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Screening Patients with Stroke for Rehabilitation Needs: Validation of the Post-Stroke Rehabilitation Guidelines

Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO, Edwardsd{at}msnotes.wustl.edu

Michele G. Hahn, MSOT/OTR

Program in Occupational Therapy, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO

Carolyn M. Baum, OTR/L

Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO

Monica S. Perlmutter, MA, OTR

Program in Occupational Therapy, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO

Catherine Sheedy, RN

Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO

Alexander W. Dromerick, MD

Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO

Background. The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. Methods. Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient’s chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. Results. Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). Conclusion. Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.

Key Words: Stroke guidelines • Cognitive impairment • Sensory and perceptual impairment

References

• Churchill C. Social problems post acute stroke. Phys Med Rehabil State of the Art Rev 1998;7:213-224.
• Mayo NE, Korner-Bitensky N, Becker R, Georges P. Predicting falls among patients in a rehabilitation hospital. Am J Phys Med Rehabil 1989;68:139-146.[Web of Science][Medline] [Order article via Infotrieve]
• Mysiw WJ, Beegan JG, Gatens PF. Prospective cognitive assessment of stroke patients before inpatient rehabilitation. Am J Phys Med Rehabil 1989;68:168-171.[Web of Science][Medline] [Order article via Infotrieve]
• Coletta EM, Murphy JB. Physical and functional assessment of the elderly stroke patient. Am Family Phys 1994;49:1777-1785.[Medline] [Order article via Infotrieve]
• Novack TA, Haban G, Satterfield WT. Prediction of stroke rehabilitation outcome from psychologic screening. Arch Phys Med Rehabil 1987;68:729-734.[Web of Science][Medline] [Order article via Infotrieve]
• Pedersen PM, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Orientation in the acute and chronic stroke patient: impact on social activities. Arch Phys Med Rehabil 1996;77:336-339.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Gresham GE, Duncan PW, Stason WB. Post-Stroke Rehabilitation Clinical Practice Guideline, No. 16. Rockville (MD): Department of Health and Human Services, Public Heath Service, Agency for Health Care Policy Research; 1995.
• Elam JT, Graney MJ, Beaver T, el Derwi D, Applegate WB, Miller ST. Comparison of subject rating of function with observed functional ability of frail older persons. Am J Public Health 1991;81:1127-1130.[Abstract/Free Full Text]
• Tinetti MF, Ginter SF. Identifying mobility dysfunctions in elderly patients: standard neuromuscular examination or direct assessment. JAMA 1988;259:1190-1193.[Abstract/Free Full Text]
• Baum CM, Perlmutter M, Edwards DF. Measuring function in Alzheimer’s disease. Alzheimer’s Care Q 2001;1:44-61.
• Baum CM, Perlmutter M, Dunn W. Establishing the integrity of measurement data: identifying impairments that can limit occupational performance and threaten the validity of assessments. In: Law M, Baum CM, Dunn W, eds. Measuring occupational performance: supporting best practice in occupational therapy, 1st ed. Thorofare (NJ): SLACK; 2001:46-47.
• Brott T, Adams HP, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864-870.[Abstract/Free Full Text]
• Ferris FL, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research. Am J Ophthalmol 1982;94:91-96.[Web of Science][Medline] [Order article via Infotrieve]
• Wilson B, Cockburn J, Halligan PW. Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil 1987;68:98-102.[Web of Science][Medline] [Order article via Infotrieve]
• Halligan PW, Marshall JC, Wade DT. Visuospatial neglect: underlying factors and test sensitivity. Lancet 2000;2:908-910.
• Schow RLK, Nerbonne MA. Communication screening profile. Ear Hearing 1982;3:135-147.[Web of Science][Medline] [Order article via Infotrieve]
• Scheuerle J. Hearing and aging. Educ Gerontol 2000;26:237-247.[CrossRef]
• Enderby PM, Wood VA, Wade DT, Hewer RL. The Frenchay aphasia screening test: a short, simple test for aphasia appropriate for nonspecialists. Int Rehabil Med 1986;8:166-170.
• Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part 1: Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989;39:1159-1165.[Abstract/Free Full Text]
• Mack WJ, Freed DM, Williams BW, Henderson VW. Boston Naming Test: shortened version for use in Alzheimer’s disease. J Gerontol Psychol Sci 1992;47:154-158.
• Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry 1983;140: 734-739.[Abstract/Free Full Text]
• Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull 1988;24:709-711.[Web of Science][Medline] [Order article via Infotrieve]
• Galski T, Bruno RL, Zorowitz RD, Walker J. Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients: the dominant role of higher order cognition. Stroke 1993;24:1794-1798.[Abstract/Free Full Text]
• Diamond PT, Felsenthal G, Massiocchi SN, Butler DH, Lally-Cassady D. Effect of cognitive impairment on rehabilitation outcome. Am J Phys Med Rehabil 1996;75:40-43.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kelley-Hayes M, Paige C. Assessment of psychologic factors in stroke rehabilitation. Neurology 1999;45:29-32.
• Kalra L, Perez I, Gupta S, Wittink M. The influence of visual neglect on stroke rehabilitation. Stroke 1997;28:1386-1391.[Abstract/Free Full Text]
• Katz N, Hartman-Maeir A, Ring H, Soroker N. Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect. Arch Phys Med Rehabil 1999;80:379-384.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Stuck AE, Walthert JM, Nikolaus T, Buela CJ, Hoehmann C, Beck JC. Risk factors for functional status decline in community living elderly people: a systematic literature review. Soc Sci Med 1999;48:445-469.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Carod-Artal J, Egidio JA, Gonzalez JL, Varela de Seijas E. Quality of life among stroke survivors evaluated one year after stroke: experience of a stroke unit. Stroke 2000;31:2995-3000.[Abstract/Free Full Text]
• Scholte op Reimer WJM, de Haan RJ, Rijnders PT, Limburg M, van den Bos G. The burden of caregiving in partners of long-term stroke survivors. Stroke 1998;29:1605-1611.[Abstract/Free Full Text]
• Evans RL, Noonan WC. Does caregiver anxiety influence adjustment to stroke? Arch Phys Med Rehabil 1988;69:799-804.
• Anderson CS, Linto J, Stewart-Wynne EG. Population based assessment of the impact and burden of caregiving for long term stroke survivors. Stroke 1995;26:843-849.[Abstract/Free Full Text]
• Hajek VE, Gagnon S, Ruderman JE. Cognitive and functional assessment of stroke patients: an analysis of their relation. Arch Phys Med Rehabil 1997;78:1331-1337.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Sands LP, Yaffe K, Covinsky K, et al. Cognitive screening predicts magnitude of functional recovery from admission to three months after discharge in hospitalized elders. J Gerontol Med Sci 2003;58:37-45.
• Dunn W. Measurement issues and practices. In: Law M, Baum CM, Dunn W, eds. Measuring occupational performance: supporting best practice in occupational therapy, 1st ed. Thorofare (NJ): SLACK; 2001: 21-30.
• Sabari JS. Occupational therapy services after stroke: are we providing the right services at the right time? Am J Occup Ther 1998;52: 299-302.[Medline] [Order article via Infotrieve]
• Erkinjuntti T, Roman G, Gauthier S, Feldman H, Rockwood K. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke 2004;35:1010-1017.[Abstract/Free Full Text]

Neurorehabilitation and Neural Repair, Vol. 20, No. 1, 42-48 (2006)
DOI: 10.1177/1545968305283038


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