Functional Evaluation of Stroke Patients PDF
Preview Functional Evaluation of Stroke Patients
Springer Tokyo Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris SantaClara Singapore N. Chino· J.L. Melvin (Eds.) Functional Evaluation of Stroke Patients With 54 Figures Springer Editors Naoichi Chino, M.D., M.S., D.M.Sc. John L. Melvin, M.D., M.M.Sc. Professor and Chairman Professor and Deputy Chairman Department of Rehabilitation Medicine Department of Physical Medicine and Keio University School of Medicine Rehabilitation, Temple University, Tokyo, Japan Pennsylvania, USA Associate Editors Murray E. Brandstater, M.B.B.S., Ph. D., Carl V. Granger, M.D. F.R.C.P.(C) Professor and Director Professor and Chairman Center for Functional Assessment Research Department of Physical Medicine and Department of Rehabilitation Medicine Rehabilitation School of Medicine and Biomedical Sciences Lorna Linda University, State University of New York at Buffalo California, USA New York, USA Prof. Dr. med Karl-Heinz Mauritz Klinik Berlin, Department of Neurological Rehabilitation, Free University Berlin, Berlin, Germany ISBN-13: 978-4-431-68463-3 e-ISBN-13: 978-4-431-68461-9 001: 10.1007/978-4-431-68461-9 Printed on acid-free paper @ Springer-Verlag Tokyo 1996 Softcover reprint of the hardcover 1st edition 1996 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broad casting, reproduction on microfilms or in other ways, and storage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and appli cation thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting: Best-set Typesetter Ltd., Hong Kong Preface Stroke is one of the major causes of disability in the world. Consequently, an effective rehabilitation regimen is the goal of specialists working in the field worldwide. The implementation of rehabilitation programs for the stroke patient is broad in scope and requires, first of all, an objective scientific evaluation method. In 1980 the World Health Organization developed the International Classification ofImpairments, Disabilities, and Handicaps. It categorized impairments and disabili ties on the basis of functional evaluation but took into account cultural and socioeco nomic factors when defining handicaps, thus making it difficult to use the same functional evaluation instrument for the three phenomena. In this monograph, experts in the treatment of stroke from Japan, the United States, and Europe share their ideas presented during the 31st Annual Convention of the Japanese Association of Rehabilitation Medicine held in June 1994. All the partici pants freely contributed their views on the functional assessment and prognosis of stroke patients. Indeed, their contributions shed light on possible breakthroughs in the future for the development of rehabilitation regimens for stroke patients. November 1995 Naoichi Chino John 1. Melvin v Acknowledgments The authors of this monograph express their thanks to the following organizing committee members: Kazuo Akaboshi, Motohide Arita, Hiroki Ebata, Toshiyuki Fujiwara, Kozo Hanayama, Yukihiro Hara, Kimitaka Hase, Fujiko Hotta, Shin-ichi Izumi, Suminori Kawakami, Ken Kondoh, Kunitsugu Kondoh, Yo shihisa Masakado, Kiyoshi Mineo, Tomoko Misawa, Eiji Mori, Masaaki Nagata, Yukio Noda, Yoshihisa Nunotani, Tetsuo Ohta, Yasutomo Okajima, Tomokichi Otsuka, Masaru Seki, Hidetoshi Takahashi, Morimasa Takahashi, Masako Takayama, Naofumi Tanaka, Hiroyuki Toikawa, Tetsuya Tomaru, Akio Tsubahara, Tetsuya Tsuji, and Kazuo Tsujiuchi. This symposium was sponsored in part by the Pfizer Health Research Foundation. vii Contents Preface v Acknowledgments vii List of Contributors xi Evaluation of Stroke: A Review John L. Melvin and John Whyte Basic Aspects of Impairment Evaluation in Stroke Patients Murray E. Brandstater 9 Stroke Impairment Assessment Set (SIAS) Naoichi Chino, Shigeru Sonoda, Kazuhisa Domen, Eiichi Saitoh and Akio Kimura 19 Evaluation of Motor Function in Stroke Patients Using the Stroke Impairment Assessment Set (SIAS) Kazuhisa Domen, Shigeru Sonoda, Naoichi Chino, Eiichi Saitoh and Akio Kimura 33 Evaluation of Impairment and Disability in Stroke Patients: Current Status in Europe Karl-Heinz Mauritz, Stefan Hesse and Petra E. Denzler 45 Rehabilitation and Functional Evaluation of the Stroke Survivor in New Jersey Thomas W. Findley, Richard D. Zorowitz, Miriam Maney and Mark V. Johnston 59 The Functional Independence Measure: A Measurement of Disability and Medical Rehabilitation Roger C. Fiedler and Carl V. Granger 75 Prognostication in Stroke Rehabilitation Murray E. Brandstater 93 ix x Contents Prognostication of Stroke Patients Using the Stroke Impairment Assessment Set and Functional Independence Measures Shigeru Sonoda, Eiichi Saitoh, Kazuhisa Domen and Naoichi Chino 103 Advantages and Disadvantages of the Functional Independence Measure for Home Care Tetsuya Adachi 115 Toward Future Research Meigen Liu and Shigenobu Ishigami 125 Index 143 List of Contributors Adachi, T. 115 Johnston, M. V. 59 Brandstater, M. E. 9, 93 Kimura, A. 19,33 Chino, N. 19, 33, 103 Liu, M. 125 Denzler, P. E. 45 Maney, M. 59 Domen, K. 19, 33, 103 Mauritz, K.