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Biomedical subjects

D T Wade

Publications and source records attributed to D T Wade.

At least 55 records · Page 3Linked to original sources
PubMed1999

Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?

OBJECTIVE: The purpose of this study was to determine whether cognitive impairment is related to cardiopulmonary bypass. METHODS: Twenty-five patients undergoing coronary artery bypass grafting without cardiopulmonary bypass were matched with 50 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. All patients received the same anesthetic regimen, and one surgeon performed all the operations. A battery of 10 standard tests of neuropsychologic function were performed before, at discharge, and 3 months after the operation. A comprehensive multidimensional measure of subjective health status was used as the primary clinical measure of functional outcome. RESULTS: The groups were similar with respect to age, sex, and ventricular function and differed only in the need for a circumflex artery graft. Both groups showed significant improvement in the comprehensive multidimensional measure of subjective health status at 3 months. At discharge most neuropsychologic tests had deteriorated in both groups (the same 4 tests had deteriorated significantly in both groups, and an additional test had deteriorated significantly in the cardiopulmonary bypass group). At 3 months all but one test in the cardiopulmonary bypass group had returned to or exceeded baseline performance. The same 2 tests had improved significantly in both groups, and a further test had improved significantly in the group without cardiopulmonary bypass. At no specific time point was there a significant difference between the absolute or change scores between the groups on any of the tests. CONCLUSIONS: The similar pattern of early decline and late recovery of cognitive function in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass suggests that cardiopulmonary bypass is not the major cause of postoperative cognitive impairment. This merits consideration in deciding optimal treatment strategies in coronary revascularization.

Cardiopulmonary Bypass↗
PubMed1999

Cognitive performance after cardiac operation: implications of regression toward the mean.

OBJECTIVE: The purpose of this study was to assess the influence of regression toward the mean on different definitions of cognitive dysfunction after coronary artery bypass graft operation. METHODS: A total of 120 patients who underwent nonemergency coronary bypass operation and who were involved in a randomized trial of an anti-inflammatory agent were assessed prospectively with a battery of 10 psychometric tests covering a variety of cognitive domains. The battery was administered before the operation and 5 days and 3 months after the operation. Data from 2 representative tests, the Rey Auditory Verbal Learning Test and the Trail Making Test (part A), were used. The influence of regression toward the mean on 3 commonly used single-case definitions of cognitive impairment (1 SD method; one-half SD method; 20% method) was analyzed. RESULTS: Group mean performance deteriorated on the Rey Auditory Verbal Learning Test at the discharge assessment (P <.001) and remained below baseline at 3 months (P =.03). Mean performance on the Trail Making Test (part A) showed a near-significant decline at discharge (P =. 06), followed by improvement at 3 months (P <.01). Regression toward the mean was demonstrated on both tests by classifying the preoperative scores into low, moderate, and high-performance categories. Applying the different definitions of dysfunction resulted in substantially larger numbers of patients in the high-performance group being classified as impaired. CONCLUSION: Single-case definitions of cognitive dysfunction are influenced strongly by regression toward the mean. Disproportionate numbers of high-baseline performers are classified as impaired, thereby questioning the validity of established definitions. Group mean analysis with controls is potentially the most reliable method for detecting real change or differences.

Cognition↗
PubMed1999

Current practice and clinical relevance of somatosensory assessment after stroke.

OBJECTIVE: To examine the perceived clinical relevance, current practice and knowledge of somatosensory testing in three professional groups involved in the management and rehabilitation of stroke. DESIGN: Structured postal questionnaire sent to therapists and doctors. SUBJECTS: One hundred and eighty occupational therapists from the National Association of Neurological Occupational Therapists (NANOT), 180 physiotherapists from the Association of Chartered Physiotherapists with an Interest in Neurology (ACPIN) and 360 doctors from the Association of British Neurologists (ABN) and the British Geriatrics Society (BSG). SETTING: Hospitals and rehabilitation centres in the UK. RESULTS: Replies were obtained from 84 occupational therapists (47%), 98 physiotherapists (55%) and 78 doctors (22%). Sixty-four occupational therapists (77%), 82 physiotherapists (84%) and 66 doctors (87%) indicated that they routinely performed somatosensory assessment as part of their clinical assessment. The two most commonly used measures were proprioception and light touch. Seventy-eight occupational therapists (93%), 88 physiotherapists (90%) and 67 doctors (91%) regarded sensory assessment as clinically significant in determining prognosis after stroke. CONCLUSIONS: Despite published reservations concerning its usefulness and reliability, most therapists and doctors routinely assess somatosensory loss after stroke. All three professions agreed that somatosensory testing presented useful information for prognosis. Furthermore, all professional groups believe somatosensory assessment to be clinically relevant.

