Annals of Rehabilitation Medicine

Brain disorders

Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation: Zoe Adey-Wakeling, Laura Jolliffe, Elizabeth O’Shannessy, Peter Hunter, Jacqui Morarty, Ian D. Cameron, Enwu Liu, Natasha A. Lannin; Ann Rehabil Med 2021;45(6):413-421. Published online December 31, 2021; DOI: https://doi.org/10.5535/arm.21034

Abstract
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Objective
To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect.
Methods
This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect.
Results
The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16).
Conclusion
Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.

Citations

Citations to this article as recorded by

Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time–motion analysis
Laura Jolliffe, Taya A Collyer, Ka Hei Sun, Lisa Done, Siobhan Barber, Michele L Callisaya, David A Snowdon
Age and Ageing.2025;[Epub] CrossRef
Addressing the intensity of rehabilitation evidence-practice gap: rapid review, stakeholder perspectives and recommendations for upper limb rehabilitation after acquired brain injury
Natasha A Lannin, Michael Pellegrini, Madeleine J Smith, Laura Jolliffe, Meg E Morris
International Journal of Therapy and Rehabilitation.2024; 31(7): 1. CrossRef
Environmental modifications to rehabilitate social behavior deficits after acquired brain injury: What is the evidence?
Salome Bozkurt, Natasha A. Lannin, Richelle Mychasiuk, Bridgette D. Semple
Neuroscience & Biobehavioral Reviews.2023; 152: 105278. CrossRef
Mapping physical activity patterns in hospitalised patients with moderate to severe acquired brain injury - MAP-ABI: Protocol for an observational study
Vibeke Wagner, Pi Gravesen, Emma Ghaziani, Markus Harboe Olsen, Christian Gunge Riberholt
Heliyon.2023; 9(11): e21927. CrossRef

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Upper Extremity Proprioceptive Assessment Test Using Virtual Environment Technique in Patients with Stroke.: Lee, Ki Hoon , Ku, Jeounghun , Jo, Sang Woo , Kim, Sun I , Song, Je Young , Park, Young Jin , Kim, Hyun Jung , Kang, Youn Joo; J Korean Acad Rehabil Med 2010;34(2):141-149.

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Objective
To examine the reliability of upper extremity proprioceptive assessment test using virtual environment technique (VET) in patients with stroke with test-retest paradigm and define criterion for normal value by comparing with unimpaired control group. Method: Thirty stroke patients and 30 control groups were recruited. The VET apparatus is consisted of virtual reality upper extremity tester (VRUPT), encoder, and head-mounted display (HMD). VET-based test is composed of two tasks. Angle assessment task is required matching of imposed joint positions without visual feedback for checking angle error. Reaching assessment task is required matching of imposed cylinder with visual feedback for checking time, number of click, total interaction error. Results: In the test-retest analysis, correlation coefficients ranged from 0.73 to 0.99 (p＜0.01). Significant differences consistently found between affected upper extremity joint of stroke group and corresponding upper extremity joint of control group for the major variables (p＜0.05). The cut off value in shoulder, elbow, wrist joints were calculated as 8.24^o, 8.41^o, 10.31^o and the frequency of proprioceptive abnormalities based on these cut off value of angle error in shoulder, elbow, wrist joints showed 60%, 67%, 83% respectively, in our stroke group. Conclusion: This VET-based proprioceptive assessment test shows promise in assessing proprioception in patients with stroke more objectively and quantitatively. (J Korean Acad Rehab Med 2010; 34: 141-149)

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Effects of Enriched Environment on Locomotion and Cognition in Neonatal Rats with Hypoxic-Ischemic Encephalopathy.: Yang, Shin Seung , Sohn, Min Kyun , Kim, Bong Ok , Choi, Pil Soon , Kim, Sung Gyum; J Korean Acad Rehabil Med 2010;34(1):1-9.

