Depression and cognitive impairment are predictive of negative outcomes in elderly patients' rehabilitation from hip fracture. This effect is mediated by rehabilitation participation, and ratings in this area may serve as a potentially useful clinical and research tool for the rehabilitation environment.

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Both devices produce equivalent functional gains.

Context.-Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who cannot function at home soon after surgery, but how soon after surgery inpatient rehabilitation can be initiated has not been studied.Objective.-To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7, without adverse consequences to the patients.Design.-Randomized controlled trial conducted from 1994 to 1996.Setting.-Tertiary care center.Participants.-A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk: 70 years of age or older and living alone, 70 years of age or older with 2 or more comorbid conditions, or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed the study.Interventions.-Random assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7.Main Outcome Measures.-Total length of stay and cost from orthopedic and rehabilitation hospital admissions, functional performance in hospitals using a subset of the functional independence measure, and 4-month follow-up assessment using the RAND 36-item health survey I and the functional status index.Results.-Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean (±SD) total length of stay (11.7±2.3 days vs 14.5±1.9, PϽ.

The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events.

Objective To examine associations between cognitive and affective impairments and rehabilitation participation during stroke rehabilitation. Design Secondary analyses of stroke patients who received acetylcholinesterase inhibitors during inpatient rehabilitation. Setting University-affiliated inpatient rehabilitation facilities. Patients Individuals admitted to inpatient stroke rehabilitation with impairment in attention, memory or executive functions (N=44). Interventions Secondary analysis of individuals receiving inpatient stroke rehabilitation care plus random assignment to one of two acetylcholinesterase inhibitors or no drug at rehabilitation admission. Main Outcome Measure(s) Correlations between measures of cognitive (Digit Span, Hopkins Verbal Learning Test, and Executive Interview) and affective impairments (Hamilton Rating Scale for Depression and Apathy Evaluation Scale) and participation (Pittsburgh Rehabilitation and Participation Scale) were examined. Significant correlates of participation were examined in a linear multiple regression model. Results Executive functions and depressive symptoms were significant correlates of participation. After controlling for baseline disability, executive functions predicted participation, but depressive symptoms did not, F4,32=9.35; R2=.54, P<.001. Conclusions These findings are an important first step toward understanding potentially modifiable clinical factors that contribute to rehabilitation participation, and overall functional status after rehabilitation. A better understanding of cognitive impairment and rehabilitation participation may be used to develop strategies for improving functional outcomes after stroke.

Presence of laryngeal synkinesis using motor amplitude ratio criteria, in the setting of good voluntary motor unit recruitment and UVFI, downgrades a patient's prognosis to one that is poor for recovery. We propose this screening protocol as an adjunct to diagnostic LEMG.

Integrating both qualitative and quantitative LEMG data improves prognostic accuracy in vocal fold paralysis patients who demonstrate voluntary motor unit activity.