Attitude of Health Personnel↗
PubMed1999

The Short Orientation-Memory-Concentration Test: a study of its reliability and validity.

OBJECTIVE: To establish the limits of intra-observer test-retest reliability of the Short Orientation-Memory-Concentration Test (SOMC), and to investigate the relationship of performance on the SOMC with a test of verbal memory. DESIGN: Each patient was assessed twice by the same assessor over an interval of 3-7 days. SETTING: Two specialist rehabilitation units concerned with patients with severe and/or complex disability arising from neurological disease. SUBJECTS: Thirty-eight patients aged 17-63 years, 25 being men, with a variety of neurological diseases. The Barthel Activities of Daily Living Index score ranged from 0 to 20, median 10.5. MEASURES: The Short Orientation-Memory-Concentration Test, the Barthel Activities of Daily Living Index and the paragraph recall subtest of the Rivermead Behavioural Memory Test (RBMT). RESULTS: There was a slight but statistically significant (p <0.01) improvement in the score of 2 points (out of 28) between the two test occasions, but this was not related to the interval between testing or to the mean score of the two tests. The scores differed by as much as +10 to -8, but most patients (n = 35; 92%) showed a difference between -2 and +6 points. The SOMC scores were correlated with the RBMT paragraph recall immediate and delayed scores (r = 0.74) but the scatterplot showed considerable variation. CONCLUSION: If used by the same observer, changes in the SOMC score are likely to reflect a real difference if it increases by more than 6 points or decreases by more than 2 points. The SOMC does seem to reflect verbal memory.

Activities of Daily Living↗
PubMed1999

Early prediction of persisting post-concussion symptoms following mild and moderate head injuries.

OBJECTIVES: King (1996) reported that a combination of emotional, organic and neuropsychological measures taken at 7-10 days following mild and moderate head injury may significantly help predict patients most likely to suffer persisting post-concussion symptoms (PCS) at three months post-injury. This study investigated a cross-validation sample (N = 57) to determine whether the results would be replicated for the early prediction of longer-term sufferers (i.e. those with persisting symptoms at 6 months post-injury). DESIGN: Multiple regression analyses were used in which scores on the Hospital Anxiety and Depression Scale, Impact of Event Scale, Short Orientation Memory and Concentration Test, Rivermead Post-Concussion Symptoms Questionnaire and Post-Traumatic Amnesia taken at 7-10 days post-injury were the independent measures. Scoring on the Rivermead Post-Concussion Symptoms Questionnaire taken at 6 months post-injury was the dependent measure. METHODS: Sixty-six consecutive patients admitted to any trauma ward in Oxfordshire with a mild or moderate head injury were recruited from a largescale randomized controlled sample. The assessment measures were administered at 7-10 days post-injury and the Rivermead Post-Concussion Symptoms Questionnaire at 6 months post-injury. Nine patients were unable to be followed up, leaving an active sample of 57. RESULTS: The cross-validation data confirmed that a similar combination of measures to that found in the original study best predicted persisting PCS but that the strength of prediction diminished for the longer term prediction (i.e. 6 months post-injury). CONCLUSIONS: The Hospital Anxiety and Depression Scale, Impact of Even Scale and Post-Traumatic Amnesia in combination are recommended as useful prognostic screening instruments for predicting persisting PCS, but great caution is required if they are used to aid predictions beyond 3 months post-injury.

Adolescent↗
PubMed1998

The left hemisphere and the selection of learned actions.

The left hemisphere's dominance for movement is well known. The basis of its dominance is less clear. We have tested 16 left hemisphere (LH) patients, 17 right hemisphere (RH) patients and 12 neurologically normal controls on a battery of five tasks. The tasks were based on animal lesion and recording studies, and human imaging and magnetic stimulation studies that identified two distributed systems that are important for the selection of motor responses and object-oriented responses. The LH patients were impaired on three response selection tasks: learning to select between joystick movement responses instructed by visual cues; learning to select between analogous object-oriented responses instructed by visual cues; learning to select movements in a sequence. Although we replicated the finding that LH damage impairs sequencing, some of the impaired tasks had no sequencing element. We therefore argue that the LH deficits are best explained as an impairment of response selection. This was confirmed by showing that LH subjects were unimpaired on a more demanding task-object discrimination learning-which imposed a greater memory load but had no response selection element. Moreover, the LH deficits could not be attributed to disorganization of movement kinematics. The lesions of the impaired LH group were widespread but always included the distributed systems known to be important for response selection-the dorsolateral frontal and parietal cortices, striatum, thalamus and white matter fascicles.