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Objective
To investigate the effect of environmental enrichment on the cognitive and motor development in the experimental hypoxia-ischemic encephalopathy neonatal rat model. Method: Hypoxic-ischemic encephalopathy models were made in neonatal Sprague-Dawley rats at 3 days of age by ligating the unilateral carotid artery followed by inhalation of 8% oxygen and raised in the enriched environment (n=10), treadmill exercise (n=8) and non-stimulation (n=10) from the 3rd to 8th weeks of age. Neurobehavioral and histopathological changes were compared. Results: The neurobehavioral tests of the rats with hypoxic- ischemic encephalopathy showed prolonged latencies of achievement for cliff avoidance and negative geotaxis (p＜0.05). Persisting abnormality into adult life of limb placing improved in exercise and enriched environment groups and spatial learning and memory in a water maze recovered in the rats with enriched environment (p＜0.05). The density of dendritic spine increased in the hippocampus with enriched environment (p＜0.05). Conclusion: The present study supports the possibilities of the positive effects after the enriched environment in the developing brain with hypoxic injury. (J Korean Acad Rehab Med 2010; 34: 1-9)

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Induction of Striatal Neurogenesis by Voluntary Exercise and Environmental Enrichment.: Min, Kyung Hoon , Im, Sang Hee , Bae, Byung Woo , Kim, Eun Sang , Park, Eun Sook , Park, Chang Il , Cho, Sung Rae; J Korean Acad Rehabil Med 2008;32(6):632-636.

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Objective: To investigate that neurogenesis in the subventricular zone (SVZ), which is already known as neurogenic area where neural stem/progenitor cells persist, and the striatum, which is non-neurogenic area, might be induced by voluntary exercise (VEx) or environmental enrichment (EE), and compare the extent of the neurogenesis with untreated controls. Method: Total 12 C57BL/6 mice, 2∼3 months old, were recruited as follows; voluntary wheel runner, EE and control. For 2 weeks, VEx group was housed in rat cage (48×26 cm) with 2 running wheels with 3∼4 animals/cage, and EE group was housed in the living condition of huge cage (86×76 cm), social interaction (13∼14 mice/cage) and objects such as toys, tunnels and running wheel, whereas control group was placed in the standard cage (30×18 cm). Results: VEx and EE tended to increase the densities of mitotic marker BrdU^＋ cells in SVZ and striatum. They also exhibited more BrdU^＋ cells (/mm³) into the striatum, even though they did not show statistical significance. Moreover, EE group showed significant increment of the newly generated neurons coexpressed with BrdU^＋and ՂIII-tubulin^＋(/mm³) in SVZ and striatum as compared to those of controls. Conclusion: Voluntary physical exercise and EE induced cell proliferation and neurogenesis in both SVZ and striatum. Characteristically, EE could significantly induce neurogenesis in striatum, non-neurogenic area as well as SVZ, typical neurogenic area. Therefore, this strategy might be used to activate neural regeneration in various central nervous system diseases. (J Korean Acad Rehab Med 2008; 32: 632-636)

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The Effect of Environmental Factors to the Mobility Disability in Independent Subjects with Stroke.: Noh, Jae Hyun , Do, Gi Chul , Kim, Jun Yeon , Kim, Dong Hyup , Kim, Chul Hyun , Lee, Yang Soo , Jung, Tae Du; J Korean Acad Rehabil Med 2008;32(4):400-405.

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Objective: To investigate the effect of environmental factors on the ability of mobility in subjects with chronic stroke who can perform nearly independent activities of daily living (ADL). Method: Sixty one patients were divided into three groups (superior, middle, and inferior) by the degree of independent walking. Modified self-administered questionnaire was completed to report how well the patients encountered the environmental elements faced in community mobility. In addition, all patients were assessed to find out the difference of ADL performance, Berg balance scale (BBS), 10 m walking time (10 mWT) and patterns of 'going out' among the three groups. Results: The group 1 (superior group) had shown better performance than group 2 (middle group) and group 3 (inferior group) in performance of ADL, BBS, 10 mWT. Secondly, the group 1 visited more places or destinations per day than the group 2 and 3, and they used more various transportation systems than other groups. Finally, there were significant differences in the distance dimension, the temporal dimension, terrain dimension (except for a 'getting on a elevator' component), and density dimension among the groups. Conclusion: Environmental factors as well as functional abilities could affect the mobility of subjects with chronic stroke. This result suggests that any kinds of compensation and the supports of social institutions are needed even in subjects of nearly independent ADL for their improvement of mobility and convenience. (J Korean Acad Rehab Med 2008; 32: 400-405)

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Function and Environmental Factors Analysis using ICF (International Classification of Functioning, Disability and Health) for People with Disabilities.: Kim, Wanho , Ahn, Mi Ra , Kim, Eun Soo , Lee, Jeong Eun , Lee, Mi Jeong , Kim, Myung Soo; J Korean Acad Rehabil Med 2008;32(1):100-105.

