AN EXAMINATION OF CHANGES IN SITTING FORWARD REACH FOR INDIVIDUALS UNDERGOING ACTIVE INPATIENT REHABILITATION AFTER A CEREBRAL VASCULAR ACCIDENT.

L. Kahn, MS, PT, MossRehab Hospital, Philadelphia, PA

S. McGhee, MPT MossRehab Hospital, Philadelphia, PA

J. Torkish, MPT Hospital of the University of Pennsylvania, Philadelphia, PA

R. Wellmon, MS, PT, NCS, Widener University, Institute for Physical Therapy Education, Chester, PA

PURPOSE: Impaired sitting balance is frequently seen among individuals who have experienced a cerebral vascular accident (CVA). Finding an instrument that is quick and easy to use to objectively quantifying impairments in sitting balance is a dilemma faced by anyone engaged in clinical practice or clinical research. The purpose of this study was to examine changes in forward reach scores (FRS) in sitting at admit and discharge for individuals diagnosed with a unilateral CVA. In addition, the present study examined the correlation between forward reaching in sitting and functional outcome at admit and discharge.

SUBJECTS: Sixty-seven subjects were recruited by convenience sampling from individuals admitted for acute inpatient rehabilitation. All subjects had a diagnosis of a single unilateral CVA. Average age was 64.6 ± 13.6 years, 37 subjects had a diagnosis of a left CVA, 22 subjects were female and mean length of stay was 22.8 days.

METHODS: Forward reach in sitting was examined using a procedure that was similiar to the functional reach test described by Duncan and colleagues. Subjects began the test seated at the edge of a mat with trunk support provided by a backboard. The subjects was asked to reach forward by inclining the trunk and bending at the waist. Each subject used the uninvolved extremity and the distance reached was recorded using a yardstick.

ANALYSES: Differences in admit and discharge FRS were examined using descriptive statistics and a paired sample t-test. The Spearman Rank-Order Correlation Coefficient was used to examine the relationship between FRS and Functional Independence Measure (FIM) scores for bed/chair transfers, tub/shower transfers, toilet transfers, and dressing. The Pearson Product-Moment Correlation Coefficient was used to determine the relationship between FRS and FIM scores for mobility and self care.

RESULTS: Discharge FRS (0 = 24.5 ± 5.43, SEM=.93, p<.001) differed significantly from admit FRS (0 = 20.52 ± 6.97, SEM=1.19, p<.001). Admit FRS correlated positively with admit and discharge FIM scores for mobility, transfers, self-care and dressing (r=.320-.638, p<.001) and negatively with length of stay (r= -.629, p<.001). Discharge FRS scores positively correlated with admit and discharge FIM scores for self-care (r=.346-.394, p<.001) and discharge FIM scores for LE dressing and bed/chair transfers (r=.334-.451, p<.001).

CONCLUSIONS: Sitting forward reach appears to have the potential to track changes in sitting balance for individuals diagnosed with a CVA. Individuals who had higher admit FRS were more functional. Admit FRS may also be a useful predictor of potential functional outcome at discharge. Individuals with higher FRS scores at admit had a shorter inpatient length of stay and were more functional at discharge.

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Accepted for poster presentation at the American Physical Therapy Association, 1999 Scientific Meeting, Washington, DC