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Purpose: To describe a standardized observation protocol to determine if nursing home (NH) staff offer choice to residents during 3 morning activities of daily living (ADL) and compare the observational data with deficiency statements cited by state survey staff. Design and Methods: Morning ADL care was observed in 20 NHs in 5 states by research staff using a standardized observation protocol. The number of observations in which choice was not offered was documented for 3 morning ADL care activities and compared with deficiency statements made by surveyors. Results: Staff failed to offer choice during morning ADL care delivery for at least 1 of 3 ADL care activities in all 20 NHs. Observational data showed residents were not offered choice about when to get out of bed (11%), what to wear (25%), and breakfast dining Location (39%). In comparison, survey staff issued only 2 deficiencies in all 20 NHs relevant to choice in the targeted ADL care activities, and neither deficiency was based on observational data. Implications: Survey interpretative guidelines instruct surveyors to observe if residents are offered choice during daily care provision, but standardized observation protocols are not provided to surveyors to make this determination. The use of a standardized observation protocol in the survey process similar to that used by research staff in this study would improve the accuracy and transparency of the survey process. Key Words: Survey process, Choice, Assessment, Observational protocol, Quality of life

Objective: To examine mental practice (MP) efficacy using a new kinematics reaching model. Method: This was a prepost, case series conducted at an outpatient rehabilitation hospital of 5 patients who [...]

Byline: Barbara M. Sluijs (1), Lies H. Hoefsloot (2), George W. Padberg (1), Silvere M. Maarel (3), Baziel G. M. Engelen (1) Keywords: oculopharyngeal muscular dystrophy; limb girdle weakness; Dutch phenotype; daily activities Abstract: Abstract. This first description of the oculopharyngeal muscular dystrophy (OPMD) phenotype in Dutch patients shows that limb girdle weakness can occur early in the course of disease and can give the first and major complaint in OPMD patients. The aim of this study was to examine clinically, histologically and genetically all Dutch OPMD patients known at the Neuromuscular Centre Nijmegen, to measure the limb girdle weakness (MRC scale) and to quantify the consequences of the limb girdle weakness on daily activities (Rankin scale). Remarkable in this population was the early onset and the severity of the limb girdle weakness. We found a higher percentage of patients with limb girdle weakness than reported before in non-Dutch OPMD populations. This limb girdle weakness caused limitations in daily activities more than the other symptoms of OPMD. It was difficult to compare the severity of the limb girdle weakness of Dutch patients with other patients because of the lack of data related to quantification of limb girdle weakness in non-Dutch OPMD patients. Because of the influence of the limb girdle weakness on the daily activities of the patients, we recommend that more attention is paid to the proximal limb muscles in OPMD patients early in the course of the disease. Author Affiliation: (1) Neuromuscular Centre Nijmegen, Dept. of Neurology, University Medical Centre Nijmegen, 9101, 6500 HB, Nijmegen, The Netherlands (2) Dept. of Human Genetics, University Medical Centre Nijmegen, Nijmegen, The Netherlands (3) Dept. of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands Article History: Registration Date: 01/01/2003 Received Date: 23/12/2002 Accepted Date: 11/06/2003

Byline: Christof Kugler (1), Thomas Altenhoner (2), Piergiorgio Lochner (3), Andreas Ferbert (3) Keywords: Key words cerebrovascular accident; recovery of function; ageing; activities of daily living; rehabilitation Abstract: Age is the most important risk factor for developing a stroke. In addition, age may also influence stroke recovery. To allow structured discharge planning, it may be important to consider the influence of age on stroke recovery during the early phase. We studied the effect of patient age on early stroke recovery in a cohort of 2219 unselected stroke patients. Data on functional status (Barthel Index Score) were collected prospectively within 24h after admission, after one week and at discharge for 2219 acute stroke patients treated in 1999 and 2000 at 7 neurological departments in the county of Hesse, Germany. Multiple regression analyses were used to test for an association between age, relative recovery and speed of recovery of ADL after stroke. More than half of the patients (58 %) improved in functional status during hospitalization. 37 % had no change in Barthel Index score and only a small number of patients (5 %) deteriorated during this period. Relative improvement decreased with increasing age: patients younger than 55 years showed an improvement of 67 % of the maximum possible improvement compared whith only 50 % for patients above 55 years (adjusted R.sup.2 = 0.120, [beta].sub.age = -0.130, p &lt 0.001). Age only had a small effect on the speed of recovery. For younger patients functional recovery was slightly faster (adjusted R.sup.2 = 0.256, [beta].sub.age = -0.080, p &lt 0.001). Despite its strong influence on case fatality, age is a poor predictor of functional recovery during the very early phase after stroke. Resulting functional recovery depends much more on the extent of the initial disability. Advanced age should not be regarded as a limiting factor in the early rehabilitation of stroke patients. Author Affiliation: (1) Institute for Integrative Care Management IVM, University Clinic Giessen, Giessen, Germany, DE (2) School of Public Health, University of Bielefeld, Bielefeld, Germany, DE (3) Department of Neurology, Klinikum Kassel, Monchebergstrasse 41--43, 34125 Kassel, Germany. ferbert@klinikum-kassel.de, DE Article note: Received: 3 July 2002, Received in revised form: 16 December 2002, Accepted: 19 December 2002 Correspondence to: Andreas Ferbert, MD

Byline: J. A. Freeman (1) Keywords: Key words Multiple sclerosis; Rehabilitation; Mobility; Activities of daily living Abstract: Persons with multiple sclerosis (MS) commonly experience restrictions in mobility and everyday functional activities. A wide range of factors including physical, psychological, environmental and economic issues may contribute to these difficulties. This is particularly the case as the disease evolves, and the impairments and disabilities become more numerous, inter-related and hence more complex. Effective management of these complex problems requires assessment and intervention from a variety of different perspectives by using a coordinated, goal-oriented, multi-disciplinary management approach. Crucially, it requires management to be considered from a long-term perspective rather than as a fragmented series of isolated 'quick-fixes'. Author Affiliation: (1) Department of Clinical Neurology (Neurorehabilitation), Institute of Neurology, Queen Square, London WC1 N3BG, UK, Tel.: +44-171-8373611 ext 4152, Fax: +44-171-8130924, GB (2) University of Plymouth, Devon, PL4 8AA, UK, GB Article note: Received: 31 October 2000, Accepted: 6 November 2000