The assessment of premorbid intellectual ability following right-hemisphere stroke: reliability of a lexical decision task.

Comparing current with estimated premorbid performance helps identify acquired cognitive deficits after brain injury. Tests of reading pronunciation, often used to measure premorbid ability, are inappropriate for stroke patients with motor speech problems. The Spot-the-Word Test (STWT), a measure of lexical decision, offers an alternative approach for estimating premorbid capacity in those with speech problems.

Effect of stroke on family carers and family relationships.

The effects of stroke on families are considerable. Family members may struggle to adapt to a care-giving role, and relationships between stroke survivors and those closest to them are often altered by the illness. This article provides an overview of the effects of stroke on family dynamics and identifies interventions to support stroke survivors and their families during this difficult time.

"Functional electrical stimulation (FES) impacted on important aspects of my life": a qualitative exploration of chronic stroke patients' and carers' perceptions of FES in the management of dropped foot.

Our purpose was to explore the impact of functional electrical stimulation (FES), as applied in the management of dropped foot, on patients with chronic stroke and their carers. A qualitative phenomenological study was undertaken. Participants were recruited from the Lothian FES clinic.

A mixed methods service evaluation of a pilot functional electrical stimulation clinic for the correction of dropped foot in patients with chronic stroke.

Aim: To undertake a service evaluation of the pilot Lothian functional electrical stimulation (FES) clinic using both quantitative and qualitative methods and clinical practice reflection.

Background: Clinical guidelines recommend that FES, for the management of dropped foot after stroke, is delivered by a specialist team. However, little detail is provided about the structure and composition of the specialist team or model of service delivery.

Neurological complications of alcohol and misuse of drugs.

The nature of many of the symptoms associated with substance and alcohol use means that patients often present to neurologists. The frequently catastrophic consequences of overlooking these patients makes this an important cause to identify. Here I will discuss various acute and non-acute substance misuse associated presentations, with particular emphasis on the neurology.

Impaired hypoglycaemia awareness and employment in people with Type 1 diabetes.

Background: Impaired awareness of hypoglycaemia (IAH) is common in adults with Type 1 diabetes mellitus (T1DM) and is a major risk factor for severe hypoglycaemia. Little is known about its effect on employment status.

Aims: To examine the effect that IAH has on the employment status or employability of people with T1DM.

Anoxic brain injury: Clinical patterns and functional outcomes. A study of 93 cases.

Background: Anoxic brain injury (ABI) is a syndrome of diverse aetiology, most case series published to date being confined to ABI of a single aetiology or to a limited numbers of patients.

Methods: This study performed a retrospective analysis on all patients admitted for rehabilitation following ABI over a 14-year period. It identified 93 cases and presents a summary of their clinical patterns and functional and psychometric outcome measures.

Two cases of recurrent stroke in treated giant cell arteritis: diagnostic and therapeutic dilemmas.

It is not established whether the increased risk of stroke in patients with giant cell arteritis (GCA) is because of atherosclerosis, persistent arterial inflammation, or an iatrogenic effect of corticosteroids. This creates difficulties in choosing the most appropriate treatment. We report 2 patients with GCA who developed repeated strokes involving different arterial territories following initiation of corticosteroid therapy, despite resolution of cranial symptoms and normalization of inflammatory markers.

A systematic review of the Heart Manual literature.

Objective: To compare the efficacy of the Heart Manual, a self help, home based cardiac rehabilitation programme, with hospital based cardiac rehabilitation programmes. Comparisons were made on key psychological, behavioural, biological, service and cost outcomes.

Method: A systematic review was conducted.

Repeatability of a new observational gait score for unilateral lower limb amputees.

The aim of this study was to assess the repeatability of an observational gait analysis score that was developed specifically for unilateral amputees. Ten videotaped sequences were analysed by six experienced observers on two separate occasions. Data were analysed using percentage agreement, the kappa statistic and the coefficient of repeatability.

Adherence to pharmacological treatment of non-malignant chronic pain: the role of illness perceptions and medication beliefs.

The objective was to identify the degree to which illness perceptions and medication beliefs explain variations in reported adherence to medication prescribed for the treatment of non-malignant chronic pain and to test the applicability of an extended version of the self-regulatory model to the chronic pain population. A cross-sectional design included 217 clinic patients completing validated questionnaires assessing their illness perceptions, medication beliefs and reported adherence to medication. Perceptions of illness (pain) as chronic, uncontrollable and unremitting were associated with greater adherence, fewer medication concerns and a belief that treatment was necessary.

