Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 28,685 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Thursday, July 18, 2024
Case Report - Is There Room for Improvement? Stroke Rehabilitation Environments May Not Reflect Home Environments in Terms of Chair, Toilet, and Bed Heights
My pet peeve was the car in the rehab center, practice getting in and out was only done on the passenger side, never the driver door or the rear doors.
The
present study aims to describe the chair, bed, and toilet heights in
rehabilitation hospitals and home environments to challenge
rehabilitation clinicians to better prepare stroke survivors for
discharge home. This study uses analysis of secondary outcomes from a
multicentre, phase II randomized controlled trial (HOME Rehab trial) and
additional observation of hospital environment. Data were collected
from six rehabilitation hospitals and the homes of two hundred
first-time stroke survivors who were aged >45 years. Chair, bed and
toilet heights were measured; we measured 936 chairs and beds in
hospital (17%) and home (83%) environments. Mean chair height at home
was 47 cm (SD 6), which was 2 cm (95% CI, 0-4) lower than in the
hospital ward and 5 cm (95% CI, 3-7) lower than in the hospital gym.
Mean toilet height at home was 42 cm (SD 3), which was 3 cm (95% CI,
2-4) lower than in the hospital. Study findings suggest a disparity in
heights between hospitals and home. Although clinicians may be aware of
this disparity, they need to ensure that chair and bed heights within
the hospital environment are progressively made lower to better prepare
stroke survivors for discharge home.
Physical
rehabilitation after stroke aims to prepare stroke survivors for
discharge home. Safe discharge home from rehabilitation includes being
able to sit, transfer, and walk.
Therefore, physiotherapy in rehabilitation is based on the practice of
these essential everyday activities to improve the performance of these
activities in preparation for discharge home.
A common everyday activity practiced in rehabilitation is standing up
from a chair. Over the previous decades, research has described the
biomechanics of standing up from a chair.
One of the important findings is that, as the chair height is
increased, lower limb joint moments are decreased, ie, it requires less
muscular effort to stand from a higher chair.
This knowledge assists rehabilitation therapists in tailoring the
difficulty of standing up to the stroke survivor's ability by modifying
the chair's height.
Rehabilitation
hospitals are modified in design and built specifically for people with
physical disability. The design of rehabilitation hospital environments
usually considers safety, eg, minimizing fall risk, but does not
necessarily consider the potential of the environment to influence
functional outcomes.
This
study aimed to describe the chair, bed, and toilet heights in the home
environment to inform rehabilitation clinicians and consider how they
can better prepare stroke survivors for discharge home. Therefore, the
research questions were (1) what are the heights of chairs, beds, and
toilets in hospital and home environments? and (2) what is the
difference in chair, bed, and toilet heights between rehabilitation
hospitals and home environments?
Methods
Design
Secondary
observational analysis of the hospitals and individuals post-stroke
participating in a discharge planning trial, the HOME Rehab trial.
The HOME Rehab trial is a multicentre, phase III randomized trial
conducted in Australia. The trial compared an enhanced occupational
therapy discharge planning intervention to usual care discharge
planning. Within this trial, environmental measures were taken at stroke
participants’ homes and in the hospital sites’ wards and gyms.
Ethics approval
This
study was approved by the Alfred Health Human Research Ethics Committee
(HREC/17/Alfred/236 [NMA]), and site-specific ethics approval was
obtained at all participating sites. All participants gave written
informed consent before data collection.
Participants, therapists, centers
Six
metropolitan hospitals that had rehabilitation wards, which were sites
in the HOME Rehab trial, were included in the hospital ward and gym
environmental analyses. The hospitals were located across 3 states of
Australia. The rehabilitation wards had a stroke throughput of >20
patients each year.
The home
environmental analysis included the first 200 stroke participants in the
HOME Rehab trial. The stroke participants had all experienced their
first stroke. They were aged >45 years, admitted to rehabilitation,
expected to return to a community (private) dwelling after discharge,
and had no significant prestroke disability (prestroke modified Rankin
Scale score, 0-2).
