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Biomedical subjects

Derick T Wade

Publications and source records attributed to Derick T Wade.

35 records · Page 2Linked to original sources
PubMed2003

Selection criteria for rehabilitation services.

In an era of inadequate resources for all health services, rehabilitation services providers are frequently asked to produce criteria defining the patients they will accept. In principle rationing of services by ability to benefit is fair. In practice there are many difficulties. The evidence to allow selection of patients for rehabilitation does not exist and probably the best criterion of ability to benefit from rehabilitation (not 'likely to have a good outcome') is demonstration of benefit within a rehabilitation programme. Basic considerations of epidemiological statistical facts also show that criteria are likely to select too many inappropriate patients into services or exclude too many appropriate patients from services. The solution is for purchasers and providers to develop mutual trust and, in the UK at least, to ensure that patients who do not need rehabilitation can be discharged quickly into appropriate support services.

Cost-Benefit Analysis↗
PubMed2003

New wine in old bottles: the WHO ICF as an explanatory model of human behaviour.

The World Health Organization's International Classification of Functioning (WHO ICF) is a good but incomplete framework for describing the situation of someone with long-term ill health. Several deficiencies exist for which improvements are suggested. The WHO needs to integrate the ICF with the ICD-10 to form a comprehensive system of classification of illness. Words are needed for normality at the level of organ and person, and the words 'histology' and 'physiology', and 'anatomy' and 'capacity' are suggested for the two levels respectively. A fourth context, that of time, is needed to understand fully a person's situation. The classification framework needs to take more account of the patient. It needs to recognize two separate perspectives, that of the subject and that of external observers and it needs to recognize two other specific person-centred phenomena: free will and quality of life. With changes and additions to take account of these deficiencies, the WHO ICF can be used as a powerful analytic and explanatory model of human experience and behaviour in any situation, not only in illness and disease.

Activities of Daily Living↗
PubMed2003

The effect of a perceptual cognitive task on exercise performance: the dual-task condition after brain injury.

OBJECTIVE: To examine the effect of additional cognitive demand on cycling performance in individuals with acquired brain injury (ABI). DESIGN: Prospective observational study. SETTING: Rivermead Rehabilitation Centre. PARTICIPANTS: Ten individuals with ABI (7 men, 3 women) (traumatic brain injury 7, tumour 1, stroke 2) and 10 healthy controls (6 men, 4 women). INTERVENTION: Individuals were asked to maintain a set cadence during a three-stage incremental cycling test in both single-task (no additional task) and dual-task (whilst performing an additional cognitive task) conditions. RESULTS: The ABI group showed a slight slowing in cadence in stages 1 and 3 of the graded exercise test from the single- to the dual-task condition, although this was not significant (p < or = 0.05). The control group showed no slowing of cadence at any incremental stage. When directly comparing the ABI with the control group, the change in cadence observed in dual-task conditions was only significantly different in stage 3 (p < or = 0.05). CONCLUSIONS: Clinicians should be aware of the possibility that giving additional cognitive tasks (such as monitoring exercise intensity) while individuals with acquired brain injury are performing exercises may detrimentally affect performance. The effect may be more marked when the individuals are performing exercise at higher intensities.

Brain Injuries↗
PubMed2003

Life goals of people with disabilities due to neurological disorders.

OBJECTIVE: To identify the life goals of people with long-term neurological disabilities and to correlate them with measures of disability. DESIGN: Cross-sectional descriptive study. SETTING: Centre for continuing disability management SUBJECTS: Patients with static or progressive neurological disorders. INTERVENTIONS: Survey using questionnaires and disability scales. MEASURES: Life goals were identified with a life goals questionnaire. Subjects were also assessed using the Barthel Index, Rivermead Extended Activities of Daily Living Index, Rivermead Mobility Index, Short Orientation Memory Concentration test and Hospital Anxiety and Depression Scale. RESULTS: Ninety-three subjects participated in the study. The frequency with which goals were chosen as extremely important was: family 64; personal care 59; residential arrangements 58; partner 53; social contacts 30; financial status 29; leisure 26; religion 22; and work 19. Positive correlation was noted between stated importance of: personal care and independence in ADL; work and independence; partner and cognitive ability; religion and age; and financial status and anxiety. There was negative correlation between grades of personal care and depression, work and age, residential arrangements and RMI, and social contact and anxiety and depression. Depressed patients rated fewer goals as being of extreme importance. CONCLUSIONS: People with disabilities attach great significance to relationships and personal care. Grades of life goals correlated with measures of disability, cognition and emotion.