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Objective: To evaluate the clinical usefulness of ICF (International Classification of Functioning, Disability and Health) through correlation among existing functional evaluation tools and examined environmental factors affecting its function. Method: One hundred eight persons with disabilities living in Seoul were randomly selected according to disability severity categories. Functional Independence Measure (FIM), modified Barthel index (MBI) and ICF were examined and subjects were interviewed by trained rehabilitation doctors and occupational therapists. We compared correlation between these three functional measurements. We coded environmental factors affecting function. That was used in second level of 74 ICF items. Results: The average of FIM, modified Barthel index, capacity and performance scores of ICF was 112.76, 92.97, 5.74 and 3.19. There was a statistical correlation among FIM, Barthel index, and ICF. The facilitator chapters among ICF's environmental factors were support and relationships (51.9%), attitudes (45.8%) in order. Most facilitated second level domains among the 68 items were immediate family (66.77%) and health professionals (52.8%). The most barrier chapters in ICF were product and a technology (19.5%), environment changes (15.5%) in order. Most barrier second level domains were design, construction and technology of buildings for public use (37%) and assets (37.0%). Conclusion: ICF correlates with the existing functional evaluation tool and can facilitate management of activity and participation by linking the result with the environmental factors, which may exacerbate or minimize them. (J Korean Acad Rehab Med 2008; 32: 100-105)

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The Environmental Control System for a Patient with Quadriplegia.: Yang, Jung In , Moon, Hae Won , Lee, Il Yung , Jang, Tae Jeong , Chung, Ikjoo; J Korean Acad Rehabil Med 1999;23(3):654-659.

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Environmental control system (ECS) is an assistive device to help the severely disabled persons to live their daily lives more independently. An 'ECS By Voice' suitable to a 54-year old C4 quadriplegic man was developed and installed in his own room for one week. The physical and psychologic impacts of the subject and caregiver were also evaluated using questionnaires including the Activity Pattern Indicator (API) and Beck Depression Inventory (BDI) before and after the application of the device. The results were as follows: (1) The voice recognition rate of the device was 97.5% in the laboratory and there was no difference in recognition rate according to the specific commanding words. (2) While using the device, both the dependency on the attendant care and the depression tendency of the subject were decreased. (3) While using the device, both caring time and depression tendency of the caregiver were decreased. We found the usefulness of ECS for the quadriplegics and the possibility of developing a Korean model of ECS which can be commercialized at a considerably less cost.

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Comparison of MBI, FIM, and ESCROW in the Evaluation of Rehabilitation Status.: Yang, Chung Yong , Cho, Eun Soo , So, Eun Ha; J Korean Acad Rehabil Med 1998;22(3):475-482.

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Objective: The main purposes of this study were to understand the correlations among Modified Barthel Index (MBI), Functional Independence Measure (FIM), and ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status) Profile, and to establish the more appropriate assessment standards to check patient's conditions in the hospital and in their homes and society.

Method: Thirty-four patients, who received the rehabilitation treatment and home visiting at the Presbyterian Medical Center, were evaluated for their functions by MBI, FIM, and ESCROW Profile.

Results: The mean scores of assessment measures by home visiting were all higher than in the hospital showing an improvement of the patients' functions after discharge from the hospital. The results of MBI and FIM in the hospital and home visiting showed a significant correlation, while the results of MBI and Cognitive FIM measure indicated a relatively low correlation coefficient. Although each result of MBI, FIM, and ESCROW provided a low correlation when the patients were in the hospital, the result for home visiting revealed very significant correlations. Especially, the items of environment, social support, outlook, and work status of ESCROW showed very significant correlations with MBI and FIM.

Conclusion: The results showed that MBI and FIM measurements were very useful in observing and following up the functional conditions of the patients, while ESCROW profile was more appropriate to evaluate the familial and social rehabilitation status.