Clinical Performance Measures for Stroke Rehabilitation: Performance Measures From the American Heart Association/American Stroke Association.

The American Heart Association/American Stroke Association released the adult stroke rehabilitation and recovery guidelines in 2016. A working group of stroke rehabilitation experts reviewed these guidelines and identified a subset of recommendations that were deemed suitable for creating performance measures. These 13 performance measures are reported here and contain inclusion and exclusion criteria to allow calculation of rates of compliance in a variety of settings ranging from acute hospital care to postacute care and care in the home and outpatient setting.

Enabling Stroke Rehabilitation in Home and Community Settings: A Wearable Sensor-Based Approach for Upper-Limb Motor Training.

High-dosage motor practice can significantly contribute to achieving functional recovery after a stroke. Performing rehabilitation exercises at home and using, or attempting to use, the stroke-affected upper limb during Activities of Daily Living (ADL) are effective ways to achieve high-dosage motor practice in stroke survivors. This paper presents a novel technological approach that enables 1) detecting goal-directed upper limb movements during the performance of ADL, so that timely feedback can be provided to encourage the use of the affected limb, and 2) assessing the quality of motor performance during in-home rehabilitation exercises so that appropriate feedback can be generated to promote high-quality exercise.

Transcranial magnetic stimulation as an investigative tool for motor dysfunction and recovery in stroke: an overview for neurorehabilitation clinicians.

Rationale: An improved understanding of motor dysfunction and recovery after stroke has important clinical implications that may lead to the design of more effective rehabilitation strategies for patients with hemiparesis.

Scope: Transcranial magnetic stimulation (TMS) is a safe and painless tool that has been used in conjunction with other existing diagnostic tools to investigate motor pathophysiology in stroke patients. Since TMS emerged more than two decades ago, its application in clinical and basic neuroscience has expanded worldwide.

Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes.

Objectives: To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness.

Design: Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later.

Setting: Follow-up interviews conducted in patient's home setting.

Comparison of clinical characteristics and functional outcomes of ischemic stroke in different vascular territories.

Background And Purpose: We aim to compare demographics and functional outcomes of patients with stroke in a variety of vascular territories who underwent inpatient rehabilitation. Such comparative data are important in functional prognostication, rehabilitation, and healthcare planning, but literature is scarce and isolated.

Methods: Using data collected prospectively over a 9-year period, we studied 2213 individuals who sustained first-ever ischemic strokes and were admitted to an inpatient stroke rehabilitation program.

Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes.

Objective: To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home.

Design: Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit.

Setting: Follow-up visits conducted in patients' home setting.

Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.

Objective: To define the minimal clinically important difference (MCID) for the FIM instrument in patients poststroke.

Design: Prospective case series discharged over a 9-month period.

Setting: Long-term acute care hospital.

Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke.

Objectives: To describe the demographics, clinical profile, and functional outcomes in posterior cerebral artery (PCA) stroke and to identify factors associated with functional change during rehabilitation and discharge disposition.

Design: Retrospective study of patients with PCA stroke admitted to a rehabilitation hospital over an 8-year period.

Setting: Free-standing urban rehabilitation hospital in the United States.

Computer adaptive testing: a strategy for monitoring stroke rehabilitation across settings.

Current functional assessment instruments in stroke rehabilitation are often setting-specific and lack precision, breadth, and/or feasibility. Computer adaptive testing (CAT) offers a promising potential solution by providing a quick, yet precise, measure of function that can be used across a broad range of patient abilities and in multiple settings. CAT technology yields a precise score by selecting very few relevant items from a large and diverse item pool based on each individual's responses.

Age and functional outcome after stroke.

The effect of age on functional outcome after stroke remains uncertain. Many studies have found that younger patients do better than older patients, whereas others have found minimal or no effect of age on rehabilitation outcomes. We examined the effect of advancing age on FIM trade mark gain, length of stay, length of stay efficiency, and home discharge in 979 stroke rehabilitation patients at a long-term acute care rehabilitation hospital.

Communication among levels of care for stroke patients.

Stroke patients in the United States frequently progress through several different locations of care and groups of providers during the course of their recovery. Consistently effective communication from one level of care and one set of providers to the next is a basic expectation, but one that is often not fully met. New concepts and promising technologies offer opportunities to improve hand-off processes at all levels.

Treatment of upper limb deep vein thrombosis with low molecular weight heparin.

Upper limb deep vein thrombosis has been an under-recognized disease; however, physicians' awareness of it as a cause of arm pain and edema is increasing. Previously thought of as benign, upper limb deep vein thrombosis has been shown in recent studies to pose a significant risk for pulmonary embolus and death. The need for treatment is now recognized; however, effective treatments for upper limb deep vein thrombosis have not been fully defined.

Upper-extremity deep vein thrombosis and paralysis: a case report.

Upper-extremity deep venous thrombosis (DVT) has been understudied in the rehabilitation population. Patients undergoing rehabilitation often have many risk factors that predispose them to DVT. It is important to recognize upper-extremity DVT, because recent studies have shown it to pose a significant risk for pulmonary embolus and death.

Vocational outcome after stroke.

This article reviews the literature on vocational outcome after stroke and discusses reasons for the minimal use of vocational outcome measures in stroke rehabilitation research. A vocational function measurement tool is proposed. The vocational rehabilitation process and experience of the Young Stroke Program at New England Rehabilitation Hospital are described, and determinants of success or failure in vocational rehabilitation after stroke as described in the medical literature are reviewed.