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Communication challenges in persons with aphasia may negatively affect their health care. Building effective communication skills is critical for health professional student education, yet communication skills for interacting with persons with aphasia are often not taught or practiced within health care education. A review of the literature found that research is limited but does demonstrate evidence‐based training can improve skills for health professional students. Through utilization of workshops, seminars, and standardized patients, medical students and other health professional students can build confidence and skills in successful communication for future encounters with persons with aphasia. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a risk factor for many adverse health outcomes. However for some cardiac conditions and cancers, evidence of an "obesity paradox" seems to exist where an elevated body mass index (BMI) is linked to protective effects in mortality and functional outcomes. Within the stroke rehabilitation literature, there are conflicting findings on this phenomenon possibly due to unaccounted for variables, such as comorbid medical conditions. Objective: To investigate the association between BMI and functional gains made in acute inpatient stroke rehabilitation, and the effects of multiple confounding variables. Design: Retrospective cohort study. Setting: Tertiary academic hospital. Patients: Three hundred ninety-two adults following a recent ischemic (82%) or hemorrhagic (18%) stroke with a mean age 62.9 years. Interventions: Acute inpatient rehabilitation. Main Outcome Measures: Functional Independence Measure (FIM) score and BMI. Results: A significant association was found between motor FIM score gains and elevated BMI when BMI was treated as a continuous variable (p < .05). However, this association disappeared when patient factors and comorbid conditions were taken into account and when BMI was conceptualized categorically (underweight [BMI <18.5], normal [BMI 18.5-24.9], overweight [BMI 25.0-29.9], obese [BMI 30.0-39.9], and severely obese [BMI ≥40.0]). Advanced age, higher motor function on admission, and a diagnosis of diabetes were all significantly associated with decreased motor FIM gains. Conclusions: The results from this study provide insufficient evidence to support the "obesity paradox" once patient factors and comorbid conditions are taken into account. Diabetes was the single comorbidity tracked that showed a significant association with change in motor function (p = .01). Further studies might explore how the unique interventions of rehabilitation physicians and ancillary health professionals might mitigate the functional debility associated with diabetes and obesity in stroke patients. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity within the hospital poststroke is recommended for cardiovascular and musculoskeletal health, but no studies have examined cerebrovascular health. We hypothesized that individuals who walked farther distances (FARhigh) during the acute phase of stroke recovery in a hospital setting would have a higher resting middle cerebral artery blood velocity (MCAv) and a greater cerebrovascular response (CVR) to moderate-intensity exercise at 3 months poststroke, compared with individuals who walked shorter distances (FARlow). Methods: At 3 months poststroke, we recorded 90 seconds of resting baseline (BL) MCAv, followed by 6 minutes of moderate-intensity exercise. We calculated CVR as the change in MCAv from BL to steady-state exercise. We retrospectively collected the farthest distance walked within the hospital poststroke from the electronic medical record. Participants were classified as FARhigh or FARlow based on the average farthest walking distance. Results: Twenty participants completed the study, aged 63 (15) years. Baseline MCAv was not different between groups (P =.07). In comparison with FARlow, we report a higher CVR in FARhigh's ipsilesional (  x ¯ = 7.38 [5.42] vs   x ¯ = 2.19 [3.53], P =.02)and contralesional hemispheres (  x ¯ = 8.15 [6.37] vs   x ¯ = 2.06 [4.76], P =.04). Conclusions: Physical activity during the hospital stay poststroke may support cerebrovascular health after discharge. Prospective studies are needed to support this finding. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background and Purpose: A major challenge for stroke rehabilitation and recovery research is the recruitment and retention of participants. Our prior challenges and successes have influenced our team to rethink our approach and the potential for large-scale stroke recruitment. Summary of Key Points: In this special interest article, we highlight how the adoption and implementation of recruitment strategies such as physician engagement and a streamlined "customer service" approach helped us improve our enrollment and maximize efficiency. Another positive outcome of enrollment was increased representation of those who identify as underrepresented minority or live in rural areas. Recommendations for Clinical Practice: Rethinking our recruitment processes and infrastructure allowed for greater interprofessional interactions, minimal burden for our stroke physician team members, and maximized enrollment into our stroke studies. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A324). [ABSTRACT FROM AUTHOR]

