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The Journals of Gerontology. Series A,... Sep 1995Although cognitive impairment has been implicated as a risk factor for dependence in activities of daily living (ADLs), little is known about the risk of ADL dependence...
BACKGROUND
Although cognitive impairment has been implicated as a risk factor for dependence in activities of daily living (ADLs), little is known about the risk of ADL dependence among older adults with cognitive impairment.
METHODS
Among a representative cohort of 1,103 community-living adults aged 72 years and older, we evaluated the 237 subjects with mild to moderate cognitive impairment who were independent in their basic ADLs. All cohort members had undergone a comprehensive assessment, including a battery of qualitative and timed performance tests.
RESULTS
ADL dependence developed in 31 (16%) of the 197 subjects who had complete data at the 1-year follow-up. Of the self-reported characteristics, only three--living alone, not being currently married, and having an impairment in IADL function--were significantly associated (p < .05) with the onset of ADL dependence. Several simple tests of physical performance, on the other hand, were strongly associated with the development of ADL dependence. Both timed and qualitative performance tests successfully identified subjects at risk for ADL dependence. A combination of two performance tests--rapid gait and qualitative chair stands--was particularly effective at distinguishing subjects at low (4.7%) and high (34%-39%) risk for ADL dependence.
CONCLUSIONS
Among community-living older adults with mild to moderate cognitive impairment, the risk of ADL dependence is high but varies considerably depending on how well and how quickly one can perform simple tasks of everyday function. An assessment strategy based on tests of physical performance may allow clinicians to identify subgroups of cognitively impaired elders at low and high risk for ADL dependence.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognition Disorders; Cohort Studies; Dependency, Psychological; Female; Humans; Longitudinal Studies; Male; Risk Factors; Self-Assessment
PubMed: 7671024
DOI: 10.1093/gerona/50a.5.m235 -
Journal of the American Psychoanalytic... 1975
Review
Topics: Birth Weight; Child Development; Dependency, Psychological; Diseases in Twins; Ego; Family; Female; Humans; Identification, Psychological; Individuation; Male; Mental Disorders; Object Attachment; Pregnancy; Psychoanalytic Theory; Psychoanalytic Therapy; Research; Schizophrenia; Science; Social Environment; Twins, Dizygotic; Twins, Monozygotic
PubMed: 1094057
DOI: 10.1177/000306517502300101 -
Stroke Aug 2008Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly...
BACKGROUND AND PURPOSE
Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy.
METHODS
This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy.
RESULTS
Among the 67,445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]=9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR=2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR=0.79; 95% CI, 0.73 to 0.85).
CONCLUSIONS
These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.
Topics: Activities of Daily Living; Acute Disease; Aged; Aged, 80 and over; Brain Ischemia; Dependency, Psychological; Disability Evaluation; Female; Geriatric Assessment; Humans; Male; Motor Activity; Physical Therapy Modalities; Predictive Value of Tests; Risk Factors; Stroke; Stroke Rehabilitation
PubMed: 18583564
DOI: 10.1161/STROKEAHA.107.506329 -
Zeitschrift Fur Rheumatologie Jun 2013The skin not only represents the organ which often reveals the first signs of systemic vasculitis, but also the organ which is most frequently involved in vasculitis.... (Review)
Review
The skin not only represents the organ which often reveals the first signs of systemic vasculitis, but also the organ which is most frequently involved in vasculitis. These diseases encompass systemic vasculitides and those which appear to involve the skin only. Among those vasculitides restricted to the skin, some are yet typically associated with other systemic diseases, such as nodular vasculitis, which often occurs during infections by M. tuberculosis, or erythema elevatum diutinum in patients with gammopathy. The type and localization of skin lesions give valuable indications as to the type of vasculitis. Subcutaneous nodules which ulcerate and are surrounded by livedo racemosa are suggestive of polyarteritis nodosa, a palpable purpura with predilection for the lower legs is almost pathognomonic for immune complex vasculitis (e.g. IgA vasculitis or cutaneous leukocytoclastic vasculitis), hemorrhagic papules and necrotic plaques which occur in acral areas after cooling indicate cryoglobulinemic vasculitis, hemorrhagic papules and macules which develop in patients who start to feel worse and develop fever should arouse suspicion of septic vasulitis, while the simultaneous presence of ulcerating nodules and hemorrhagic papules without predilection for the lower legs will suggest ANCA-associated vasculitis. The different morphology of the cutaneous signs of the various vasculitides depends to a large extent on the size of the vessels primarily involved. In this review the cutaneous signs of vasculitides will be presented with reference to the revised nomenclature of the Chapel Hill Consensus Conference from 2012.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Physical Examination; Skin; Skin Diseases; Vasculitis
PubMed: 23743986
DOI: 10.1007/s00393-013-1136-7 -
Journal of Reconstructive Microsurgery Jun 2013Given the morbidity caused by facial nerve paralysis, there have been consistent approaches to treatment over the past 20 years in reanimation of the facial nerve.... (Review)
Review
INTRODUCTION
Given the morbidity caused by facial nerve paralysis, there have been consistent approaches to treatment over the past 20 years in reanimation of the facial nerve. Treatment depends on accurate clinical examination, a good understanding of the anatomic course, and appropriate diagnostic tests. There are various options when it comes to dynamic facial nerve reanimation that range from nerve grafting, nerve anastomosis, crossover techniques and muscle transfer to microneurovascular muscle flaps, and-recently-potentially new concepts with microelectromechanical systems (MEMS) technology. The various dynamic facial nerve treatment modalities are discussed.
