Epidemiology of disabling neurological disease: how and why does disability occur?
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Disability Evaluation↗
Biomedical subjects
D T Wade
Publications and source records attributed to D T Wade.
The Oxfordshire Head Injury Register.
This paper looks at the process of setting up a Head Injury Register whose aims are: (1) to identify reliably and rapidly patients who have sustained a head injury so that service can be offered to them; and (2) to obtain epidemiological data to identify needs and inform future service planning and development. The register records all cases of head injury in patients aged 16-65, regardless of severity, which present to hospital services in Oxfordshire whether or not admitted as inpatients. It was set up as part of a research project into the value of providing an early follow-up service for head injury patients. The paper highlights the difficulty of identifying these patients reliably. It details the administrative and technological problems encountered, together with some of their solutions.
Craniocerebral Trauma↗
The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability.
After head injuries, particularly mild or moderate ones, a range of post-concussion symptoms (PCS) are often reported by patients. Such symptoms may significantly affect patients' psychosocial functioning. To date, no measure of the severity of PCS has been developed. This study presents the Rivermead Post Concussion Symptoms Questionnaire (RPQ) as such a measure, derived from published material, and investigates its reliability. The RPQ's reliability was investigated under two experimental conditions. Study 1 examined its test-retest reliability when used as a self-report questionnaire at 7-10 days after injury. Forty-one head-injured patients completed an RPQ at 7-10 days following their head injury and again approximately 24 h later. Study 2 examined the questionnaire's inter-rater reliability when used as a measure administered by two separate investigators. Forty-six head-injured patients had an RPQ administered by an investigator at 6 months after injury. A second investigator readministered the questionnaire approximately 7 days later. Spearman rank correlation coefficients were calculated for ratings on the total symptom scores, and for individual items. High reliability was found for the total PCS scores under both experimental conditions (Rs = + 0.91 in study 1 and Rs = + 0.87 in study 2). Good reliability was also found for individual PCS items generally, although with some variation between different symptoms. The results are discussed in relation to the major difficulties involved when looking for appropriate experimental criteria against which measures of PCS can be validated.
Adolescent↗
Unilateral somatoparaphrenia after right hemisphere stroke: a case description.
We report a case of somatoparaphrenia in a 41 year-old man after right temporo-parietal stroke. An elaborate system of delusional beliefs was observed concerning the initially paralysed left leg, arm, and hand. The course of these beliefs is analysed as the patient progresses from a full-blown delusional state to having excellent insight into his condition. We outline the types of explantation that seem required to understand how somatoparaphrenic beliefs can arise.
Adult↗
Reduplication of an event after head injury? A cautionary case report.
We report the case of a 69 year-old man who suffered head trauma in a road-traffic accident. Subsequently, there was personality change, memory-impairment and the persisting 'delusion' that he had been involved in an earlier car-accident. On the basis of detailed interviews with the patient (and his wife), we provide an explicit account of how the content of his reduplicative paramnesia could have arisen. We are concerned to stress that the patient's 'delusion' is a belief held on reasonable grounds.
Accidents, Traffic↗
Sensory disorganization and perceptual plasticity after limb amputation: a follow-up study.
We report a follow-up study of a patient who initially suffered from carpal tunnel syndrome in the right hand, that was alleviated by surgery. Subsequently, the patient's right arm was amputated, and a phantom limb was experienced. Originally, stimuli applied to different areas on the right side of the face evoked sensations that were referred to the phantom by precise topographic mapping. On follow-up, one year after our initial studies, the topography of referred mapping had become extremely disorganized. Furthermore, a new, equally disorganized, pattern of referred sensations was now found upon stimulation of the left side of the face.
Adult↗
Enhanced physical therapy for arm function after stroke: a one year follow up study.
Ninety seven patients with stroke who had participated in a randomised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year. Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life, the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year. This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly. It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment. This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation.
Aged↗
Diminution and enhancement of visuo-spatial neglect with sequential trials.
We report three cases of visuo-spatial neglect after unilateral right hemisphere damage. Each patient undertook 100 sequential trials of line bisection. All patients were grossly impaired, placing their transections of the longer lines significantly to the right of true centre. When the trials were analysed in two consecutive halves, one patient showed only minimal differences in accuracy between the two blocks. One patient improved greatly on the second block, and one patient became significantly worse. The results are discussed in terms of differential "learning" and "fatigue" effects, and their clinical significance is outlined.
Attention↗
Thumb in cheek? Sensory reorganization and perceptual plasticity after limb amputation.
We describe a patient who initially suffered from carpal tunnel syndrome that was alleviated by surgery. Subsequently, the patient's right arm was amputated and a phantom limb emerged. Stimuli applied to different areas of the face gave rise to sensations that were referred to the phantom by precise topographic mapping. This perceptual mapping of the (phantom) hand onto the face area modelled the form of prior pathology due to carpal tunnel syndrome. The findings have implications for the relief of phantom pain.
Adult↗
Neurologic rehabilitation.
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Brain Damage, Chronic↗
Measurement in neurologic rehabilitation.