Background: Lung function is compromised in stroke survivors, which may cause fatigue and exercise intolerance. Furthermore, past studies of aerobic exercise have involved only stroke survivors who could walk independently. Stroke survivors who were unable to walk were not included in the previous research-investigating changes in lung function from walking exercise interventions. In this pilot study, the feasibility and the effect of aerobic walking exercise on lung function was examined in non-ambulatory stroke survivors using a treadmill, bodyweight support system, and a gait training device. Methods: This study was a single group trial. Eight non-ambulatory stroke survivors (five males, mean age 63.3 ± 13.7 years, seven with ischemic stroke) completed a low intensity walking exercise program (30 min/session; three sessions/week for 8 weeks) and lung function test. Before and after the intervention, vital capacity (VC) and forced vital capacity (FVC) using a spirometer were measured according to the guideline from American Thoracic Society/European Respiratory Society. Results: The rates of compliance and attrition were 100% and 10%; respectively, and no adverse events were reported. There were significant differences between pre- and post-intervention assessments in FVC (p =.09), percentage of predicted VC (p =.08), and percentage of predicted FVC (p =.08). Conclusions: In non-ambulatory stroke survivors, aerobic walking exercise is feasible and safe. Also, the results are promising and suggest that aerobic walking exercise may improve lung function; more data are needed. [ABSTRACT FROM AUTHOR]

Because more patients with advanced heart failure are receiving a left ventricular assist device (LVAD) as destination therapy or a bridge to transplantation, there is increasing attention on functional outcomes and quality of life after LVAD implantation. Rehabilitation providers in the acute inpatient rehabilitation setting increasingly will treat patients with an LVAD and should understand the exercise physiology, medical management, rehabilitation considerations, and outcomes after rehabilitation for patients with an LVAD. The purpose of this article is to provide the physiatrist with a comprehensive understanding of the rehabilitation of patients with advanced heart failure and LVAD implantation. Changes in relevant organ system physiology and exercise physiology after LVAD are summarized. Safety of rehabilitation and program considerations for acute inpatient rehabilitation are reviewed. Recommendations for medical management and prevention of secondary complications seen in patients with an LVAD are outlined. A discussion of outcomes after acute inpatient rehabilitation, the dual diagnosis of stroke and LVAD placement, and long-term cognitive, functional, and quality-of-life outcomes after LVAD placement is presented. [ABSTRACT FROM AUTHOR]

