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Latest & greatest articles for stroke rehabilitation
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, representing a 15 fold cost increase compared to controls 5 . Of note, this figure does not capture costs of families including loss of income, reduced employment, rehabilitation expenses, and psychosocial consequences for child and family. Costs are higher for childhood than for neonatal stroke, and higher for haemorrhagic than ischaemicstroke 5 . Higher costs correlate with worse impairment, emphasising the importance of rehabilitation to maximise recovery 6 . The key difference between children (...) population This guideline addresses the subacute management and care of acute arterial ischaemicstroke and non-traumatic intracranial haemorrhage in children (aged 29 days to 18 years or until school completion). The scope of this guideline does not include perinatal (aged 28 days or younger at stroke onset), subdural haemorrhage secondary to trauma, spinal stroke syndromes or cerebral venous thrombosis without infarction.Victorian Subacute Childhood Stroke Guidelines 8 3. METHODOLOGY 3.1. G u i d e l i
Stereotactic radiosurgery SSNAP Sentinel Stroke National Audit Programme STOP Stroke Prevention Trial in Sickle Cell Anaemia SWiTCH trial Stroke With Transfusions Changing to Hydroxyurea trial TAC/F Team Around the Child/Family TBI Traumatic brain injury TCD Transcranial Doppler ultrasonography TIATransientischaemicattack TIPS trial Thrombolysis in Pediatric Stroke trial TMS Transcranial magnetic stimulation tPA Tissue plasminogen activator UKHCDO United Kingdom Haemophilia Centre Doctors' Organisation (...) assessment 38 5.2 Framework for early functional assessment 41 vi 5.3 Prevention, identification and management of complications 45 6. Arterial IschaemicStroke 49 6.1. Conditions and factors associated with a risk of AIS or recurrence 49 6.2. Medical and surgical interventions 59 7. Haemorrhagic Stroke 75 7.1. Conditions and factors associated with a risk of HS or recurrence 75 7.2. Medical and surgical interventions 82 8. Discharge from hospital 99 8.1. Discharge 99 9. Rehabilitation 103 9.1. Framework
A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use (...) of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges.Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies
Cognitive rehabilitation for memory deficits after stroke. Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.Some studies have reported positive results of cognitive rehabilitation for memory problems, but the results obtained from previous systematic reviews have been (...) less positive and they have reported inconclusive evidence. This is an update of a Cochrane review first published in 2000 and most recently updated in 2007.To determine whether participants who have received cognitive rehabilitation for memory problems following a stroke have better outcomes than those given no treatment or a placebo control.The outcomes of interest were subjective and objective assessments of memory function, functional ability, mood, and quality of life. We considered
with recreational therapy on motor recovery in patients after an acute ischaemic stroke.In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemicstroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient strokerehabilitation units from four countries (Canada , Argentina , Peru , and Thailand ). Participants were (...) discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups.In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function
Inpatient rehabilitation following operative spontaneous spinal epidural hematoma mimicking stroke: a case report Spontaneous spinal epidural hematoma (SSEH) is a rare cause of spinal cord compression. Symptoms may include sudden-onset axial pain followed by neurologic involvement including weakness, numbness and incontinence. Here we report the case of a patient followed prospectively after surgical intervention following SSEH and recovery following inpatient rehabilitation. This patient
Strokerehabilitation: maximizing arm and hand function after strokeStrokerehabilitation: maximizing arm and hand function after stroke - Evidently Cochrane Search and hit Go By June 28, 2016 // In the third guest blog of our new series Evidence for Everyday Allied Health (#EEAHP), occupational therapist Danny Minkow looks at evidence on interventions to improve upper limb function after stroke. Stroke is the leading cause of disability in developed countries. The effects of stroke (...) healthcare providers a succinct overview of the typical interventions for stroke to rehabilitate the upper limb. So what did they find? Good news and bad news. The bad news is they found that: “There is no high quality evidence for any interventions that are currently routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions.” In other words, the evidence is insufficient to show which of the interventions are the most effective for improving upper
What makes strokerehabilitation patients complex? Clinician perspectives and the role of discharge pressure Approximately 80% of people who survive a stroke have on average five other conditions and a wide range of psychosocial issues. Attention to biopsychosocial issues has led to the identification of 'complex patients'. No single definition of 'patient complexity' exists; therefore, applied health researchers seek to understand 'patient complexity' as it relates to a specific clinical (...) context.To understand how 'patient complexity' is conceptualized by clinicians, and to position the findings within the existing literature on patient complexity.A qualitative descriptive approach was utilized. Twenty-three strokerehabilitation clinicians participated in four focus groups.Five elements of patient complexity were identified: medical/functional issues, social determinant factors, social/family support, personal characteristics, and health system factors. Using biopsychosocial factors
Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits.To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation.Phase 3, pragmatic, single-blind (...) SIS, 4%; 95% CI, -9% to 16%; P = .48; and DEUCC vs UCC: WMFT, -2.1 seconds; 95% CI, -4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, -9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study.Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either
