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Biomedical subjects

C V Granger

Publications and source records attributed to C V Granger.

At least 91 records · Page 5Linked to original sources
PubMed1988

The stroke rehabilitation outcome study--Part I: General description.

Part I describes the background of the study, the characteristics of the patient population, and their functional status before onset of stroke, at rehabilitation admission, and at discharge, and the outcomes six months after discharge. Results showed that the average age was 69; 40% had right hemiparesis, 43% left, and 17% bilateral deficits. Medical complications during rehabilitation hospitalization were more common in patients who, at follow-up, were either living in a long-term care facility or had died. Average length of medical rehabilitation stay was 37 days, with mean admission and discharge Barthel Index scores of 37 and 66, respectively. Seventy percent of patients were discharged to the community and 68% were in the community six months after discharge. Patients with higher Barthel Index scores at discharge were more likely to be living in the community at follow-up. Patients living in the community at follow-up, with higher Barthel Index scores, were more likely to be satisfied with life in general, have more person-to-person contacts, and be more active in community affairs.

Aged↗
PubMed1983

Ethylene oxide-induced polyneuropathy. A clinical and electrophysiologic study.

Occupational exposure to ethylene oxide (ETO) was manifested as a subacute polyneuropathy, with bilateral footdrop and denervation potentials on electromyography as the principal abnormalities in three young adults whom we examined. To our knowledge, this is the second report of neurotoxic effects caused by long-term ETO exposure in humans and brings the number of patients described with symptomatic polyneuropathy to five.

Adolescent↗
PubMed1983

Discharged rehabilitation patients: impact of follow-up surveillance by a friendly visitor.

The period after hospital discharge is the most critical for rehabilitation patients returning to a community setting. A friendly visitor surveillance program using nonprofessional volunteers was designed to monitor treatment regimen compliance by alerting medical professionals of impending crises among discharged rehabilitation patients. A randomized experimental design was used to evaluate the impact of 1 year of program exposure on rehospitalization, service use, and psychosocial outcomes experienced by 142 patients. Patients were randomized into 3 groups: friendly visitors (FV) and biannual nursing visits; biannual nursing (RN) visits only; and controls (CON). Over 1/3 of the sample was rehospitalized at least once during the 1-year impact period, yet no differences were found across experimental groups nor patients' diagnostic category. No meaningful pattern of significant differences between the groups was observed at the p less than 0.1 probability level in any of the other outcome areas. The need to alert the medical system of impending patient problems occurred rarely, suggesting that existing informal support systems and regular use of medical services may be sufficient to monitor rehabilitation patients' progress.

Activities of Daily Living↗
PubMed1982

Functional assessment: bridge between family and rehabilitation medicine within an ambulatory practice.

This study describes development of a functional assessment instrument used to screen ambulatory care patients who have difficulty performing daily activities. Sample selection occurred in 2 stages. In the first stage, an interdisciplinary team used clinical selection criteria in order to screen patients into 2 groups: group 1, those likely to have functional limitations; and group 2, those not likely to have functional limitations. Using clinical selection criteria for a 3-week period in an ambulatory primary care setting, it was found that 20% of the outpatients seen fell into group 1. In the second stage, a randomly selected subsample of 194 persons was used, with 97 in group 1, and 97 in group 2. The Functional Assessment Screening Questionnaire (FASQ) was tested using this second sample. The FASQ was found to discriminate between the 2 groups, with those in group 1 having a significantly greater number of functional difficulties than those in group 2. An analysis was conducted to investigate which diagnostic problems were more likely to be associated with patients reporting functional limitations. Fourteen diagnostic patient problems found to be significantly more limiting than for the total sample were identified. The factor structure of the FASQ was examined and a format for clinically integrating the FASQ factors was offered.

Activities of Daily Living↗
PubMed1982

Stroke: comparison of admissions in a community hospital.

A retrospective comparison was made of characteristics of stroke patients admitted to 3 distinct areas of the Union-Truesdale Hospital (renamed Charlton Memorial Hospital) in Fall River, MA. The Union Division has the option for admission to an acute care stroke unit or to the medical/surgical units. The Truesdale Division is separated by 1 mile and contains medical/surgical units. The Union Division also has a rehabilitation unit for post-acute care. The 2 divisions were separate corporations with generally separate medical staffs until a merger was effected in October, 1975. Using Professional Activity Studies (PAS) reports, a cohort of 418 patients discharged between October 1, 1975, and September 30, 1976, was developed. According to ICDA-8 coding, the 3 areas of the hospital had different profiles of patients. Outcomes in terms of types of discharges were also different between 4 categories of stroke pathology. Of 57 patients referred for rehabilitation, 43 had abrupt onset with persisting focal deficit (ICDA-8 codes 433/434/436), and 14 had less clear onset with diffuse neurologic loss (ICDA-8 codes 437/438). Of the patients referred for rehabilitation, 75% were returned home after an average of 16 acute hospital days and 23 rehabilitation hospital days. This study is on a small scale and may seem to have only local relevance, but the following estimates seem to offer a reasonable probability for planning rehabilitation facilities: approximately 25% of discharges with ICDA-8 codes of 433, 434, and 436; approximately 10% of discharges with ICDA-8 codes of 437 and 438; and approximately 2% of other stroke diagnoses. Average daily hospital charges were significantly less for patients cared for in the stroke unit.

