehabilitation ward. Walking speed was strongly related to the ability to stand up from a chair without help. Placement decisions at discharge were made without knowledge of gait speed data so that they could be used as a standard against which to compare walking speed as a valid and practical measure of mobility. It was found that a discharge walking speed of 0.15 m/s best separated immobile subjects who required long-term hospital care from those sufficiently mobile to be discharged home alone or to a rest home (54% versus 0% below cut-off, respectively). Relative walking speed (speed/height) was no better at predicting placement or mortality than walking speed. Uncorrected walking speed therefore remains the preferred clinical measure of velocity. A serial record showing improvement in walking speed proved useful in predicting eventual independent mobility of poorly mobile subjects. Thus walking speed is an objective yet inexpensive method of monitoring gait rehabilitation.
In order to validate measurement of urinary sulphatoxymelatonin as an accurate method of estimating plasma melatonin secretion in older people, we compared 24 h plasma melatonin secretion and sulphatoxymelatonin excretion with renal function in 20 subjects 62-89 years of age. There was a good correlation between plasma and urinary sulphatoxymelatonin over the same 24 h period (R2 = 0.797) and no relationship between creatinine clearance and sulphatoxymelatonin excretion (R2 = 0.075). The results suggest that sulphatoxymelatonin excretion estimation is a good surrogate measurement of plasma melatonin secretion in older people, at least across the range of creatinine clearance for the subjects in the study, 0.41-1.81 ml/sec.
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