RESUMEN
OBJECTIVE: To investigate whether the Australian National Sub-acute and Non-acute Patient Casemix Classification (SNAP) and Functional Independence Measure and Functional Related Group (Version 2) (FIM-FRG2) casemix systems can be used to predict functional outcome, and reduce the variance of length of stay (LOS) of patients undergoing rehabilitation after strokes. DESIGN AND SETTING: The study comprised a retrospective analysis of the records of patients admitted to the Cedar Court Healthsouth Rehabilitation Hospital for rehabilitation after stroke. SUBJECTS: The sample included 547 patients (83.3% of those admitted with stroke during this period). Patient data were stratified for analysis into the five SNAP or nine FIM-FRG2 groups, on the basis of the admission FIM scores and age. MAIN OUTCOMES: The AN-SNAP classification accounted for a 30.7% reduction of the variance of LOS, and 44.2% of motor FIM, and the FIM-FRG2 accounts for 33.5% and 56.4% reduction respectively. Comparison of the Cedar Court with the national AN-SNAP data showed differences in the LOS and functional outcomes of older, severely disabled patients. Intensive rehabilitation in selected patients of this type appears to have positive effects, albeit with a slightly longer period of inpatient rehabilitation. CONCLUSIONS: Casemix classifications can be powerful management tools. Although FIM-FRG2 accounts for more reduction in variance than SNAP, division into nine groups meant that some contained few subjects. This paper supports the introduction of AN-SNAP as the standard casemix tool for rehabilitation in Australia, which will hopefully lead to rational, adequate funding of the rehabilitation phase of care.
Asunto(s)
Centros de Rehabilitación/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/clasificación , Actividades Cotidianas/clasificación , Anciano , Australia , Cognición/clasificación , Episodio de Atención , Financiación Gubernamental , Humanos , Tiempo de Internación , Evaluación de Resultado en la Atención de Salud , Admisión del Paciente , Recuperación de la Función , Rehabilitación/clasificación , Centros de Rehabilitación/economía , Atención Subaguda/economíaRESUMEN
Competing visual stimuli lead to slower responses to targets. This response competition must be resolved before correct responses are executed. Neuroimaging suggests that response competition monitoring may be subserved by an integrated neural network including the anterior cingulate cortex (ACC). In this study, 1 patient with a parietal lesion (Patient J.S.) and 1 with an ACC lesion (Patient G.M.) were presented with 2 flanker tasks; 1 required verbal identification of color targets, and the other required an opposite response to targets (e.g., see red and say "green"); a control group was also tested. For controls, perceptually incongruent flankers interfered with the ability to inhibit prepotent responses to targets. Patient J.S. performed in a similar manner, even when flankers appeared in the neglected field. Patient G.M. demonstrated reduced interference effects for contralesional flankers. Results are discussed in terms of goal-directed selective attention and response competition monitoring.
Asunto(s)
Atención/fisiología , Lateralidad Funcional , Objetivos , Giro del Cíngulo/diagnóstico por imagen , Lóbulo Parietal/diagnóstico por imagen , Adulto , Movimientos Oculares/fisiología , Femenino , Humanos , Masculino , Procesos Mentales/fisiología , Persona de Mediana Edad , Red Nerviosa/fisiología , Pruebas Neuropsicológicas , Tiempo de Reacción , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Campos Visuales/fisiología , Percepción Visual/fisiologíaRESUMEN
Patients with parietal lesions often fail to identify stimuli in the contralesional field (i.e. neglect) but may nevertheless demonstrate implicit processing of neglected stimuli. Explanations of implicit processing in neglect range from intact preattentive mechanisms, to intact higher level categorical processing. Such theories assume implicit processing in neglect is passive and not subject to attentional modulation. We investigated implicit processing in a neglect patient US) using a flanker task in which targets differed on two dimensions simultaneously (i.e. coloured letters). Controls demonstrated interference effects only from goal-relevant dimensions of flankers. JS showed a similar pattern of results even when flankers appeared in his neglected field, suggesting that implicit processing of neglected stimuli can be modulated by behavioural goals.
Asunto(s)
Atención/fisiología , Procesos Mentales/fisiología , Percepción Espacial/fisiología , Anciano , Conducta/fisiología , Objetivos , Humanos , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
Patients with striate cortical damage causing a hemianopic field defect can nevertheless demonstrate residual visual capacities in their blind field. Previous research investigating blindsight required patients to respond explicitly to stimuli appearing in the blind field by making forced choice judgements. We present data from a patient with a left occipital lesion resulting in a homonymous hemianopia, using the flanker task. This patient displayed a significant flanker congruency effect (FCE) for colour and letter stimuli even when they appeared in the blind field. A control patient with a lesion of the right thalamus showed no FCE in the blind field. This suggests that thalamo-extrastriate neural pathways are necessary for residual functioning in blindsight.