Adult↗
PubMed1998

Routine follow up after head injury: a second randomised controlled trial.

OBJECTIVE: To confirm that patients admitted to hospital with a head injury benefit from a routinely offered early intervention service. PATIENTS AND METHODS: A mixed rural and urban Health District of 560000 people with two accident and emergency departments provided the setting. Existing routine services for most patients with head injury are minimal. All patients aged 16-65 years admitted to hospital after a head injury of any severity, with or without other injuries entered the trial. Prospective randomisation, with a block randomisation procedure was used to allocate all eligible patients to either: a group offered an additional service by a specialist team; or a group receiving existing standard services. Patients were assessed at follow up six months after injury. The primary outcome measure was the Rivermead head injury follow up questionnaire, a validated and reliable measure of social disability. The Rivermead post-concussion symptoms questionnaire was used to estimate severity of post-concussion symptoms. Each patient in the trial group was contacted 7-10 days after injury, and offered assessment and interventions as needed. These initially focused on the provision of information, support, and advice. Forty six per cent of patients in the trial group also received further outpatient intervention or additional support by telephone. RESULTS: 314 patients were registered: 184 were randomised into the trial group, 130 into the control group. For prognostic data, the groups were comparable at randomisation, and remained comparable when assessed at six months. 132 trial and 86 control patients were followed up at six months after injury. Patients' posttraumatic amnesia ranged from mild (n=79, 40%), and moderate (n=62, 32%), to severe (n=38, 19%) and very severe (n=17, 9%). The trial group patients had significantly less social disability (p=0.01) and significantly less severe post-concussion symptoms (p=0.02) at follow up at six months after injury than the control group patients. CONCLUSIONS: The early interventions offered by a specialist service significantly reduced social morbidity and severity of post-concussion symptoms in trial group patients at six months after head injury. Recommendations about how specialist services should be targeted are made both in the light of these results and those from a previous randomised controlled trial.

Adolescent↗
PubMed1998

Visual gait analysis: the development of a clinical assessment and scale.

OBJECTIVES: To develop and evaluate a four-point scale visual gait assessment form, the Rivermead Visual Gait Assessment (RVGA), for clinical use with patients with neurological deficits. DESIGN: Preliminary clinical testing of reliability, validity and sensitivity to change. SETTING: Patients were recruited from the Rivermead Rehabilitation Centre (RRC), a centre specializing in rehabilitation for patients with neurological disease. PATIENTS: Ten inpatients were assessed by up to seven physiotherapists for the main reliability study, and eight different patients were also assessed by two raters one week apart. Twenty outpatients with multiple sclerosis (MS) who were receiving physiotherapy to improve their mobility and 27 inpatients with various neurological conditions were also assessed and the data used to examine validity, re iability and sensitivity to change. OUTCOME: The other comparative measures used were walking time, stride length, step length asymmetry, balance and the Rivermead Mobility Index. RESULTS: Inter-rater reliability between multiple raters was reasonable both for the global scores from the gait assessment form (Kendall's coefficient of concordance; p < 0.001), and for individual items (complete agreement occurred on 63.8% of all observations). There was a significant correlation between the global RVGA score and the various criterion measures (r = 0.53-0.79; p < 0.001) and between change in the RVGA score and change in walking time in patients who received treatment (r = 0.68; p < 0.01). CONCLUSIONS: The RVGA provides the clinician with a clinical assessment of the quality of gait which may be used in conjunction with other measures to inform and monitor the value of physiotherapy treatment for people with MS and stroke, and possibly other neurological deficits.

Central Nervous System Diseases↗
PubMed1998

The impact of an information pack on patients with stroke and their carers: a randomized controlled trial.