The increasing emphasis on evaluating outcomes has led to the development of standardized health status measures. Before using one it is vital to check its suitability for the intended purpose. Will the measure detect the change or difference expected? Other more specific measures should be considered. Some focus on common impairments, such as cognitive dysfunction, whereas others focus on disabilities seen with specific pathologies such as head injury. Developing new measures is difficult and should be avoided if possible.
Adolescent↗
Three arms: a case study of supernumerary phantom limb after right hemisphere stroke.
A case of supernumerary phantom limb is described after a haematoma within the right basal ganglia. The phantom, which persisted for many months, occurred in the context of severe left hemiplegia, sensory loss, hemianopia, and neglect. The subjective reality of this "third arm" caused the patient considerable distress, which was not ameliorated by his attempts to rationalise its existence. Although deeply confused by the phantom, the patient was otherwise fully oriented, with a high verbal IQ, and normal cognition. Two distinct formal interpretations of the phenomenon are discussed.
Aged↗
Services for people with stroke.
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Cerebrovascular Disorders↗
Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project.
BACKGROUND AND PURPOSE: There have been relatively few community-based studies of long-term prognosis after acute stroke. This study aimed to provide precise estimates of the absolute and relative risks of dying in an unselected cohort of patients with a first-ever stroke. METHODS: Six hundred seventy-five patients were registered by a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed up for up to 6.5 years. Their relative risk of death was calculated using age- and sex-specific mortality rates for Oxfordshire. RESULTS: During the first 30 days, 129 (19%) patients died. Patients who survived at least 30 days after a first-ever stroke thereafter had an average annual risk of death of 9.1%, 2.3-fold the risk in people from the general population. Although the absolute (about 15%) and relative (about threefold) risks of death were highest in these 30-day survivors over the first year after the stroke, they were at increased risk of dying over the next few years (range of relative risk for individual years, 1.1-2.9). Predictably, older patients had a worse absolute survival but, relative to the general population, stroke also increased the relative risk of dying in younger patients. During the first 30 days stroke accounts for most deaths; after this time nonstroke cardiovascular disease becomes increasingly important and is the most common cause of death after the first year. CONCLUSIONS: These data highlight the importance of long-term secondary prevention of vascular events in stroke patients, targeted as much at the cardiovascular as at the cerebrovascular circulation.
Age Factors↗
Is stroke rehabilitation worthwhile?
Rehabilitation is an educational problem-solving process that focuses on disability and aims to minimize the patient's disability and distress and the stress on family members. There is established evidence that rehabilitation helps individual patients, and now there is good evidence that applying rehabilitation policies generally improves outcome in groups of patients. Moreover, well-organized specialist rehabilitation is efficient because total resources are reduced.
Cerebrovascular Disorders↗
Stroke: rehabilitation and long-term care.
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Cerebrovascular Disorders↗
Physiotherapy intervention late after stroke and mobility.
OBJECTIVE: To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke. DESIGN: Randomised crossover trial comparing two groups offered intervention by a physiotherapist, one immediately after entry into the trial and the other after a delay of three months. The intervention consisted of identifying problems and offering advice and help to solve the problems. SETTING: Patients' homes in Oxfordshire. SUBJECTS: Patients who had reduced mobility due to a stroke more than one year before entry; 60 were recruited from a community stroke register and 34 in other ways. MAIN OUTCOME MEASURES: Standard measures of mobility including gait speed, functional ambulation categories, the Nottingham extended activities of daily living index, and individual items from the Barthel activities of daily living index and the Frenchay activities index. Measures of manual dexterity, depression, and anxiety were used as controls. RESULTS: 94 patients entered the trial and 49 were randomised to immediate and 45 to delayed physiotherapy; 89 were compared at the crossover point. At randomisation the two groups were comparable. At three months the group given early therapy showed an improvement in gait speed whereas the untreated group had declined (differences of -3.9 v 6.4 s to walk 10 m; p less than 0.01); between three and six months the group given delayed therapy showed improvement and the previously treated group declined (differences of 6.5 v -3.9 s to walk 10 m; p less than 0.01). A 9% (95% confidence interval 0% to 18%) decrease in time taken to walk 10 m was associated with treatment and a 12% (2% to 19%) increase when patients were untreated. Other measures did not change significantly. CONCLUSION: Intervention of an experienced physiotherapist late after stroke specifically improves mobility, albeit by a small amount, but the effects do not seem to be maintained, perhaps because there is an underlying decline in mobility in these patients. Gait speed offers a simple and sensitive measure of outcome.
Activities of Daily Living↗
Visuo-spatial neglect: qualitative differences and laterality of cerebral lesion.
From a large sample of patients who sustained a first stroke, 98 patients were selected with unilateral left brain damage and 92 with unilateral right brain damage. Examined on a visual search task (Star Cancellation) approximately four years after onset, we found a comparable incidence of visual inattention in the two groups. Despite this quantitative similarity, the qualitative pattern of performance was different in the two impaired samples. Patients with right brain damage showed a distinctive linear relationship whereby omission errors increased from right to left across the stimulus page. Within the left brain damaged sample, two subgroups could be discerned. As expected, one subgroup showed more contralesional than ipsilesional errors, but the other subgroup was comparable to the sample with right hemisphere damage. The reasons are discussed for these qualitative differences, drawing particular attention to the importance of motor/manual factors in the determination of performance on visual search tasks.
Aged↗