-H. 45 Melvin, J. L. 1 Fiedler, R. C. 75 Findley, T. W. 59 Saitoh, E. 19,33, 103 Sonoda, S. 19,33, 103 Granger, C. V. 75 Whyte, J. 1 Hesse, S. 45 Zorowitz, R. D. 59 Ishigami, S. 125 Evaluation of Stroke: A Review John L. Melvin'" and John Whyte'" Summary. A comprehensive review of evaluation issues related to stroke would re quire more than a short chapter. However, the subject is of great importance. Stroke is the most frequent cause of death in the United States. Health care and lost produc tivity costs associated with stroke reached an estimated 15.6 billion dollars in the United States in 1991. Despite these significant impacts, clinicians in the United States often treat similar stroke patients quite differently. This suggests that greater unifor mity in evaluation and treatment could result in better clinical outcomes and eco nomic efficiency. To accomplish these goals, evaluation of stroke patients requires the development of a patient database that includes information categorized as in the International Classification of Impairment, Disability, and Handicap. Additionally it should include medical and quality-of-life information. Information regarding these conceptually different categories permits the development of appropriate strategies for their treatment and the framework to evaluate their outcomes. These categories also permit facilities to compare their results against others. Although clinicians focus primarily on medical and functional outcomes, organizations responsible for health care increasingly include patient and family satisfaction and cost efficiency as mea sures of effectiveness. Those performing evaluations select their measurement instru ments on the basis of sensibility, validity, reliability, and sensitivity. A number of examinations, instruments, and scales provide appropriate information regarding the pathology, impairment, disability, handicap, and quality oflife of stroke patients. This will increasingly become the foundation of clinical practice as outcome analysis influ ences which treatments may be utilized in the treatment of stroke. Introduction A full discussion of the evaluation issues related to stroke would be a task beyond the scope of a short chapter. The presentation of stroke varies widely, not only in its pathology but also in the resulting permanent neurological impairment, disability, IMossRehab Hospital and The Moss Rehabilitation Research Institute, l200 West Tabor Road, Philadelphia, PA 19141-3099, USA 2Temple University, Department of Physical Medicine and Rehabilitation, 3401 N. Broad St., Philadelphia, PA 19140, USA 2 J.L. Melvin and J. Whyte and handicap [1]. The relationships among these hierarchical concepts are themselves complex, further adding to the difficulty of presenting a full discussion of evaluation. Thus, this chapter is limited to alerting clinicians to the need to improve evaluation procedures, outlining the goals to be achieved by evaluation, presenting promising measurement tools, and recommending approaches to evaluation likely to keep the assessments of clinicians effective, efficient, and contemporary. Need to Review Stroke Evaluation Clinicians in rehabilitation medicine begin evaluating stroke patients early in their training. Most continue to do so regularly thereafter. Thus, some might question the need to discuss evaluation in a monograph targeted for rehabilitation clinicians. However, the magnitude of the impact of stroke on patients and society combined with increased economic restrictions on health care makes such a review timely and imperative. Stroke is a problem of such size that relatively small increases in treat ment effectiveness and efficiency could significantly improve patient lives and save millions of dollars in social costs. In the United States, stroke is the third most frequent cause of death; approximately 500000 strokes per year result in 150000 deaths [2]. The American Heart Association [2] estimates that the United States has 3 million stroke survivors, many of whom have significant impairment and disability. The consequences of these strokes on individuals and their families can be significant as they may go beyond physical dependence to changes in role relationships, social isolation, and financial crisis. The impacts of stroke go beyond the personal consequences on patients and their families. From a social point of view, the economic impact is tremendous. Health care and lost productivity costs reached an estimated 15.6 billion dollars in the United States in 1991 [2]. Health care costs alone are significant. Stroke is the largest category of patients admitted to rehabilitation hospitals [3]. The increase in number of rehabili tation hospitals has been substantial, from 357 in 1984 to 812 in 1990. These facilities cost 14 billion dollars per year [4]. Stroke patients with no apparent differences are treated in a highly variable fashion. Survivors are discharged to a number of post acute care options including home health care, skilled nursing facilities, rehabilitation hospitals, and nursing homes with limited evidence of facility-specific influences on outcomes [5]. Admission rates to rehabilitation hospitals vary widely. In a three-city study, for instance, admission rates varied from 11% to 20% [5]. This same study showed that use of home health care varied from 20% to 38% and that of skilled nursing facilities from 10% to 36% [5]. This suggests the need to identify inequitable or inefficient approaches. Another reason to reexamine the information available from stroke evaluation is the need to strengthen the case for stroke rehabilitation. Most papers addressing this question are descriptive in nature rather than conforming to a disciplined experimen tal design. As a result, there are legitimate questions as to how much improvement occurs through spontaneous recovery, how much functional adaptation might occur through informal mechanisms, and how much can be attributed to specific rehabilita tion treatment. This questioning occurs at a time when the scarcity of resources available for human services includes health care. Thus, any service without a strong research supported rationale is vulnerable to restrictions.
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