Measures
A
comprehensive environmental evaluation was completed in rehabilitation
hospital wards, gyms, and homes. In the hospital evaluation, a trained
therapist measured the heights of chairs, plinths, toilets, and beds
using a standardized procedure. In the home evaluation, dining chair,
lounge, toilet, and bed heights were measured by a trained family
member, who also took a photograph of the procedure that a trained
therapist checked. In both environments, the same procedure was used,
and it involved using a tape measure from the floor to the top of the
chair or bed to the nearest millimeter. All chairs and beds were
measured at the height they were found on entry to the room without
adjustment. All chairs and toilets were measured when vacant, and beds
and plinths (therapy mat tables) were measured with a person sitting on
them to account for mattress compression when occupied.
Additionally,
in the rehabilitation environment evaluation, beds or plinths (therapy
mat tables) were measured under further conditions; after measuring at
the height found, they were adjusted to the lowest possible and highest
possible height. Five individual chairs or beds were measured in the
ward and therapy gym areas for each type.
Data analysis
Descriptive
statistics (mean ± SD) were used to describe the average height of each
type of chair or bed in the hospital ward, hospital gym, and home. The
difference in heights was calculated as mean difference and 95% CI.
Results
Height
data were included from 65 chairs, 60 beds/plinths (therapy mat
tables), and 30 toilets across 6 hospitals rehabilitation wards and
gyms. Height data from 200 stroke participant homes were available. The
height of chairs, beds, and toilets in the home and rehabilitation
hospital environments are detailed in table 1.
Table 1Mean
± SD height (centimeters) of chairs, beds, and toilets in each
environment and mean difference (95% CI) between environments.
In
terms of height, the mean ± SD chair height was 47±6 cm, lounge
(recliner) height was 43±5 cm, toilet height was 42±3 cm, and bed height
was 59±9 cm (table 1).
Height of chairs and beds in hospital ward and gym environments
In
the ward, beds were adjustable to a minimum height of 42±12 cm and a
maximum height of 88±9 cm. In the gym, plinths (therapy mat tables) were
adjustable to a minimum height of 46±2 cm and a maximum height of 89±7
cm. The mean toilet height was 45±2 cm.
Difference in heights between hospital and home environments
Bed
height and variability were similar across environments. Toilet height
was 3 cm (95% CI, 2-4) lower in the home than in the hospital. Chair
height was 2 cm (95% CI, 0-4) lower in the home than in the hospital
ward and 5 cm (95% CI, 3-7) lower in the home than in the hospital gym.
See table 1 and figure 1.
Fig 1Mean ± SD height (cm) of chairs in each environment.
The
current study identified that the heights of beds were similar between
environments; however, chairs were lower in the home than those in
hospital environments (mean 2 cm lower). This result is not surprising
because hospitals are purpose-built spaces for people with physical
disability and, therefore, designed to make everyday activities more
manageable for these people.
In addition, chairs in the gyms were even higher, perhaps because very
disabled people are practicing this everyday activity within the gym, so
using a higher height to make standing up more manageable with a focus
on improving technique.
Notably,
there was more variability in heights in the home environment than in
the hospital, eg, the SD of chair heights in homes was more than double
the SD in hospital wards. This suggests that stroke survivors need to be
equipped to be able to stand up from some very low chairs and beds that
will be present in the home environment. Moreover, when accessing the
community or using a car, the height may be even lower than found in the
home.
Strengths and limitations
The
current study has both strengths and limitations. Limitations include
different height measurers in the hospital and home environments.
However, all measurers followed a standard procedure. A significant
strength of the study is the large sample size of stroke survivor homes
and the inclusion of 6 hospitals across 3 states of Australia. This
large sample helps to assure certainty in the results presented in this
study. Further, these are the hospital environments the stroke survivors
accessed before discharge home.
Conclusions
The
findings of the current study suggest clinicians should pay particular
attention to the height of chairs and beds within the hospital
environment. Chair and bed height should be matched to the stroke
survivor and lowered as their ability improves over time.
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