Background: Malignant brain tumors cause significant impairments in function because of the nature of the disease. Nevertheless, patients with malignant brain tumors can make functional gains equivalent to those with stroke and traumatic brain injury in the inpatient rehabilitation setting. However, the efficacy of outpatient rehabilitation in this population has received little study.Objective: To determine if an interdisciplinary outpatient rehabilitation program will improve functional outcomes in patients with malignant brain tumors.Design: Nonrandomized prospective longitudinal study.Setting: Six affiliated outpatient sites of one institution.Patients: Forty-nine adults with malignant brain tumors were enrolled.Methods: Patients received interdisciplinary therapy services, with duration determined by the therapist evaluations. The therapists scored the Day Rehabilitation Outcome Scale (DayROS) and Disability Rating Scale (DRS) on admission and discharge. The caregivers filled out the DRS at discharge, 1 month, and 3 months after discharge.Main Outcome Measurements: The primary study outcome measure was the DayROS, which is a functional measure similar to the Functional Independence Measure. DRS was another functional outcome measure assessing basic self-care, dependence on others, and psychosocial adaptability.Results: Forty-six of 49 enrolled patients (94%) completed the day rehabilitation program. The average length of stay was 76.9 days. There was a significant improvement in total DayROS (P < .001), mobility (P < .001), Activities of Daily Living ( P < .001), and communication (P < .001) DayROS subscores from admission to discharge. There were no significant changes over time in the DRS scores. Women had higher DayROS gains (P = .003) and better therapist DRS scores from admission to discharge than men (P = .010).Conclusions: Patients with malignant brain tumors can make functional gains in an interdisciplinary outpatient rehabilitation program. This level of care should be considered in this patient population.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of neck dissection and radiation treatment for head and neck cancer (HNC) with subsequent shoulder range of motion (ROM) and quality of life (QOL) in 5-year survivors.Design: A cross-sectional convenience sample.Setting: Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center.Patients: Five-year, disease-free survivors of HNC.Methods: Demographic and cancer treatment information was collected, including type of neck dissection (none, spinal accessory "nerve sparing," and "nerve sacrificing") and radiation. QOL questionnaires were administered, and shoulder ROM was measured.Main Outcome Measurements: University of Washington Quality of Life (UWQOL), Functional Assessment of Cancer Therapy (FACT) Head and Neck, and Performance Status Scale for Head and Neck. Shoulder ROM measurements included abduction, adduction, flexion, extension, internal and external rotation.Results: One hundred and five survivors completed QOL surveys; 85 survivors underwent additional shoulder ROM evaluations. The nerve sacrifice group exhibited significantly poorer scores for UWQOL measures of disfigurement, level of activity, recreation and/or entertainment, speech and shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT Head and Neck (P < .05). Shoulder ROM for flexion and abduction was poorest in the nerve sacrifice group (P < .05). Radiation was associated with significantly worse UWQOL swallowing (P < .05), but no other differences were found for QOL or ROM measurements. Decreased QOL scores were associated with decreased shoulder flexion and abduction (P < .05). Survivors with decreased shoulder abduction had significantly (P < .05) worse scores in disfigurement, recreation and/or entertainment, employment, shoulder disability, and FACT emotional well-being.Conclusions: Sparing the spinal accessory nerve during neck dissection is associated with significantly less long-term shoulder disability in 5-year survivors of HNC. QOL measures demonstrated the highest level of function in the no dissection group, an intermediate level of functioning with nerve sparing, and poorest function when the nerve is sacrificed. Decreased shoulder flexion and abduction is associated with reduced QOL in long-term survivors of HNC. [ABSTRACT FROM AUTHOR]

Abstract: Improvements in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors with impairments in physical function, cancer-related symptoms, and reduced quality of life. Exercise and physical activity have therapeutic value at multiple points along the cancer disease continuum, spanning disease prevention, treatment, survivorship, prognostic outcomes, and end-of-life issues. Molecular mechanisms for the influence of exercise in persons with cancer include altering tumor initiation pathways and affecting hormonal, inflammatory, immune, and insulin pathways. Physical activity has been found to play a role in the prevention of certain malignancies, including breast, colon, and other cancers. An increasing amount of evidence indicates that physical activity may affect prognostic outcomes in certain cancer diagnoses, especially breast cancer. Structured exercise and physical activity interventions can be helpful in addressing specific survivorship issues, including overall quality of life, cardiorespiratory impairment, cancer-related fatigue, and lymphedema. Exercise also may be helpful during the palliative care phase to alleviate symptoms and increase physical well-being. This article will familiarize physiatrists with the current state of evidence regarding the role and efficacy of exercise in persons with cancer. [Copyright &y& Elsevier]

Objective Investigate associations of level and duration of injury with pulmonary function in patients with chronic, motor complete, cervical spinal cord injury (SCI). Patients with moderate duration had greater FVC, FVC%-predicted, FEV1, FEV1%-predicted, and inspiratory capacity than did patients with long duration ( I P i <.05). Multivariate analysis showed that injury level had significant independent effects on FVC, FVC%-predicted, FEV1, FEV1%-predicted, ERV, and ERV%-predicted ( I P i <.05), and that injury duration had significant independent effects on FVC, FVC%-predicted, FEV1, FEV1%-predicted, and inspiratory capacity ( I P i <.05). [Extracted from the article]