The motor relearning programme was found to be effective for enhancing functional recovery of patients who had a stroke. Both 'sequential' and 'function-based' concepts are important in applying the motor relearning approach to the rehabilitation of stroke patients.

This study explored the relationships between the motor and cognitive abilities, and the functional performance of patients with stroke. Motor and cognitive abilities were measured by the Fugl-Meyer Assessment (FMA) and the Neurobehavioural Cognitive Status Examination (NCSE), and functional performance was measured by the Functional Independence Measure (FIM). All assessments were conducted at admission, after 2 and 4 weeks, and at discharge. A total of 37 patients with first stroke at mean age 62.3 years (SD=5.4) participated in the study. Results indicated that the lower extremity and balance scores on the FMA were highly correlated with the FIM (motor subscale) on all occasions (r = 0.65--0.92), whereas upper extremity and hand scores on the FMA were moderately correlated (r = 0.53--0.73). Cognitive abilities such as judgement, comprehension and repetition had moderate positive relationships with functional performance (r = 0.35--0.62). Consistent with previous studies, motor functional performance at discharge was best predicted by balance and judgement abilities at admission, or lower extremity abilities and balance at 2-weeks, or lower extremity and repetition abilities at 4-weeks. At admission, lower extremity and cognitive abilities were found to be the best predictors of patients' length of stay. The results from this study substantiated the fact that motor impairment, including balance and lower limb ability, strongly accounts for functional recovery in the rehabilitation of patients with stroke staying in hospital. This study provided good data for rehabilitation professionals on monitoring neurological recovery, especially balance and lower extremity abilities, to enhance the functional recovery of patients after stroke. More intensive intervention in these aspects should be provided to patients to promote more efficient functional regain and shortening of the length of stay.

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care.

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