Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis.

Objective: To examine the effectiveness of pharmacotherapy for the treatment of depression following traumatic brain injury (TBI).

Design: Systematic review and meta-analysis. Multiple electronic databases were searched to identify relevant studies examining effectiveness of pharmacotherapy for depression post-TBI.

Treatment with botulinum toxin improves upper-extremity function post stroke: a systematic review and meta-analysis.

Objective: To examine whether treatment with botulinum toxin type A (BTX-A) is associated with improvements in activity capacity or performance associated with poststroke spasticity in the upper extremity.

Data Sources: MEDLINE, EMBASE, Scopus, and ISI Web of Science databases were searched from 1985 to November 2011.

Data Selection: Studies were included if (1) the study design was a randomized controlled trial comparing injection of BTX-A with placebo or a nonpharmacologic treatment condition; (2) at least 60% of the sample was composed of adult subjects recovering from either first or subsequent stroke; (3) subjects presented with moderate to severe upper-extremity spasticity of the wrist, finger, or shoulder; and (4) activity was assessed as an outcome.

Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery.

Purpose: Canada's Best Practice Recommendations for Stroke Care state that a minimum of one hour per day of each of the relevant core therapies be provided to patients admitted for inpatient rehabilitation. We examined whether this standard was met on a single, specialized stroke rehabilitation unit and if amount of therapy was an independent contributor to functional improvement.

Methods: One-hundred and twenty-three, consecutive patients admitted to a 30-bed stroke rehabilitation program over a 6-month period with the confirmed diagnosis of stroke, were included.

Inpatient stroke rehabilitation in Ontario: are dedicated units better?

Background: The superiority of dedicated stroke rehabilitation over generalized rehabilitation services has been suggested by the literature; however, these models of service delivery have not been evaluated in terms of their relative effectiveness in situ.

Aims: A comparison of the process indicators associated with these two models of service provision was undertaken within the Ontario healthcare system.

Methods: All adults admitted with a diagnosis of stroke for inpatient rehabilitation in Ontario, Canada during the years 2006-2008 were identified from the National Rehabilitation Reporting System database.

Predicting length of stay in patients admitted to stroke rehabilitation with high levels of functional independence.

Purpose: In Ontario, stroke patients with relatively mild functional deficits are admitted to inpatient rehabilitation programmes. Despite apparently minor impairments, many of these patients remain in rehabilitation for prolonged periods of time. The objective of the present study is to identify variables that predict length of stay (LOS) within this population of high functioning stroke patients.

Clinical Outcome Variables Scale: A retrospective validation study in patients after stroke.

Objective: The construct, predictive and longitudinal validity of the Clinical Outcome Variables Scale (COVS), an assessment of functional mobility, was examined in relation to measures of functional disability (Functional Independence Measure (FIMTM)), balance (Berg Balance Scale (BBS)) and length of stay in inpatient stroke rehabilitation.

Methods: Associations between admission and discharge scores on each measure were examined retrospectively for 134 patients admitted for inpatient stroke rehabilitation. The association between admission scores and length of stay was tested using a simple linear regression.

Does the treatment of spastic equinovarus deformity following stroke with botulinum toxin increase gait velocity? A systematic review and meta-analysis.

While botulinum toxin-A (BT-A) has been used to treat lower-limb focal spasticity successfully, its effect on characteristics of gait has not been well defined. The objective of this systematic review was to establish the treatment effect associated with the use of BT-A for equinovarus to improve gait velocity following stroke, using a meta-analytic technique. Relevant studies were identified through a literature search encompassing the years 1985 to November 2009.

Impact of caring for individuals with stroke on perceived physical health of informal caregivers.

Purpose: Caring for a person who has experienced stroke can be a formidable task placing considerable demands upon the informal caregiver. Although the impact of caring on mental health has been well established, less convincing associations between caregiving and declining physical health have been reported. In order to examine the impact of caregiving over time on the physical health of individuals providing informal care for individuals with stroke, we conducted a review of the published literature.

Social support interventions and mood status post stroke: a review.

Objective: Psychological consequences of stroke are important determinants of health-related quality of life. As many as one-third of individuals with stroke will experience post-stroke depression; however, perceived social support may be protective in terms of both onset and duration of depressed mood. Improvement of available social support could be an important strategy in reducing or preventing psychiatric distress and warding off post-stroke depression.

Assessment of participation outcomes in randomized controlled trials of stroke rehabilitation interventions.

In recent years, the importance of understanding the impact of interventions on an individual's ability to participate in social roles after a stroke event has gained much attention. Comprehensive assessment of treatment effectiveness should include a broader range of outcomes, including social participation. This study attempted to determine the degree to which the assessment of social participation has been included in randomized controlled trials of stroke rehabilitation.

Mobility assistive device utilization in a prospective study of patients with first-ever stroke.

Objective: To estimate the extent to which clinical and functional features of stroke were related to the use of mobility assistive technology devices.

Design: Longitudinal study of quality of life after stroke.

Setting: Hospitals, rehabilitation centers, and universities in Ontario and Quebec.

Clinical and electrophysiologic correlates of quantitative sensory testing in patients with incomplete spinal cord injury.

Objective: To determine the degree of association among indices of preserved sensation derived from quantitative sensory testing (QST), somatosensory evoked potentials (SEPs), and the clinical characteristics of patients with spinal cord injury (SCI).

Design: A controlled correlational study of diverse measures of preserved sensory function.

Setting: Regional SCI rehabilitation center in Ontario, Canada.

The art and science of a behavioural approach to care.

Behavioural psychology has much to offer residents, families and staff. Properly developed, a behavioural approach to care is at once humane, scientific and practical. In our experience, the dedication of resources and expertise to implementation of a behavioural approach to care has been truly beneficial for all concerned.