Biomedical subjects

D T Wade

Publications and source records attributed to D T Wade.

At least 127 records · Page 7Linked to original sources

PubMed1987

Epidemiology of some neurological diseases with special reference to work load on the NHS.

This paper reviews evidence relating to the incidence, prevalence, and likely workload upon the NHS in relation to neurological diseases, particularly those causing long-term disability. Three studies suggest that a population of 250,000 people will contain about 5000 people with disabling neurological disease, of whom 1500 will be sufficiently disabled to require daily assistance. The review highlights the scarcity of reliable information concerning the epidemiology of neurological diseases and their disabilities, and emphasizes the need to plan neurological services at the level of the district general hospital serving a population of 250,000 people.

Brain Neoplasms↗

PubMed1987

Aphasia after stroke: a detailed study of recovery in the first 3 months.

This is a prospective study of recovery of aphasia in 19 stroke patients selected from 117 consecutive hospital admissions by virtue of having significant aphasia and surviving 13 weeks. Aphasia was measured using the Frenchay Aphasia Screening Test (FAST) at frequent intervals from early after stroke. A wide variation in speed and extent of recovery was seen, particularly when compared with mean scores. Patients who made the most recovery had started to improve by 40 days post-stroke. An aphasic patient's FAST score at 13 weeks post-stroke could be predicted from his first score (within 2 weeks).

Adult↗

PubMed1987

The Frenchay Aphasia Screening Test: a short, simple test for aphasia appropriate for non-specialists.

This paper describes preliminary studies on a screening test for aphasia which takes 3-10 minutes to complete and which is suitable for use by general practitioners, junior medical staff and other non-specialists. Data are presented to show that it is a reliable, valid assessment. Using cut-off values derived from normal people, the test is sensitive, but its specificity is limited by such associated factors as hemianopia. Using cut-off values derived from patients known to have aphasia, its specificity is improved. An abnormal result needs to be interpreted in the light of all available clinical information. The test should help identify patients with linguistic disturbance.

Aphasia↗

PubMed1987

The natural history of visual neglect after stroke. Indications from two methods of assessment.

A simple copying task and a measure of position preference on a multiple-choice test were used to assess the incidence of visual neglect after stroke. The patients studied were drawn from a register of strokes occurring in a typical health district. These tests detected visual neglect in 8-11% of patients 3 weeks after stroke and it was more frequent after right-sided rather than left-sided brain damage. Significant neglect was rarely observed by 6 months after stroke but further recovery did occur between 6 months and 1 year. Neglect appeared to exert a slowing influence on rehabilitation and we propose that training procedures to combat neglect should be evaluated for routine use in rehabilitation centres.

Aged↗

PubMed1987

Walking after stroke. Measurement and recovery over the first 3 months.

Sixty surviving patients had their walking ability and speed assessed regularly over the first 3 months after an acute stroke. Sixty-four matched controls were studied to allow categorisation of speed as 'slow' or 'normal'. Fourteen patients never had any significant loss of walking speed; fifteen patients never recovered the ability to walk and one patient remained dependent upon verbal support. Of the 30 showing significant recovery, only 10 regained normal speed, and 8 remained dependent upon a physical aid at 3 months. Plotting individual recovery curves of walking speed over time showed the wide range of change which may be expected. It is argued that timing of gait over 10 metres is a valid reliable measure that is currently underused.

Adult↗

PubMed1987

Who looks after stroke patients?

This article first reviews the evidence concerning who does look after stroke patients, including those at home, and then puts forward a plan for improving the care of all stroke patients.

Cerebrovascular Disorders↗

PubMed1986

Effects of living with and looking after survivors of a stroke.

Information from a two year, longitudinal study on a community sample of patients with acute stroke was analysed to determine the effects of the stroke on the mood of the chief carer (the person living with the patient). Increased anxiety was the most commonly reported change six months after stroke. Significant depression was seen in 11-13% of carers over the first two years after stroke. The patient's functional disability was associated with depression in the carer over the first year but not at two years. A perceived poor recovery by the patient, a low level of general activities by the patient, and depression in the patient were also associated with depression in the carer within the first year. At two years after stroke none of the measured factors were related to a carer's level of depression. Carers of patients who have suffered stroke showed anxiety and emotional distress unrelated to the patient's physical disability after two years. More help from stroke support groups for carers is perhaps needed.

