1. BY: ANNETTE FERNANDEZ OLD DOMINION UNIVERSITY SCHOOL OF NURSING NURSING GRAND ROUNDS NURS 441 – REHAB

2. INTRODUCTION  Mr. J.A.  62yo African American male  Cervical stenosis with myelopathy  Cervical laminectomy  Focus?

3. CLIENT HISTORY AND ASSESSMENT  Pertinent history  CVA in 1984  Cervical stenosis with myelopathy  Ataxia  Why rehab?  Laminectomy however…  Improvement in speech and physical ability

4. PHYSICAL ASSESSMENT  Left-sided weakness in upper and lower extremity  Unsteady gait requiring assistance from both walker and physical therapist  Stutter  Occasional urinary incontinence – x1 per shift  Independent in eating and using urinal

5. PSYCHOSOCIAL HISTORY  *Lives with mother who is in her 80s  Prior smoker/drinker  Stairs in the front, ramp in the back – one story home  Home aid from 9am-2pm  Home health was suggested to stay longer hours  Mostly wheelchair bound at discharge

6. CONCEPT MAP

7. CONCEPT MAP CONTINUED

8. IDENTIFICATION OF PROBLEMS  Interventions  Physical therapy  Occupational Therapy  Speech Therapy referral  Yes/no questions  Engaged in conversation by initiating  Alternatives: Communication board Paper calendar - orientation  Client status  Improved speech  Gained physical strength evidenced by improved distance with walker

9. RESEARCH  Observational longitudinal study on stroke patients in mixed rehabilitation unit  14 patients observed for activity levels using purpose-designed behavioral mapping checklist  Direct observation 8am to 8pm  Physical, cognitive and social activity observed on weekday and weekend at baseline and again at a later date for comparison  Level of independence and mood were also measured  Focus of rehab?  Function and Independence!

10. RESEARCH CONTINUED  Physical Activity  Purposeful physical movement  Eating, drinking, participation in transfers, ADLs, participation in physical, occupational or speech therapy  Cognitive Activity  Non-physical mental activity  Reading, listening to music/the radio, crosswords, puzzles, games, speech therapy language exercises, occupational therapy cognitive exercises, writing, video games, etc.  Social Activity  Interaction involving verbal communication and non verbal communication (touching, kissing, holding)  Talking, laughing, use of telephone, being present within a group of people engaged in group therapy

11. RESEARCH CONTINUED  Any activity  Results  At baseline: FIM: 69/126 (moderate level of independence) PHQ-9: 10/27 (low mood given – 10 = lower limit of moderately severe depression) Any activity: 49% Social activity: 32% Physical activity: 23% Cognitive activity: 4%  Two weeks later: FIM: mean 19-point increase PHQ-9: 4-point reduction (indicative of improvement) Physical activity: +4% No change in any, social or cognitive activity levels

12. RESEARCH IMPLICATIONS  Positive correlation between change in activity level and change in level of independence (FIM)  Negative correlation between change in social activity and change in PHQ-9 score  5% less physical activity on weekends  Finding ways to alter environment of rehabilitation units to enrich rehabilitation experience, improve mood, level of independence and recovery  Increase activity in stroke patients

13. CLOSING QUESTIONS?