A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally (...) enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology-enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke
to span the entire course of rehabilitation, from the early actions taken in the acute care hospital through reintegration into the community. The end of formal rehabilitation (commonly by 3–4 months after stroke) should not mean the end of the restorative process. In many respects, stroke has been managed medically as a temporary or transient condition instead of a chronic condition that warrants monitoring after the acute event. Currently, unmet needs persist in many domains, including social (...) , and the initiation of prophylactic and preventive measures. Although the delivery of rehabilitation therapies (OT/PT/SLT) is generally not the first priority, data strongly suggest that there are benefits to starting rehabilitation as soon as the patient is ready and can tolerate it. The cardinal feature of acute inpatient care for stroke patients in the United States is its brevity; the median length of stay for patients with ischemicstroke in only 4 days. Regardless of whether rehabilitation is started during
. The end of formal rehabilitation (commonly by 3–4 months after stroke) should not mean the end of the restorative process. In many respects, stroke has been managed medically as a temporary or transient condi- tion instead of a chronic condition that warrants monitoring after the acute event. Currently, unmet needs persist in many domains, including social reintegration, health-related qual- ity of life, maintenance of activity, and self-efficacy (ie, belief in one’s capability to carry out a behavior (...) , the delivery of acute stroke treatments, and the initiation of pro- phylactic and preventive measures. Although the delivery of rehabilitation therapies (OT/PT/SLT) is generally not the first priority, data strongly suggest that there are benefits to starting rehabilitation as soon as the patient is ready and can tolerate it. 11 The cardinal feature of acute inpatient care for stroke patients in the United States is its brevity; the median length of stay for patients with ischemicstroke in only 4 days
[Cognitive rehabilitation in cognitive deficit secondary to stroke] Rehabilitación cognitiva en déficit cognitivo secundario a accidente cerebrovascular [Cognitive rehabilitation in cognitive deficit secondary to stroke] Rehabilitación cognitiva en déficit cognitivo secundario a accidente cerebrovascular [Cognitive rehabilitation in cognitive deficit secondary to stroke] Ruano Gándara R, Rey-Ares L, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López (...) A Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Ruano Gándara R, Rey-Ares L, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A. Rehabilitación cognitiva en déficit cognitivo secundario a accidente cerebrovascular. [Cognitive rehabilitation in cognitive deficit secondary to stroke] Buenos Aires: Institute
Ward-based interventions for patients with hemispatial neglect in strokerehabilitation: A systematic literature review To identify rehabilitation interventions that can be integrated into ward-based nursing for patients with hemispatial neglect following stroke in the right brain hemisphere.A systematic review of interdisciplinary literature.A preliminary literature search without time limits was conducted in the Cochrane Controlled Trials Register. We then searched the PubMed, CINAHL (...) and computer-based training (Grade C); and (11) visual scanning training (Grade D).A total of 11 promising rehabilitation interventions were found. Encouraging results were, in particular, seen with smooth pursuit eye-movement training. It should be noted that the general low level of evidence and the diversity of interventions makes it difficult to endorse specific priorities and combinations for implementation. Instead, interventions should be applied after careful evaluation of each patient's unique
Strokerehabilitation at home before and after discharge reduced disability and improved quality of life: A randomised controlled trial To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care.Interventional, randomised, safety/efficacy open-label trial.University hospital stroke unit in collaboration with three municipalities.Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than (...) three days and in need of rehabilitation.Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients.Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100
Home-based versus centre-based rehabilitation for community-dwelling postacute stroke patients: an economic rapid review Home-based versus centre-based rehabilitation for community-dwelling postacute stroke patients: an economic rapid review Home-based versus centre-based rehabilitation for community-dwelling postacute stroke patients: an economic rapid review Ghazipura M Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation Ghazipura M. Home-based versus centre-based rehabilitation for community-dwelling postacute stroke patients: an economic rapid review. Toronto: Health Quality Ontario (HQO). Economic Rapid Review. 2015 Authors' conclusions Due to the lack of cost-utility studies comparing home-based versus centre-based rehabilitation for community dwelling postacute stroke patients, this study is unable to establish a cost per
Home-based versus centre-based rehabilitation for community- dwelling postacute stroke patients: a rapid review Home-based versus centre-based rehabilitation for community- dwelling postacute stroke patients: a rapid review Home-based versus centre-based rehabilitation for community- dwelling postacute stroke patients: a rapid review Ghazipura Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality (...) of this assessment has been made for the HTA database. Citation Ghazipura. Home-based versus centre-based rehabilitation for community- dwelling postacute stroke patients: a rapid review. Toronto: Health Quality Ontario (HQO). Rapid Review. 2015 Authors' conclusions On the basis of one SR comparing home-based rehabilitation to centre-based rehabilitation in community dwelling stroke patients, the following conclusions were reached: Low quality evidence indicates that community dwelling stroke patients receiving