OBJECTIVES: To assess the impact of information packs on patients with stroke and their carers, and to pilot some of the methodology for a trial of a Family Support Organiser (FSO). SUBJECTS: Seventy-one patients admitted to Oxford hospitals with acute stroke during February-July 1995, and 49 informal carers of these patients. DESIGN: Randomized controlled trial. Intervention group received an Information pack containing various Stroke Association publications one month after their stroke, or at discharge from hospital, whichever was sooner. Control group received nothing. Follow-up was by interview at the place of residence of the patients six months after their stroke. MEASURES: Outcome measures assessed knowledge about stroke; satisfaction with information received; patient behaviour in terms of access to community services and benefits; and health status and quality of life. RESULTS: Patients and carers in the intervention group tended to know more about stroke, but these differences were not significant once adjusted for age. Patients in the intervention group (but not carers) tended to be more satisfied with the information that they had received, but the differences were not significant. There were no differences with regard to any aspects of quality of life in patients in the intervention group, though carers in the intervention group were found to have significantly better mental health (p = 0.04). CONCLUSIONS: While the study was too small to generate firm conclusions, information leaflets may lead to improved knowledge about stroke several months after they have been distributed. This finding is worth following up with larger studies. The stroke knowledge questionnaire that was piloted in this trial seems to be able to detect differences between groups.

Aged↗
PubMed1998

Assault, post-traumatic amnesia and other variables related to outcome following head injury.

OBJECTIVE: To estimate how many patients who sustain a head injury might benefit from intervention and support each year and to consider whether relationships can be found between demographic data relating to patients' circumstances at the time of head injury, and their outcomes six months later. DESIGN: Data collected on 625 patients through follow-up interviews and assessments by the Oxford Head Injury Service for a randomized controlled trial of intervention conducted in 1993-94. SETTING: A mixed rural and urban Health District with a population of approximately 560,000. PATIENTS: Patients were aged between 16 and 65 years and resident in Oxfordshire. They presented over 13 months to accident and emergency departments, or were admitted to hospital. All were diagnosed as having suffered a head injury. OUTCOME MEASURES: The Rivermead Head Injury Follow Up Questionnaire and the Rivermead Post Concussion Symptoms Questionnaire. RESULTS: Data are given on age, sex, social circumstances, employment, cause of injury, severity of associated injuries, post-traumatic amnesia (PTA), anticonvulsants, postconcussion symptoms and activities of everyday life. Outcome at six months was significantly worse for those who had been assaulted as against all other causes of injury combined (p = 0.0001); and/or had been admitted to hospital (p = 0.0001)l and/or had sustained more severe additional injuries (p = 0.04); and/or had experienced any PTA (p = 0.00001). The minimum incidence of such injuries in those aged 16-65, calculated for Oxfordshire, is 292 per annum (74/100,000 aged 16-65 per year). CONCLUSIONS: In the general population 52/100,000 patients per annum will experience more serious head injuries as indicated by hospital admission and/or one or more fractures and/or any length of PTA and/or having been assaulted. This group may benefit from monitoring and support and their needs should be considered when planning services.

Accidents↗
PubMed1998

A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study.

OBJECTIVE: To use a pilot study to compare two physiotherapy approaches to improve walking in patients with gait disturbance due to multiple sclerosis (MS). DESIGN: Patients were assessed and then randomly assigned to one of two groups using a block randomization technique. They were treated by the research physiotherapist for a minimum of 15 treatments over a 5-7-week period and then reassessed by an independent therapist one week after treatment. SETTING: Both assessment and treatment were undertaken at a specialist rehabilitation centre. SUBJECTS: Outpatients with clinically stable MS (chronic progressive or relapsing-remitting types) who were referred for physiotherapy to improve their mobility. INTERVENTION: Comparison was between a facilitation (impairment-based) approach and a task-oriented (disability-focused) approach. OUTCOME: Mobility was assessed using four measures: the 10-metre timed walk, the Rivermead Mobility Index, stride length and the Rivermead Visual Gait Assessment. Balance was assessed using the Berg Balance Test. RESULTS: Twenty-three patients were entered, and 10 in each group completed the study. The groups were similar on all measured items both before and after treatment. There was no significant difference in improvement between the two approaches. Following treatment, patients in both groups showed a significant overall improvement (p < 0.05) in both impairment and disability measures. CONCLUSIONS: No significant differences in effectiveness between the two methods were demonstrated. Both a task-oriented approach and a facilitation approach to the treatment of MS outpatients were associated with improved mobility.

Disability Evaluation↗