The purpose of this study was to determine the factors involved in predicting dependence or independence in activities of daily living (ADL) over a three-month period after the onset of ruptured aneurysmal subarachnoid hemorrhage (SAH). One hundred and fifty cases with a mean age of 60.6±11.1 years, who had been admitted to the neurosurgical unit at Kanazawa University Hospital from 1989 to 2003, were investigated. ADL at three months were scored with the Barthel Index (BI). The independent group with a BI≥85 comprised 103 cases, and the dependent group with a BI≤80 comprised 47 cases. The following were analyzed in terms of predictive value, false positive rate and sensitivity: Japan Coma Scale scores (JCS) at 2 and 4 weeks, computed tomographic (CT) findings at 4 weeks, severity of motor impairment at 4 weeks and notification of voiding at 4 weeks. Normal notification of voiding at 4 weeks was a valid predictor for the independent group (97% in terms of predictive value, with false positive rate and sensitivity scoring 4% and 69%, respectively). By contrast, moderate to severe motor impairment at 4 weeks was valid for the dependent group (97%, 1% and 68%). Though sensitivities were low, the JCS 100-300 at 2 weeks (100%, 0% and 19%) and the JCS 20, 30 a/o apallic state at 4 weeks (100%, 0% and 32%) were estimated to be specific predictors for the dependent group. These results may help in discussions at a relatively early stage of SAH regarding appropriate patient-specific rehabilitation strategies to be followed after discharge to acute phase inpatient units.
Balance function is thought to be a one of the key factors that influence walking ability. The purpose of this study is to investigate the relationship between walking ability and various balance function tests. We measured maximum walking speed (MWS), functional reach (FR), postural sway and timed up and go test (TUG), in 25 young and 24 older healthy adults. The height of the young adults correlated with MWS, FR, total length and outer area of postural sway while standing in the tandem position and TUG, but no correlation was detected in the older adults. We found that MWS was related to the outer area of postural sway while standing in the tandem position and TUG in the young adults, and was related with FR, total length of postural sway while standing in the tandem position and TUG in the older adults. It is thought that any correlation between MWS and the balance tests in the young adults was height dependent. This study suggests that static and dynamic balance functions influence walking ability in older adults.
In order to improve medical record sharing between 5 acute phase hospitals (APHs) and 13 rehabilitation hospitals (RHs) in the course of designing a liaison-critical pathway for cerebral infarction, we sent out a questionnaire targeting APHs and RHs concerning the description items requested for medical records by each. The number of hospitals requesting description items was significantly greater amongst the RHs than the APHs in 4 items out of 14 common questions which were asked to both the APHs and RHs. Although most of the description items requested were already recorded, some items, such as the “itemized Barthel Index score” requested by the APHs, and the “explanation to the patient and family members” and “modified Rankin Scale” requested by the RHs, are recorded in fewer than half of the hospitals at present. We need to improve medical record usage and sharing between APHs and RHs, and to accomplish this we first need to know the specific data fields required by each. Designing and implementing a liaison-critical pathway may be the best way to solve this problem for our entire region.