Although the organization of KRWs is in flux as the system of hospitals grows, results over the past 8 years suggest that changes in national insurance policies are affecting the quantity and organization of rehabilitation interventions and improvement in patient outcomes.
A new method for the evaluation of stroke patients, designated the Stroke Impairment Assessment Set (SIAS) is presented. The SIAS primarily employs single task assessment of various functions and rates performance on scales of 0 to 5 or 0 to 3. The items evaluated include motor function, muscle tone, sensation, range of motion, pain, trunk control, visuospatial perception, aphasia and functions on the unaffected side. Scores for each item are plotted on a radar chart, so that deficits can be identified at a glance. The inter-observer variation in SIAS scores is acceptable and assessment can be performed as part of a routine clinical examination.
The incidence rate, location, and timing of falls and performance of activities of daily living (ADLs) in 256 patients with stroke admitted to an 88-bed rehabilitation ward was observed with information on falls and level of ADLs upon admission extracted from patients' records. Of 273 falls among 121 of the 256 patients, 229 occurred in the patient's room or lavatory and 147 within 4 weeks of admission. Significant differences were detected between motor subscores under 64 and over 65 on the Functional Independence Measure (FIM) in fall proportional analysis. The mean fall rate in motor subclass of 26 to 38 was higher than in other subgroups. Those with cognitive subscore on the FIM lower than 29 were prone to fall. Also, deteriorated motor and cognitive functions were associated with a high risk of falls.
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