Prognosis In Neurologic PT

Question 1

Inpatient rehab requirements

Answer 1

• must have medical needs to see a doc daily
• realistic long term goals of home discharge
• tolerate 3 hours of therapy
• Approved dx and case mix

Question 2

Subacute rehab requirements

Answer 2

• often housed as a unit in SNF
• receive nursing care but less frequent MD visits
• Amount of therapy determined by team in consideration of diagnosis, age, and IE
• less therapy per day but still have therapy daily

Question 3

Skilled nursing requirements

Answer 3

• May receive some therapy services
• Palliative services or no services
• Therapy and MD visits would not be a required aspect of stay
• stag may be long term.

Question 4

Day rehab vs. Outpatient vs. Home health

Answer 4

Day rehab — require patient to need more than one discipline and have care conferences with rehab doc and team.
Outpatient — patient seen for PT as a single service
Home health — need to be home bound.

*caregiving services not covered by insurance.

Question 5

What are some strategies for determining prognosis

Answer 5

Decision making frameworks — help guide clinician in problem solving or decision making

Models of health and disease — highlight concepts and constructs that influence functioning

Evidence — valid prognostic studies can help answer questions and assist in weighing the various factors that maybe contribute to specific outcomes.

Question 6

Positive prognostic indicators

Answer 6

• support system at home
• motivation
• active and independent prior to injury
• younger
• fewer comorbidities if any
• no cog issues
• able to understand instructions and communicate needs
• motor recovery
• good insight into deficits

Question 7

Negative prognostic indicators

Answer 7

-Older
-Lots of comorbidities
-Minimal independence before injury
-No movement
- poor insight or cog deficits
- impulsive

Question 8

Paying for equipment in acute or inpatient

Answer 8

Medicare will not pay for equipment for discharge home more than 48 hours before discharge and patient must be discharging home vs. Another facility.

Question 9

Important indicators of outcomes at six months

Answer 9

Initial severity of disability and extent of improvement observed within first weeks

*most recovery within 10 weeks and plateaus typically 3-6 months post injury.

Question 10

Predictors of ADL improvement

Answer 10

• younger age predicts favorable ADL outcome
• lower score on NIHSS at admission
• urinary continence, good sitting balance, absence of aphasia, absence of DM

Question 11

Ambulation prognosis

Answer 11

70-80% of chronic stroke have ability to walk but only 30-50% regain community ambulation
- gait speed is key determinant of success

Sitting balance 2 weeks post can predict 6 month ambulation ability

Gait speed over 0.4 m/s and low fear of falling at 3 months can help predict community ambulation at 6 months

Question 12

Upper extremity prognosis

Answer 12

Ability to shrug and abduct shoulder at admission to rehab predicts hand function at discharge

Presence of finger extension at 7 days post predicts improved hand ability at 6 months

Patient with active should abduction and some active finger extension after mass grasp within 72 hours of stroke have 98% probably of improving at least 10 points on ARAT at 6 month follow up

Question 13

Return to work in young stroke

Answer 13

Return to work increases with time
- 41% between 0-6 months
- 53% at 1 year
- 56% at 1.5 years
- 66% between 2-4 years

Greater independence in ADLs, fewer neurological deficits, and better cognitive ability are most common predictors of return to work.