Activities of Daily Living↗
PubMed2003

The effect of increasing effort on movement economy during incremental cycling exercise in individuals early after acquired brain injury.

OBJECTIVE: To investigate the effect of increasing effort on energy cost as measured by oxygen consumption (VO2) during cycling exercise in individuals early after acquired brain injury (ABI). DESIGN: An experimental correlation design. SETTING: Specialist neurorehabilitation centre. PARTICIPANTS: Thirty-eight individuals were recruited early after acquired brain injury. Nine individuals had spasticity; Ashworth Scale >1 in either upper or lower limbs. INTERVENTION: The VO2 was measured in relation to workload during a graded exercise test. RESULTS: The VO2 increased in a linear fashion with increases in workload in 34 individuals. Only one individual with spasticity demonstrated a nonlinear relationship. CONCLUSION: Increasing the workload during cycling exercise does not disproportionately increase energy cost in most individuals with spasticity early after ABI.

Activities of Daily Living↗
PubMed2003

Relative contribution of footwear to the efficacy of ankle-foot orthoses.

OBJECTIVE: To examine the relative effects of footwear and an ankle-foot orthosis (AFO) on hemiplegic gait. DESIGN: A case series with three contrasting conditions: walking without footwear, with footwear alone, and with footwear and an AFO. Spatio-temporal parameters reflecting walking performance were analysed using an analysis of variance (ANOVA). PATIENTS: Five patients with hemiplegia and reduced mobility following stroke. SETTING: A specialist rehabilitation centre. INTERVENTION: Wearing either footwear alone, or footwear with an AFO. MEASURES: Video recordings of gait were subjected to a kinematic analysis to determine spatio-temporal parameters. RESULTS: Stride length was increased by an average of 5 cm when wearing footwear. An additional 5-cm increase was also observed when wearing an AFO. Swing velocity was also affected by the manipulation. CONCLUSIONS: The appropriate comparative baseline for assessing the efficacy of an AFO is subjects walking with existing footwear and not barefoot.

Adult↗
PubMed2003

Changes in life goals of people with neurological disabilities.

OBJECTIVE: To investigate the relationship between changes in life goals and progression of disabilities among subjects with neurological disorders over a period of four years. DESIGN: Retrospective study. SETTING: A centre for continuing disability management in the UK. SUBJECTS: Patients with static or progressive neurological disabilities. INTERVENTIONS: Review of rehabilitation team notes. MAIN OUTCOME MEASURES: Barthel ADL Index and Rivermead Life Goals Questionnaire from four consecutive annual assessments from 1997 to 2000. RESULTS: Thirty-two subjects had progressive disabilities and 24 had static disabilities. In subjects with static disabilities there was no significant change in grades of any of the life goals over a period of four years. Among subjects with progressive disabilities, significant reductions were noted in importance given to partner (p = 0.034), work (p = 0.008) and leisure (p = 0.028) over four years. While there was no significant change in number of life goals considered as extremely important in subjects with static disabilities, there was a significant reduction in number of goals considered as extremely important in subjects with progressive disabilities (p = 0.022) CONCLUSION: People with progressive disabilities tend to downgrade the significance attached to goals related to partner, work and leisure. They also reduce number of goals graded as extremely important. This change is not seen in people with static disability.

Activities of Daily Living↗
PubMed2002

RIVCAM: a simple video-based kinematic analysis for clinical disorders of gait.

This paper describes the development of and reports on the accuracy of the Rivermead video-based clinical gait analysis method (RIVCAM), a simple and comparatively inexpensive movement recording system, which operates at 50 Hz. The system comprises five basic steps; firstly subjects are recorded using a PAL video camera with white markers affixed to the leg. Second, the video footage is digitised onto a computer. Thirdly, a program analyses each frame of footage to locate the position of white markers located on the subject's leg. Fourth, the data are calibrated (turned into real world co-ordinates) and the markers on the legs are identified (such as, heel, toe, etc.). Finally, a kinematic analysis is performed on the data, which not only produces a range of relevant spatio-temporal parameters (such as gait velocity, cadence and stride length), but also determines the joint angles at the hip, knee and ankle during the gait cycle. Overall the system has a reasonable constant and variable error; in a recorded scene measuring 2.6 x 1.6 m and divided into a 3 x 3 grid, a 400 mm bar was recorded, on average, as being 401.1 mm with a standard deviation (S.D.) of 2.97 mm. Although not without shortcomings when compared with more expensive and complicated systems, the RIVCAM system represents a valid, reliable and affordable way of collecting objective measures of gait in a busy therapy setting.