Cerebrovascular Disorders↗

PubMed1986

Services for stroke patients one year after stroke.

The use of community services by stroke patients was investigated one year after their stroke. Survivors from a register of all patients from a defined community were followed up one year after their stroke. Four hundred and thirty six of the 492 survivors were seen: 301 lived at home with someone, 82 lived at home alone, and 53 were in long-stay care. One hundred and forty seven (38%) of those at home were visited by one or more community services, the major ones being district nurse (73), home help (73), day centres (42), and meals on wheels (30). Analysis suggests that these services reach the patients who need most help. However, some 57 (19%) disabled patients are being looked after at home without any outside help.

Activities of Daily Living↗

PubMed1986

Aphasia after stroke: natural history and associated deficits.

Data relating to 976 patients registered as suffering an acute stroke has been analysed to determine the natural history of speech disturbance: these patients came from a community survey of 215,000 people over a 28 month period. Of the 545 patients assessed within 7 days of stroke, 24% were aphasic and 28% unassessable. At 3 weeks, when over 90% of survivors were tested, 20% of those tested had aphasia. At 6 months only 12% of survivors had significant aphasia, but 44% of patients and 57% of carers thought speech was abnormal. Of those aphasic within 7 days, 40% remained so at 6 months; 60% of those aphasic at 3 weeks remained so. There was a high correlation between early and late aphasia scores. Aphasia was associated with more severe disability (degree of limb weakness, loss of function, loss of IQ), and with a less good recovery of social activities, but did not cause any measurable increase in stress upon carers. In a Health District of 250,000 people, about 60 patients each year may be referred for speech therapy after an acute stroke.

Acute Disease↗

PubMed1986

Driving after a stroke.

Four hundred and thirty-eight stroke patients from a community register covering a period of 28 months were interviewed at one year post-stroke. Of 144 (34%) living at home who had been driving prior to their stroke, 82 (58%) did not resume post-stroke. Assessments of arm function, walking, functional ability and IQ showed ex-drivers to be significantly more disabled than drivers. Stopping driving was associated with a loss of social activities and with a higher frequency of depression amongst ex-drivers when compared with drivers. This was despite 79% of ex-drivers having easy access to alternative car transport. Extending mobility allowance to the 49 (60%) ex-drivers over 65 years old at the time of their stroke might ease their situation. More appropriate assessments would be needed to establish whether ex-drivers would benefit from retraining or car adaptations to enable them to return to driving.

Activities of Daily Living↗

PubMed1986

Memory disturbance after stroke: frequency and associated losses.

138 patients who survived an acute stroke had their memory assessed at 3 months. As a group these patients had no impairment of digit span when compared with published age-matched normal data. Immediate logical memory (of a story) was poor in 29 per cent, and 14 per cent could not draw a picture immediately after seeing it. Poor memory function was not associated with more severe strokes, but was associated with poor functional ability on everyday tasks. Poor visual recall was associated with lower abilities at ADL, independent of any effect of age. Statistically significant recovery was detected in immediate logical memory and visual recall between 3 and 6 months.

Activities of Daily Living↗

PubMed1986

Loss of arm function after stroke: measurement, frequency, and recovery.

This study aims to establish the frequency of paralysis and other arm problems after stroke; the recovery of lost function; and to compare various tests of the affected arm. Thirteen per cent of the sample had no arm paralysis when first seen within 14 days. At 3 months 24 per cent of survivors had moderate or severe paralysis; 57 per cent could place nine pegs into holes within 50 seconds; 19 per cent had significant sensory disturbance; 5 per cent had shoulder pain; 8 per cent had restricted passive shoulder movement; and 17 per cent had some paralysis of the dominant arm. Between 3 and 6 months, improvement of motor power was seen in 40 per cent of patients, and 13 per cent of patients improved their function. Severity of initial paralysis was an important prognostic factor.

Aged↗

PubMed1986

Acute stroke.

Explore the source record for details and available documents.

Acute Disease↗

PubMed1986

Stroke: associations with age, sex, and side of weakness.

