Michael cleary’s scientific contributions in rehabilitation and traumatic brain injury brain anoxia

[show abstract] [hide abstract] ABSTRACT: objectives: (1) describe trends in time to rehabilitation admission and rehabilitation length of stay (LOS),

(2) compare functional independence at discharge from rehabilitation between patients who arrived

Directly from acute care versus those from elsewhere and (3) identify independent predictors of

Functional outcomes following rehabilitation. Setting: traumatic brain injuries rehabilitation unit of

King fahad medical city, riyadh, saudi arabia. Methods: we collected information on time from injury

To rehabilitation admission, rehabilitation LOS, functional independence measure (FIM) score (admission

And discharge) and demographic variables for 66 patients who arrived to rehabilitation from acute care

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And 142 patients who arrived from elsewhere. A mixed model analysis of variance measured change in

FIM score between groups. Hierarchical regression was employed to investigate variables associated

With FIM score at rehabilitation discharge. Results: patients arriving directly from acute care had a time

From injury to rehabilitation admission 1/3 that of, and a higher discharge FIM score than, patients

Arriving from elsewhere. For the latter group, increasing time from injury to rehabilitation admission was

Associated with lower rehabilitation discharge FIM score. Conclusions: reducing time from injury to

Rehabilitation admission and promoting enrolment to inpatient traumatic brain injury rehabilitation

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Directly from acute care may improve functional outcome at discharge from rehabilitation.

[show abstract] [hide abstract] ABSTRACT: objective: the relationship between availability of psychosocial resources and inpatient stroke rehabilitation length of stay (LOS) has been inadequately studied. The purpose of this prospective observational study was to identify psychosocial determinants that prolong LOS of patients in a stroke rehabilitation program. Methods: patients admitted to a multidisciplinary inpatient stroke rehabilitation program in southern ontario, canada, were consecutively recruited from october 2008 to august 2010. Patients diagnosed as having had a cerebrovascular event resulting in neurological impairments that required intensive rehabilitation were eligible for the study.Brain anoxia independent variables included psychosocial (awaiting long-term care placement, poststroke depression, inadequate family support, limited access to community home care services), medical (comorbidity, medical complications), neurological (type and location of stroke, neurological deficits), and functional (functional independence measure [FIM] score on admission and discharge, modified rankin disability scale score) factors. The main outcome measure was length of hospital stay (days). Results: A total of 117 patients were recruited. The mean and median LOS were 49.8 and 45 days respectively. Most patients (92.3%) were discharged home. On multivariate linear regression analysis, the significant determinants associated with longer LOS were awaiting long-term care placement (P0.001), low admission FIM score (P=0.001), post-stroke depression (P=0.007), difficulties arising from inadequate family support (P=0.033), limited access to community home care services (P=0.035), and presence of medical complication(s) (P=0.039).Brain anoxia these 6 factors, 4 of which were psychosocial, accounted for 48.8% of the total variance in LOS. Conclusion: psychosocial factors were key determinants of longer LOS in addition to medical/neurological factors such as severity of stroke and medical complications. Health care systems must incorporate psychosocial information to a greater extent and recognize its fundamental role in rehabilitation outcomes.