Adult↗
PubMed2002

Correlation between motor improvements and altered fMRI activity after rehabilitative therapy.

Motor rehabilitation therapy is commonly employed after strokes, but outcomes are variable and there is little specific information about the changes in brain activity that are associated with improved function. We performed serial functional MRI (fMRI) on a group of seven patients receiving a form of rehabilitation therapy after stroke in order to characterize functional changes in the brain that correlate with behavioural improvements. Patients were scanned while performing a hand flexion-extension movement twice before and twice after a two-week home-based therapy programme combining restraint of the unaffected limb with progressive exercises for the affected limb. As expected, the extent of improvement in hand function after therapy varied between patients. Therapy-related improvements in hand function correlated with increases in fMRI activity in the premotor cortex and secondary somatosensory cortex contralateral to the affected hand, and in superior posterior regions of the cerebellar hemispheres bilaterally (Crus I and lobule VI). fMRI offers a promising, objective approach for specifically identifying changes in brain activity potentially responsible for rehabilitation-mediated recovery of function after stroke. Our results suggest that activity changes in sensorimotor regions are associated with successful motor rehabilitation.

Adult↗
PubMed2002

The Guy's Neurological Disability Scale in patients with multiple sclerosis: a clinical evaluation of its reliability and validity.

OBJECTIVE: To establish reliability and validity of the Guy's Neurological Disability Scale (GNDS) for the assessment of patients with multiple sclerosis (MS) and to investigate whether it can be used by postal questionnaire. DESIGN: An observational study assessing one group of 22 patients using the GNDS face-to-face, repeating the assessment two or three weeks later with other tests; and assessing a second group of 21 patients first using a postal version of the GNDS and then seeing them face-to-face. SETTING: Patients in the community attending a day centre or a voluntary support group. SUBJECTS: Patients with multiple sclerosis. MEASURES: The GNDS was the primary measure, and was compared with the Barthel Index, the Expanded Disability Status Scale (EDSS), the Short Orientation Concentration and Memory Test, the Nine-hole Peg Test, the Rivermead Mobility Index, the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale, visual acuity assessment, swallowing 50 ml of water, and a clinical assessment of dysarthria. RESULTS: The test-retest reliability of the GNDS total score (r= 0.972) and each of its components (r varied from 0.685 to 0.987) was good. When compared with the EDSS or the Barthel, the GNDS had good validity (respectively r = 0.636 and r = -0.757). The validity was also measured for the different areas of the GNDS by comparison with corresponding indices or test. The results varied from good to excellent (r from -0.557 to 0.910). The results were only a little less reliable when a postal questionnaire was used. CONCLUSION: The GNDS is a valid and reliable tool for the assessment of MS patients. The test-retest correlation varies from good to excellent. It can be used as postal questionnaire even if, as expected, the interviewer-administered method shows slightly better results.

Adult↗
PubMed2002

Cognitive assessment and neurological rehabilitation.

Two recent studies evaluating cognitive assessment in patients with multiple sclerosis and stroke found no benefit from providing information derived from a full cognitive assessment, and one study also failed to find any benefit following specific 'cognitive treatments'. These studies might suggest that rehabilitation teams do not need clinical psychologists. However it is already known that isolated assessment does not affect outcome, and the nature and context of the assessments and interventions in these studies simply reinforces this. Thus, given the frequency of cognitive deficits in these patients and given the strong evidence in favour of multidisciplinary teamwork in rehabilitation, these studies could be used as strong evidence that clinical psychologists should be integral members of all neurological rehabilitation teams.

Cognition Disorders↗
PubMed2002

Delayed discharges from Oxford city hospitals: who and why?