This study on patients who had strokes investigates the relevance of a patient's age, sex, and the side of any symptoms in association with prestroke status, initial signs, initial disability, and recovery during the first six months. Disability was assessed using the Barthel activities of daily living (ADL) index; non-ADL (social) activities were measured using the Frenchay activities index. Data were collected from 976 patients registered in a community study, and were analyzed statistically using Chi square test, correlation coefficients (for age), analysis of covariance, and two-way analysis of variance. The 469 patients aged 75 years or older included more women (308; p less than 0.001), more who lived alone (147; p less than 0.001), and fewer patients with no prestroke disability (247; p less than 0.001). In this group, the 265 patients who were seen within one week of stroke had a more severe initial disability (p less than 0.001), but not a more severe paralysis. More patients from this age group died (268; p less than 0.001) and more survivors required long-term care. Further analysis showed that older patients made a less good recovery, even after allowing for the correlation between early and six-month Barthel scores (r = +0.41; p less than 0.01). Age had an inverse correlation with level of non-ADL activities at six months (r = -0.365; p less than 0.001). Young women had more severe initial disability (p less than 0.001), but other associations with sex reflected the preponderance of women in the the older age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1985

Controlled trial of a home-care service for acute stroke patients.

In a controlled trial of a home-care service available for the first 6 months after acute stroke, 440 patients received the new service and 417 patients were in the control group. The trial group used more hospital bed days, had a slightly higher admission rate, and did not show better emotional adjustment to stroke than the control group. There was no difference between the 2 groups in stress on relatives. Functional recovery was equal in the 2 groups. A quarter of patients managed at home in each group were severely disabled. Providing a new service does not necessarily alter clinical decisions in the short term, and care should be taken before expanding domiciliary services to reduce hospital use.

Acute Disease↗

PubMed1985

Hospital admission for acute stroke: who, for how long, and to what effect?

Data from 976 patients registered in a community survey as suffering an acute stroke have been analysed to discover what factors are associated with admission to hospital, how long patients spend in hospital, and whether there are any specific benefits attributable to hospital admission. Six hundred and twenty-five patients were admitted on account of their index stroke. These patients were compared with the 249 who remained at home throughout the first six months after the stroke--the remaining patients were admitted for other reasons or had their stroke in hospital. Two major factors related to an increased chance of admission: having a more severe disability and not having a carer. The same factors were associated with a longer length of stay for those who returned home within six months. Nevertheless 26% of patients managed at home were severely disabled when first seen within seven days. Patients admitted had a median stay of seven days if they died, 19 days if they returned home, and 149 days if they needed alternative long-term accommodation. Patients from the study population of 215 000 people occupied an average of 11.4 beds/100 000 over the first six months after their stroke. After making allowance for the increased severity of disability seen in those admitted to hospital, no differences in functional, social or emotional outcome were found for either place of care.

Acute Disease↗

PubMed1985

Recovery after stroke--the first 3 months.

Ninety-nine patients had their function recorded regularly over the first 13 weeks after their stroke. Five functional areas were studied: urinary continence, mobility, the ability to dress, feeding, and the ability to transfer from bed to chair. Thirty-two patients died before 13 weeks. Forty-five of the 67 survivors had assessments twice weekly from within 4 days of their stroke. Recovery in these 45 patients occurred fastest in the first 2 weeks, by which time at least 50% of recovery had occurred, but it was still continuing at 13 weeks. Urinary incontinence present between 7 and 10 days after stroke was the most important adverse prognostic factor both for survival and for recovery of function. Age was the second most important factor. Hospital discharge seemed to occur once recovery had stopped, although four of the 49 patients discharged had been fully independent for at least 12 days prior to discharge. It is suggested that rehabilitative therapy should concentrate less on physical function and more on cognitive ability.

Activities of Daily Living↗

PubMed1985

Social activities after stroke: measurement and natural history using the Frenchay Activities Index.

A method of assessing general (i.e. other than personal care) activities of stroke patients is described: the Frenchay Activities Index (FAI), a scale comprising 15 individual activities summed to give an overall score from 0 (low) to 45 (high). Data from 976 patients with acute stroke were analysed to establish the validity and reliability of the index, and to give information on the level of activities seen before stroke, at 6 months and 1 year post-stroke. Factors related to a lower overall score included loss of functional (ADL) ability, more depression, a lower IQ and, at 1 year, being female.

Activities of Daily Living↗