Aged↗
PubMed1980

Vocational status: prediction by the Barthel index and PULSES profile.

Functional assessment measures of patients in a rehabilitation hospital were used to predict vocational status 18 months after discharge. The Granger adapted version of the Barthel index and the PULSES profile were administered to 118 disabled persons at discharge. Their total scores were correlated with vocational status measured by a scale of 1 to 6, ranging from unemployment to full-time employment. Analysis of data reveals that the Barthel index and sex (female) predicted vocational status 18 months after discharge (p < 0.05). PULSES showed no significant correlation with vocational status. Further analysis indicates that in a stepwise regression of independent variables on vocational status, the best predictors were the Barthel index, sex (female), age (the younger are more likely to pursue a vocation), contacts with state rehabilitation counselor, and contacts with Tufts counselor. Further studies are needed to examine specific subgroups of the physically impaired population seen by medical centers and state rehabilitation agencies.

Adolescent↗
PubMed1979

Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index.

In view of current emphasis on evaluation of benefits derived from rehabilitation programs, it is important that there be easily replicated measures for demonstrating the efficiency and effectiveness of services provided, as well as for transmitting information on patient functional status when transferring service responsibilities from one agency or facility to another. The authors used the PULSES profile and the Barthel index to measure severity of disability and to monitor rehabilitation progress in a heterogeneous sample of 307 severely disabled persons in 10 comprehensive medical rehabilitation centers, geographically selected. Gains in functional independence were registered for up to 2 years after admission. Cutting points of PULSES score totals or Barthel score totals distinguished the degree of severity of disability. The 2 scoring modalities appear valid, reliable, and sensitive for describing functional abilities and change over a period of time. They can be applied both to medical records and direct observations, and staff of medical facilities can readily be trained in their use.

Activities of Daily Living↗
PubMed1979

Stroke rehabilitation: analysis of repeated Barthel index measures.

Functional abilities of stroke patients in a rehabilitation hospital are recorded every 2 weeks using the Barthel index. For purposes of this study, data were collected retrospectively and prospectively from consecutive records according to predetermined criteria on forms coded for computer analysis. Total scores of 110 patients were correlated with length of stay, placement at discharge and scores in individual functional abilities. Analysis of the data reveals that an initial score over 40 on the Barthel index defines a population with a greater proportion of discharges to home and that patients with initial scores over 60 have a shorter length of stay. Further analysis indicates a predictable progression in the development of functional skills in this population so that with a Barthel score below 40, no one was independent in the mobility skills and fewer than 50% were independent in the very basic skills, such as feeding, grooming and sphincter control. A score of 60 appears to be a pivotal score where patients move from dependency to assisted independence.

Activities of Daily Living↗
PubMed1976

Prognosis in Bell's palsy.

This is a concluding report of a study in which only patients with Bell's palsy initially seen within ten days of onset are included. The purposes are to observe the natural course of the disorder and to illustrate electromyographic EMG) criteria by which early forecast of recovery is possible. Appraisals of facila muscle strength, nerve stimulation responses and electromyographic needle electrode examinations correlated with the time required for recovery and the relative degree of recovery of patients with Bell's palsy. Three categories of recovery are evident. Of 90 patients, 79% recovered completely within two months (class I), 7% recovered adequately within two to six months (class II) and 14% required longer than six months (class III). Using clinical and electromyographic methods it should be possible to forecast recovery within three days after onset in order to preselect patients in need of any proposed curative treatment program designed to salvage the facial nerve. For prognosis in patients without clinically detectable facial muscle function, the data suggest that they be evaluated on a daily basis from onset until day 4 (past 72 hours). Finding that residual motor unit potentials are sustained in four to five muscles during that period strongly indicates a favorable outcome. Finding activity in two to three muscles could be less favorable and finding zero to one muscle with activity is clearly unfavorable. During this period of time there is a tendency for progressive loss of EMG activity in the facial muscles, both in patients with favorable and with less favorable outcomes.

Adolescent↗