OBJECTIVE: To determine the extent and characteristics of discharge delays of younger patients from acute hospital beds in Oxford, England. DESIGN: Three-month prospective analysis of patients deemed to have delayed discharge. MEASURES: The primary measure was the number of days from the patient being no longer in need of acute medical inpatient care to eventual discharge. Additional assessments included demographic data, primary diagnosis, Motricity Index, Short Orientation-Memory-Concentration Test (SOMC), Barthel Index and contextual data. SETTING: The major acute hospitals serving the county of Oxfordshire (560,000 people). SUBJECTS: Fifty patients aged 18-70 years identified by referrals, delayed discharge lists and ward visits whose discharge from hospital had been delayed. RESULTS: The mean (standard deviation, SD) delay period was 36.1 (26.8) days. The mean prevalence and incidence of discharge delays for each three-day period was 19.7 (SD 1.7) and one (SD 1.7) respectively. Most (88%, n = 44) had a primary neurological diagnosis. Twenty-four (48%) patients had Motricity Index scores of less than 50% in one or more limbs and 16 (32%) in two or more limbs. Twenty-six (52%) patients had cognitive impairment (SOMC <18/28). Thirty-nine (78%) patients had a Barthel Index score of less than 15/20 and 24 (48%) of less than 10/20. The period of discharge delay did not correlate with SOMC, Motricity or Barthel Index scores. Only nine had appropriate accommodation available. CONCLUSION: Patients whose discharge is delayed were common; most had a neurological disability and cognitive impairment; and accommodation was unsuitable or absent for most. Reorganizing services to give patients access to specialized disability services might both improve the care of these patients and increase the efficiency of the health service.

Adolescent↗
PubMed2002

Diagnosis in rehabilitation: woolly thinking and resource inequity.

The diagnostic process in rehabilitation has traditionally been termed assessment. However the goals of assessment are no different to the goals of diagnosis in traditional medical practice. The purpose is, in both instances, to acquire sufficient information to understand the cause(s) of the presenting problem(s), to allow more-or-less specific intervention(s) to be undertaken and, where appropriate, to allow a prognosis to be given. The main difference is that in rehabilitation the presenting problems are limitations in activities and the main items investigated are impairment and contextual matters, whereas in medicine the presenting problems are symptoms, and the goals are the diagnosis and treatment of the underlying disease. Unfortunately it is commonly assumed that rehabilitation diagnosis is simple and unimportant. Consequently few resources are allocated by purchasers to the process of making a rehabilitation diagnosis, in comparison to the huge resources devoted to achieving disease diagnosis.

Disability Evaluation↗
PubMed2002

The Rivermead Assessment of Somatosensory Performance (RASP): standardization and reliability data.

OBJECTIVE: To develop a standardized, clinically relevant, quantitative assessment of somatosensory performance in patients with stroke. DESIGN: Prospective observational study and test evaluation. SETTING: Local Oxford hospitals and a regional neurological rehabilitation centre. SUBJECTS: Stroke patients with a first, lateralized acute stroke in hospital, and age-matched control subjects. METHOD: Each patient was assessed in a structured way using a new battery of formal tests of somatosensory performance. RESULTS: A total of 100 patients and 50 controls were fully investigated. Control subjects performed at or near ceiling on all tests, but patients showed impaired performance on all tests. The Rivermead Assessment of Somatosensory Performance (RASP) showed good intra-rater and inter-rater reliability for all subtests. There were however only weak relationships between scores of sensory impairment and scores of motor impairment or mobility and dependence. CONCLUSIONS: The RASP provides a practical and reliable assessment of sensory loss, which provides the clinician with a comprehensive picture of the patient's performance and can be used to inform and monitor rehabilitation and recovery.

Adult↗
PubMed2002

Rehabilitation is a way of thinking, not a way of doing.

There is strong evidence that the processes used by rehabilitation services are effective at reducing mortality and morbidity, yet purchasers still feel that there is insufficient evidence to warrant buying rehabilitation. Why? Evidence in support of many individual treatments is either weak or absent, but it is important not to conflate evidence about the process with evidence about specific actions. The absence of evidence concerning specific interventions should not be interpreted as meaning that rehabilitation is ineffective, and should certainly not be used as an excuse not to purchase rehabilitation. The evidence strongly suggests that the whole system works and until we have further evidence, the system should be bought as a whole. Further research into specific interventions should continue, but in addition there should be more research attention paid to the rehabilitation process itself.

Humans↗