Physical therapists must screen all individuals who have experienced a potential concussive event and document the presence or absence of symptoms, impairments, and functional limitations that may relate to a concussive event. Screening for Indicators of Emergency ConditionsA Physical therapists must screen patients who have experienced a recent potential concussive event for signs of medical emergency or severe pathology (eg, more serious brain injury, medical conditions, or cervical spine injury) that warrant further evaluation by other health care providers. Referral for further evaluation should be made as indicated (FIGURE 1). Differential DiagnosisA Physical therapists must evaluate for potential signs and symptoms of an undiagnosed concussion in patients who have experienced a concussive event but have not been diagnosed with concussion. Evaluation should include triangulation of information from patient/family/witness reports, the patient's past medical history, physical observation/examination, and the use of an age-appropriate symptom scale/checklist (see FIGURE 1 for diagnostic criteria).

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BACKGROUND: Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose. METHODS: Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons. RESULTS: Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses. CONCLUSIONS: Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.

Participation is the measure of the amount and types of meaningful activities a person engages in at a societal level. 1 Participation of people with disability in society is a primary aim of rehabilitation and yet definitions vary, and it is often not measured or reported. 1 Participation With Recombined Tools-Objective (PART-O) is a National Institute of Neurological Disorders and Stroke traumatic brain injury (TBI) common data element that measures frequencies of participation within the subdomains of productivity, social interaction, and out and about. 2,3 There are three Yes/No items and the rest of the items are ordinal scale with higher scores indicating more participation. Balanced scoring and Rasch scoring methods are established on the PART-O. 1 Subscale scores are calculated by taking the mean score of all items within the subscale. The PART-O demonstrates excellent construct validity (0.61-0.82) with CIQ, CHART, POPS, Mayo-Portland Participation Index, Cognitive FIM, Supervision Rating Scale, Glasgow Outcome Scale extended, and Disability Rating Scale. 4 PART-O has adequate construct validity (0.34-0.59) with the Motor FIM, and the Satisfaction with Life Scale, excellent interrater reliability, and adequate internal consistency. 4,5 Convergent validity is supported by adequate to excellent correlations between various commonly utilized scales and at least 1 factor of the PART-O. 4 The PART-O can be administered in 15-30 minutes and does not require training or additional equipment. The measure and additional resources can be found on the Center for Outcome Measurement in Brain Injury website. 2 This abbreviated summary provides a review of the psychometric properties of the PART-O in adults with TBI. A full review of the PART-O and reviews of over 460 other instruments for patients with various health conditions can be found at: www.sralab.org/

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