Nutrition and rehabilitation after discharge from the hospital: accelerating the rehabilitation with nutrition and physical training.
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Over a period of 12 months, all persons among the 10.4 million inhabitants of the state of Baden-Württemberg were included in the study who had suffered severe brain damage and were treated in special early rehab units, comprising 147 beds for adults and 43 for children. With 830 patients admitted, the incidence of severe brain damage was 7.98/100.000 in adults and 1.11/100.000 in children. 50 to 70 year old patients were over-represented, those older than 70 years were underrepresented due to geriatric rehab facilities for the latter. Male patients dominated, while female were somewhat younger. 54% of the patients were admitted from the hospital which had performed primary care, with an average stay of 67 days. Average early rehab duration was 53 days (arithmetic average; median 40 days, some patients required up to one year). 32.8% of the patients had suffered traumatic brain damage (ICD 851, 852, 854) and 40.9% non-traumatic brain affection (ICD 430, 431, 433-438, 310, 348), including 12.2% CVA (ICD 433-438), 8.5% subarachnoid and 12.3% intracerebral hemorrhage. Severity as indexed by the early rehab Barthel index improved from an initial average of -119 to -34 at discharge. 80% of the patients showed an overall improvement (71% of them by up to 200 points and 46% by up to 100 points).
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The aim of this article is to describe the need for assistive devices and environmental modifications among long-living stroke survivors and to investigate if the need is continued and growing over time. The study sample of 155 consecutive stroke patients with stroke-related impairment, discharged home from three hospitals in Copenhagen from 1996 through 1998, constituted 20% of the total population of stroke survivors in this area. The results showed that 75% of these patients were provided with assistive devices and/or environmental modifications at discharge. Six months after discharge the proportion was 81%. The aids most frequently prescribed were bath seats, aids for mobility, grab bars, and removal of door thresholds. At follow-up 3-5 years later, 74% of the survivors were seen (76 patients). Almost all of the survivors were dependent on assistive devices and/or environmental modifications, most frequently wheelchairs and aids for walking and bathing. In addition there was a significant increase in aids for cooking/eating and reading/hearing/writing adaptations. Of those devices abandoned, most were aids for the household. These findings suggest that home visits by therapists should be required in order to target stroke survivors' changing needs for assistive devices and environmental modifications.
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