Zolpidem in a minimally conscious state.

Background: Case reports of the use of zolpidem in Permanent Vegetative States (PVS) have led to interest by the media and court judgements defining treatment with such drugs. It is uncertain whether this paradoxical effect of zolpidem in raising consciousness may be evident in other low awareness states such as Minimally Conscious State (MCS).

Case Study: This study treated a 44 year old male with MCS some 4 years after his traumatic brain injury with zolpidem for 1 week on and 1 week off treatment.

Gender differences in amputation outcome.

Purpose: To assess the influence of gender on the success of limb-fitting after amputation.

Methods: One-hundred and five successive in-patients admitted to an amputee rehabilitation ward were followed to assess the success of limb-fitting at discharge. The influence of demographic, clinical and social factors on the success of lower limb-fitting was assessed using linear regression analysis and group comparisons.

The rapid resolution of depression and anxiety symptoms after lower limb amputation.

Objective: To ascertain the course of depressive and anxiety symptoms shortly after amputation and again after a period of inpatient rehabilitation.

Design And Settings: A cohort study in inpatients admitted to a rehabilitation ward after lower limb amputation.

Subjects: One hundred and five successive admissions over a one-year period.

Fluid collections in amputee stumps: a common phenomenon.

Objectives: To assess the incidence of fluid collections in postoperative amputee stumps and the impact on limb-fitting outcomes in patients with such collections.

Design: Cohort study.

Setting: Inpatient rehabilitation ward.

Parkinson's disease and driving ability.

Objectives: To explore the driving problems associated with Parkinson's disease (PD) and to ascertain whether any clinical features or tests predict driver safety.

Methods: The driving ability of 154 individuals with PD referred to a driving assessment centre was determined by a combination of clinical tests, reaction times on a test rig and an in-car driving test.

Results: The majority of cases (104, 66%) were able to continue driving although 46 individuals required an automatic transmission and 10 others needed car modifications.

Alphabetical prejudice in team discussions (or would Zebedee ever get seen on a ward round).

Purpose: To ascertain whether the order in which patients are discussed in a team meeting determines the time spent on discussion.

Design: Prospective study over 18 consecutive multidisciplinary team meetings.

Setting/subjects: Multidisciplinary team meetings on a Brain Injury Rehabilitation Unit, Edinburgh.

Driving experiences of disabled drivers.

Objective: To study the influence of non-standard controls on return to driving after disability, including prevalence of accidents/retraining difficulties.

Design: Postal questionnaires sent within two years of assessment to 972 disabled drivers seen over a three-year period.

Setting: Scottish Driving Assessment Service.

Myasthenia gravis masquerading as post-poliomyelitis syndrome.

A 79-year-old man with previous bulbar poliomyelitis developed dysphagia and was diagnosed as having post-polio syndrome. Over 2 years, his swallowing deteriorated and he suffered an aspiration pneumonia. Only after the subsequent development of fatigue and facial weakness was myasthenia gravis diagnosed.

Predicting those who will walk after rehabilitation in a specialist stroke unit.

Objective: To establish whether the ability to use a wheelchair shortly after a stroke or continence are related to the likelihood of walking by time of discharge.

Design And Subjects: An observational study in patients admitted to a stroke rehabilitation unit for under-65s over a three-year period.

Methods: Functional Independence Measure (FIM) subscores for walking were examined on all patients at time of admission and discharge.

Late mortality after head injury.

Objectives: To investigate mortality trends in a cohort of people admitted to a regional head injury unit with all severities of injury in the calendar year 1981.

Methods: A computerised database with details of 1919 admissions was compared with deaths registered by the NHS Central Register, Scotland for the years 1981 to mid-2002. Death certificate information for matches was analysed.

Preventing falls and stump injuries in lower limb amputees during inpatient rehabilitation: completion of the audit cycle.

Objectives: To study the factors contributing to falls among recent lower limb amputees, and to reduce the number of falls during inpatient rehabilitation and resulting injuries.

Design: Retrospective, followed by prospective, cohort study, then a follow-up study conducted after interventions.

Setting: Twenty-bedded inpatient rehabilitation unit for amputees.

The challenges of managing dysphagia in brain-injured patients.

Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury.