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PURPOSE Optimal community reintegration is a key rehabilitation outcome post-stroke. This concept has been investigated in many countries but not qualitatively in New Zealand. We explored perceptions about community reintegration of stroke survivors living in southern New Zealand. METHOD Qualitative interviews were used to collect data. Recruitment was via local stroke clubs, inviting adult stroke survivors (stroke duration > six months, any severity or type) living in the lower South Island. Data were analysed using the General Inductive Approach. RESULTS Eight stroke survivors (two female, six males; age range 50-80 years, mean 66 years (SD = 12); mean time since stroke 6.5 (SD = 4) years) participated. Participants' perceptions of what is integral to reintegration into their community were shaped by four themes, namely: (1) personal relationships, (2) re-establishing normality (old and new), (3) purpose in life, and (4) independence. CONCLUSIONS Stroke survivors in New Zealand hold many similar perceptions about optimal community reintegration with those living elsewhere. Key to successful community reintegration, irrespective of geography, culture and ethnicity, appears to be involvement in meaningful activities, and reduced reliance on others whilst maintaining or developing good social relationships. These fundamental components are then contextually nuanced by what is meaningful and important to the individual.IMPLICATIONS FOR REHABILITATIONOptimal community reintegration post-stroke is arguably the key goal of rehabilitation, and thus should be enabled and measured.To optimise community reintegration post-stroke, rehabilitation should focus on enabling stroke survivors' social relationships, independent community mobility, and engagement in meaningful activities.Optimal community reintegration post-stroke is however contextual. Rehabilitation professionals must understand what each patient considers successful community reintegration to be for them and tailor their rehabilitation accordingly.

Purpose: To summarize the available maximal and submaximal aerobic exercise tests for wheelchai-rdependent persons with a spinal cord injury (SCI) and to identify useful applications for clinical rehabilitation.Method: The databases of PubMed, CINAHL (R), EMBASE, and PsycINFO (R) were searched for English-language studies published prior to March 2015. Two independent raters identified and examined studies that reported on laboratory-based aerobic exercise tests in persons with an SCI, according to the PRISMA statement.Results: The test protocols of maximal (n = 105) and submaximal (n = 28) exercise tests, covered by 95 included studies, were assessed. A large variety in patient characteristics, test objectives, test protocols, exercise modes, and outcome parameters was reported. Few studies reported on adherence to recommendations, adverse events, and peak outcome validation.Conclusions: An incremental test protocol with small, individualized, increments per stage seems preferable for testing maximal aerobic capacity, but additional validation of the available test modes is required to draw conclusions. Submaximal testing is relevant for assessing the performance at daily life intensities and for estimating VO2peak. Consensus regarding reporting test procedures and outcomes needs to be achieved to enhance comparability of rehabilitation results.

Purpose: To summarize the available maximal and submaximal aerobic exercise tests for wheelchair-dependent persons with a spinal cord injury (SCI) and to identify useful applications for clinical rehabilitation. Method: The databases of PubMed, CINAHL®, EMBASE, and PsycINFO® were searched for English-language studies published prior to March 2015. Two independent raters identified and examined studies that reported on laboratory-based aerobic exercise tests in persons with an SCI, according to the PRISMA statement. Results: The test protocols of maximal (n = 105) and submaximal (n = 28) exercise tests, covered by 95 included studies, were assessed. A large variety in patient characteristics, test objectives, test protocols, exercise modes, and outcome parameters was reported. Few studies reported on adherence to recommendations, adverse events, and peak outcome validation. Conclusions: An incremental test protocol with small, individualized, increments per stage seems preferable for testing maximal aerobic capacity, but additional validation of the available test modes is required to draw conclusions. Submaximal testing is relevant for assessing the performance at daily life intensities and for estimating VO2peak. Consensus regarding reporting test procedures and outcomes needs to be achieved to enhance comparability of rehabilitation results.Implications for Rehabilitation Regularly testing the cardiovascular capacity during SCI rehabilitation will enable us to monitor the impact of rehabilitation interventions on an individual level. The incremental arm ergometry test with small increments per stage is most relevant for the assessment of the peak cardiovascular capacity. For the assessment of daily life functioning, the submaximal wheelchair ergometer test is preferable. Hand cycling is a promising exercise mode for both testing and training. Systematically reporting on test termination, criteria for attaining valid peak outcomes and adverse events is necessary to enhance comparability of results.

To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the post-acute context.Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI.Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42 second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of 'activities and participation' included as the candidate categories of the brief version.In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific 'activity' aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects. Implications for Rehabilitation Rehabilitation professionals should select appropriately validated outcome measures specific to the health condition in order to evaluate the effectiveness of rehabilitation. Rehabilitation professional working with outcome measures should be aware of the limitations of measures, in terms of content, and supplement the evaluation with appropriate standardised measures or the use of the Core Sets. To enhance evidence-based practise in routine clinical practise, standardised outcome measures should be used.

To describe the rehabilitation treatment and outcome of progressive multifocal leukoencephalopathy (PML) in the context of Human Immunodeficiency Virus (HIV).The medical history of two HIV-positive patients with PML was reviewed; information on their neurological impairments, rehabilitation treatment and outcome was gathered.The patients, a 47-year-old married man and a 34-year-old single man, both suffered from dense right hemiplegia and motor aphasia. Their rehabilitation course was delayed and prolonged: they were suitable for intensive multidisciplinary rehabilitation only 8 months or more after the initial presentation. Their treatment in outpatient rehabilitation daycare three times a week, that lasted 7 months on average, resulted in slow and steady functional improvement. At the end of the rehabilitation treatment, both patients were living at home, able to express themselves, and able to walk independently with an assistive device. They remained with moderate disability (modified Rankin scale of 3).PML patients require prolonged multidisciplinary rehabilitation treatment; however, considerable progress can be achieved. Implications for Rehabilitation Progressive multifocal leukoencephalopathy (PML) is a disabling disease occurring in particular in the context of Human Immunodeficiency Virus (HIV). Presently a growing number of HIV-positive PML patients eventually survive the disease and remain with severe neurological impairments. PML patients require prolonged multidisciplinary rehabilitation treatment, and considerable progress can be achieved.

To assess the relationship between the Clock Drawing Test (CDT) and rehabilitation outcome in hip fracture patients within normal range of the Mini Mental State Examination (MMSE).This retrospective study was performed in a post-acute geriatric rehabilitation centre. One hundred and forty-two patients with proximal hip fracture admitted from January 2006 to June 2008 whose MMSE scores was within normal range (23) were enrolled in the study. The patients were divided into two groups according to CDT performance (impaired versus intact). The differences between the two groups in relation to age, gender, education level, living arrangement, pre fracture functional level, fracture type, and outcome measurements [Functional Independent Measure (FIM), motor FIM, Rate of in-hospital Improvement (RI) in FIM and motor FIM, and Length of Stay (LOS)] were assessed.Discharge FIM score and motor FIM scores were significantly lower for the impaired CDT group (89 ± 13.7 vs. 94.9 ± 11.6, p = 0.007; 61.6 ± 11.1 vs. 65.7 ± 9.6, p = 0.022 respectively); LOS was significantly longer (28.2 ± 7.9 vs. 25.3 ± 8.5, p = 0.033) and rates of improvement in FIM and motor FIM were significantly slower (0.62 ± 0.35 vs. 0.77 ± 0.45, p = 0.036; 0.61 ± 0.34 vs. 0.75 ± 0.42, p = 0.033, respectively). Nevertheless, FIM and motor FIM scores changes were similar in both CDT groups. Following adjustment for age, LOS of patients with impaired CDT was significantly longer (p = .027).The CDT may assist the multidisciplinary team in identifying hip fracture patients whose MMSE scores are within the normal range, but yet need a longer training period to extract their rehabilitation potential.

Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. It is a challenge to manage these problems effectively, particularly in times of resource stringency. One proposal for how to do this has arisen out of an approach to general mental health management: a system of 'stepped care'. Such a system directs intervention by considering level of need, thereby making the most efficient use of available resources. It is the purpose of this article to articulate a stepped psychological care approach for emotional problems after stroke.Narrative review and elaboration of the model proposed by the Department of Health in England for the management of emotional problems after stroke.A stepped care model for the management of emotional problems after stroke is presented in detail, including descriptions of specific interventions and guidance to inform the level of management.The stepped psychological care proposal for emotional problems after stroke requires evaluation but is potentially of use within comparable healthcare systems. Implications for Rehabilitation Emotional problems are common after stroke and effect rehabilitation outcomes. A stepped care approach to these problems offers the ability to cater to all according to need. Greater specification of the services at each step can be outlined. While recommended, such an approach requires evaluation to prove its efficacy.

