Discussion Questions for Articles Flashcards
Systematic Review - Models to predict functional outcomes after stroke - What 2 measures did they use as dependent variables
Barthel Index
Functional Independence Measure
Barthel Index - measures what
ability to perform 10 ADLs and they are assessed as either dependent or independent
Barthel Index - higher score indicates
Greater functional ability
FIM - measures what
Rather than disability, this one looks more at burden of care
FIM - higher score indicates
greater functional independence
Systematic Review - Models to predict functional outcomes after stroke - the authors categorized variables from previous research into what four groups
Stroke characteristics and consequences
Medical history/Comorbidities/Risk Factors/Bio Markers
Demographic/Social Data
Processes of Care
Systematic Review - Models to predict functional outcomes after stroke - the admission FIM was found to be a significant predictor of function at time of discharge what percentage of the time
90%
Systematic Review - Models to predict functional outcomes after stroke - The higher the FIM score at time of acute care discharge was associated with what
a higher FIM score at time of discharge from inpatient rehab
Systematic Review - Models to predict functional outcomes after stroke - What variables did the authors find to be best at predicting level of function at time of DC from IPT rehab?
Age NIHSS BI (assessed at acute discharge) FIM (assessed at acute discharge) OAI
Systematic Review - Models to predict functional outcomes after stroke - are variables related to past/prior medical condition useful in predicting post-rehab function
Generally poor predictors with the exception of a previous stroke
Systematic Review - Models to predict functional outcomes after stroke - Which demographic variable was strongly associated with functional outcome?
Age (age especially)
Ethnicity
Sex
Systematic Review - Models to predict functional outcomes after stroke - What does OAI stand for?
The time between stroke onset and rehab admission
Systematic Review - Models to predict functional outcomes after stroke - Relationship with OAI and functional outcome
Negatively associated with each other
less time between, or lower the OAI - the better the functional outcome
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - How does this study differ from the systematic review?
1 - Examines pts 3-6 months post stroke (versus at dc from acute hospital)
2 - Experiment with intervention vs. systematic review
3 - Uses similar, but different measures as predictors of treatment gain (measure of brain injury and neural/cortical function)
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - How did the authors define brain injury
Image acquisition and analysis
Infarct volume
Gray matter injury
White matter injury
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - What is the different between the measures of brain injury and cortical function
Brain injury - looked at image acquisition and analysis, infarct volume, gray matter and white matter injury
Cortical function - looked at image acquisition and analysis
With cortical function the image acquisition was taken with T2 weighted and was done while the subjects were visually guided to use the paretic distal UE for a grasp release movement
Also, with cortical function, the image analysis looked at activation versus injury
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - What is cortical connectivity
Tries to determine the continuity of neural pathways - the correlation between two areas
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - With visually guided mvoement we would expect higher correlations between what what
Visual cortex and parietal cortex
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - With this study what cortical connectivity did they look at
Premotor and primary motor areas
They looked at this connection ipsilesionally and contralaterally
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - What is the ARAT
Action Reach Arm Test
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - How did they use the ARAT in this study
As an assessment of impairment
Performed with Fugl Meyer once at baseline and again 1-3 wks later to ensure stability of motor status
Also assessed before and 1 month after the 3 week course of robotic therapy
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Greater ipsilesional MI - contralesional MI functional connectivity each significantly predicted
larger treatment induced behavioral gains
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - 3 categories had at least 1 variable that significantly predicted tx induced bx gains - what was the most significant bivariate predictor of gains?
Percentage CST injury determined by lesion overlap
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Main findings
Response to restorative therapy after a stroke is best predicted by a model that includes measures of both neural injury and function
Neuroimaging measures were the best predictors
Harrison - Assessment scales in stroke - Scale domains move from what to what as the subject progresses
impairment to activity/participation as the subject progresses
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Examples of impairment scales
GCS MRC NIHSS MOCA Days 0-7
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Examples of activity/participation scales
mRS modified ashworth ARAT Anxiety and depression screens Euro-QOL Driving assessments Days 30-120
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Responsiveness of a scale is what
the ability to detect meaningful change over time
Especially important for conditions like stroke that have high incidence and prevalence
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Reliability is what
a measure of consistency of scoring
Quinian - Neural function, injury and stroke subtype predict tx gains after stroke - Differences between scales
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