METHODS AND RESULTS
A comprehensive review of the literature was performed detailing various techniques used for dynamic rehabilitation following facial nerve injury and their known results and complications.
CONCLUSIONS
Currently, techniques have been attempted to achieve adequate dynamic facial reanimation of the paralyzed facial nerve. Despite the advances that have occurred in the last few years, it has been classically very difficult to achieve a House-Brackmann grade better than grade III. Outcomes are improving. Ultimately, the approach depends on the surgeon's experience.
Topics: Diagnostic Imaging; Electrodiagnosis; Facial Expression; Facial Muscles; Facial Nerve Injuries; Facial Paralysis; Humans; Microsurgery; Neurosurgical Procedures; Physical Examination; Plastic Surgery Procedures; Surgical Flaps
PubMed: 23564297
DOI: 10.1055/s-0033-1343501 -
Physical Therapy Aug 2022
On "Updates in Motor Learning: Implications for Physical Therapist Practice and Education." Leech KA, Roemmich RT, Gordon J, Reisman DS, Cherry-Allen KM. Phys Ther. 2022;102:pzab250. https://doi.org/10.1093/ptj/pzab250.
Topics: Educational Status; Humans; Physical Examination; Physical Therapists
PubMed: 35713522
DOI: 10.1093/ptj/pzac083 -
Journal of Medical Ethics Mar 2006This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some...
This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some essential values and norms that must be observed in an ethical evaluation of physical restraint. These values and norms provide the ethical foundation for a number of concrete recommendations that could give clinical and ethical support to caregivers when they make decisions about physical restraint. Respect for the autonomy and overall wellbeing of older persons, a proportional assessment of the advantages and disadvantages, a priority focus on the alternatives to physical restraint, individualised care, interdisciplinary decision making, and an institutional policy are the central points that make it possible to deal responsibly with the use of physical restraint for older persons in nursing homes.
Topics: Aged; Attitude to Health; Caregivers; Dependency, Psychological; Family; Homes for the Aged; Humans; Nursing Homes; Patient Participation; Personal Autonomy; Restraint, Physical; Risk Factors
PubMed: 16507658
DOI: 10.1136/jme.2005.012708 -
Nederlands Tijdschrift Voor Geneeskunde Mar 2002For a wide range of complaints, there is an indication for digital rectal examination. The position patients should adopt depends on their physical condition and the...
For a wide range of complaints, there is an indication for digital rectal examination. The position patients should adopt depends on their physical condition and the indication concerned. The reach of the palpating index finger is fairly short. The severity of micturition complaints has little or no relation to the size of the prostate. The sensitivity of digital rectal examination for detecting prostate carcinoma ranges from about 50 to 80%. Therefore, a prostate carcinoma cannot be excluded on the basis of digital rectal examination. The positive predictive value of digital rectal examination for detecting prostate carcinoma increases as the serum PSA level increases. Digital rectal examination can make an important contribution to the diagnosis of anorectal disorders, including rectal carcinoma. In total, 5-10% of consultations with general practitioners are related to anorectal or urogenital complaints and 50% of the elderly have micturition problems; therefore digital rectal examination is one of the physician's basic skills.
Topics: Diagnosis, Differential; Humans; Male; Physical Examination; Prostatic Neoplasms; Rectum; Reproducibility of Results; Sensitivity and Specificity
PubMed: 11925800
DOI: No ID Found -
Studies in Health Technology and... Aug 2023Communication for people with motor impairments is a difficult, yet necessary, task in daily activities. To do so, soft keyboards, digital counterpart of physical...
Communication for people with motor impairments is a difficult, yet necessary, task in daily activities. To do so, soft keyboards, digital counterpart of physical keyboards, are used. Depending on their features, several designs can be considered, however their thoughtful evaluation in real-life is not feasible. Therefore, it becomes necessary to filter the possible configurations wisely, taking advantage of simulation tools. This paper presents STAACS3, a Simulation Tool for AAC with Single-Switch scanning, that allows to model and simulate the performance of any type of scanning keyboard regardless of its keys configuration, scanning strategy or prediction systems.
Topics: Humans; Communication; Computer Simulation; Physical Examination
PubMed: 37638953
DOI: 10.3233/SHTI230666 -
Clinics in Sports Medicine Apr 2012Leg pain in runners is a common complaint in any sports medicine practice. Although the possible diagnoses are many, the evaluation depends on a thorough history. A... (Review)
Review
Leg pain in runners is a common complaint in any sports medicine practice. Although the possible diagnoses are many, the evaluation depends on a thorough history. A comprehensive physical examination should include not only examination of the injury but the kinetic chain and core. It is imperative to recognize functional deficiencies in core strength and balance to prevent further injury. The successful integration of history, physical examination, and functional testing will enhance your evaluation of the injured runner and help return athletes to sport.
Topics: Athletic Injuries; Diagnosis, Differential; Humans; Medical History Taking; Pain Measurement; Physical Examination; Physician-Patient Relations; Risk Factors; Running; Shoes
PubMed: 22341012
DOI: 10.1016/j.csm.2011.11.002