Objective : To examine the characteristics of rehabilitation in patients with cervical spinal cord injury, we statistically analyzed the factors that affected their home discharge. Methods : We examined 122 inpatients diagnosed with cervical spinal cord injury in our hospital from January 2001 to December 2010. We categorized the patients into a home discharge group and a non-home discharge group, and ruled out inpatients that underwent rehabilitation at other hospitals after discharge. We analyzed the following factors with regard to their influence on home discharge : sex, age, length of stay, surgery after injury, cervical vertebral fracture at injury, the grade on the Frankel grading system, Functional Independence Measure (FIM) scores, movement ability, pain severity, the number of comorbidities, complications, and the number of caregivers. Results : The factors that favored home discharge included : improvement of paralysis, improvement of FIM scores, high-FIM scores at both admission and discharge, and high potential for movement at discharge. The factors that hindered home discharge included : advanced patient age, long length of stay, pain severity, and urinary infection. Multivariate analyses showed that age, pain severity, and movement ability were the most relevant factors that influenced home discharge. Conclusion : Pain control as well as improvement of movement ability are important factors affecting home discharge in rehabilitation units.

The purpose of this study was to implement a community-based exercise program for postdischarge stroke survivors in the public health center. The subjects were fourteen male stroke survivors with chronic upper and lower limb paresis (63.0±5.9 years) . The study design was quasiexperimental, with each subject serving as his own control. All subjects have to meet following inclusion criteria: (1) first stroke resulting in hemiplegia, (2) at least 6 months post-stroke, (3) able to walk independently, and (4) free from grave aphasia, apraxia, agnosia, or disequilibrium. A 25-week (2 deek) training program consisted of a warm-up, lower and upper extremity muscle strengthening, recreational activities, walking training, and a cool down. The duration of this program is approximately 70 minutes a day. The outcome measure was the 12 functional fitness test items and questionnaire in activities parallel to daily living. Significant improvements (P<0.05) were found for handgrip strength, knee extension strength, tandem balance, standing and sitting, and timed up and go in the treatment period. However, the scores in activities parallel to daily living were not significant. These results suggest that they may attain significant functional improvements in response to implementation of a community-based exercise program. In conclusion, post-discharge stroke survivors can improve their functional fitness status by participating in a community-based exercise program.

Objective : This study aimed to investigate the changes in the functioning of users of visiting rehabilitation services and related factors. Methods: Among 107 users in 22 visiting rehabilitation centers, we analyzed the data of 80 who completed the 6-month study. Their Functional Independence Measure (FIM), Life-Space Assessment (LSA), and level of caregiver burden (J-ZBI_8) were compared at the commencement of this study, and at 3 and 6 months afterwards. A multiple linear regression analysis was performed to examine the factors related to the variables, which changed over 6 months. Results : Over a period of 6 months from the commencement of the study, we found that FIM and LSA scores significantly improved from 82.4 to 87.3 (p=0.016) and from 9.9 to 12.3 (p=0.05), respectively, in the group who were still within 1 year from the time since onset/injury. A multiple regression analysis revealed that the period of time since onset/injury, independence degree of daily living for the demented elderly, and presence of goal setting for activities of daily living/domestic work significantly influenced changes in total FIM scores (p=0.001, R²=0.32). Furthermore, the change in LSA scores was significantly influenced by gender, presence of cerebrovascular diseases, period of time since onset/injury, number of occupations involved in visiting rehabilitation services, and J-ZBI_8 scores (p=0.0001, R²=0.36). Conclusion : Effective visiting rehabilitation requires having appropriate goals set for daily living activities and the establishment of interprofessional collaboration within visiting rehabilitation centers.