The overall objective was to apply the goal attainment scaling (GAS) in neuropsychological rehabilitation in multiple sclerosis (MS). The specific aims were to evaluate whether (1) GAS-rated goals are attained; (2) attaining goals is related to standardized rehabilitation outcome measures; and (3) GAS-rated goals can be mapped to the International Classification of Functioning, Disability, and Health (ICF).56 relapsing-remitting MS patients received neuropsychological rehabilitation conducted once a week for 13 consecutive weeks. The attainment of GAS-rated personal goals and the association between achievement of goals and standardized rehabilitation outcome were evaluated. Moreover, GAS-rated goals were mapped to the ICF.Median (interquartile range) GAS attainment T-score was 56.0 (50.0-62.0); 88.8% of personal goals set were fully achieved. The attainment of goals was not significantly associated with the outcome in majority of the standardized measures. Of the 182 meaningful concepts identified in the goals, 181 could be mapped to the ICF.GAS seems to be an appropriate outcome measure in neuropsychological rehabilitation in MS. GAS-rated personal goals were well achieved, and GAS was found to tap changes not covered with standardized outcome measures. Implications for Rehabilitation GAS seems to be an appropriate outcome measure in neuropsychological rehabilitation in MS. GAS-rated personal goals were well achieved, and GAS was found to tap changes in the areas not covered with standardized outcome measures. GAS seems to offer a possibility to take into account the specific needs of each individual patient. The ICF can be used to classify goals in neuropsychological rehabilitation in MS.

This paper reviews the strengths and weaknesses of two different approaches to assessing ICF concepts: coding versus quantitative scales. It illustrates the advantages of an alternative, integrative approach, called functional staging.A prospective cohort study. A total of 516 subjects in the Rehabilitation Outcome Study.ICF codes provide a useful approach for classifying easy-to-interpret health-related information on individuals that can be incorporated into administrative records and databases. By minimizing measurement error, quantitative scales are well suited for synthesizing health-related data that can be used to compare the health states of groups of individuals across studies, conditions, and countries as well as to detect clinically meaningful change. A functional staging approach combines the attractive features of ICF coding and quantitative scales to help the user interpret the clinical meaningfulness of summary scores while retaining measurement reliability, validity and precision.A functional staging approach to assessing ICF concepts holds promise as a useful technique for measuring and interpreting the core concepts in the ICF framework.

PURPOSE: To evaluate the available literature on outcome of critical illness polyneuropathy (CIP) and to identify rehabilitation problems. METHODS OF STUDY SELECTION: A literature search in electronic databases. Primary articles on outcome in CIP using the classification of ICIDH or Quality of Life were enrolled in this study. Because of the types of study design, the lack of information regarding validity and the variability, a quantitative analysis was not possible. Instead, the overall results were evaluated in a qualitative approach. RESULTS: In the literature minimal attention was given to the rehabilitation aspects and long-term outcome of patients with CIP. Outcome measures were mainly used on the level of impairments and in lesser extent on the level of disabilities. One year after the onset of CIP, muscle weakness and decreased sensory function were frequently observed. Reported functional disabilities were dependency in Activities of Daily Living (ADL) and walking disabilities. CONCLUSION: The specific course and long-term outcome of CIP remains unclear. Research on the course and long-term functional outcome in CIP is necessary in order to identify rehabilitation problems and to formulate treatment strategies specifically directed towards the outcome of CIP

The reliability of the Functional Assessment Measure (FIM+FAM) is an important issue with its increased use in the measurement of neurological disability and rehabilitation outcome. Although the Motor items have good reliability ratings, the Cognitive items are more difficult to complete and their reliability is not as good. This study tests the suggestion that this might be due to the Cognitive items being more abstract. A keyword from each of four Motor items was compared with a keyword from four Cognitive items. Abstractness was measured by measuring the 'imageability' of each keyword. The Motor items were found to have a significantly higher mean imageability rating than the Cognitive items. Thus, there is support for the suggestion that abstractness contributes to the poorer reliability of the Cognitive items. These results led to the proposal that the reliability of the Cognitive items might be improved by various methods of increasing the tangibility of these measures (e.g. subdivision of broad categories of disabilities, enhancing item descriptions, training raters to increase their recognition of relevant observations, and using specific assessment tasks to elicit relevant behaviours).

Recent work suggests that lifestyle can be considered using a 2 x 2 model of indoor/outdoor and work/leisure activities. This paper replicates the factor analysis of the Frenchay Activities Index (FAI) reported by Bond et al., using a group of subjects living independently in the community. Results confirmed empirically the existence of the four hypothesized dimensions of lifestyle. Further analyses demonstrated the construct validity of these dimensions by establishing their sensitivity to age, sex, domestic circumstances, and physical and cognitive status. We discuss ways in which various deficiencies in the FAI might be rectified in a revised index of activities designed to retain and clarify the four established dimensions of lifestyle. Future directions include the development of such an instrument, and its application as a rehabilitation outcome measure.

The quest for better measurement strategies utilizing new approaches was discussed at a conference sponsored by the National Centre for Medical Rehabilitation Research (NCMRR) at The National Insti...