Beyond restoration to transformation: positive outcomes in the rehabilitation of acquired brain injury.

This paper compares the situation of the person with acquired brain injury to that of the people of Israel in the sixth century BCE (before the current era) during the period of exile in Babylon. Both situations are characterized by traumatic multiple losses, and a struggle to regain a sense of identity: personal, national or spiritual. Evidence from the literature on both brain injury rehabilitation and from the Hebrew Scriptures indicates that models of restoration of function and transformation of suffering have been applied to both situations.

Transverse myelitis as the first manifestation of systemic lupus erythematosus or lupus-like disease: good functional outcome and relevance of antiphospholipid antibodies.

Objective: Transverse myelitis (TM) is a rare complication of systemic lupus erythematosus (SLE). Although usually a late manifestation of SLE, it can occur at presentation. We investigated the clinical presentation, treatment and outcome of 15 patients with TM as the presenting manifestation of SLE or lupus-like disease.

Satisfaction of members of interdisciplinary rehabilitation teams with goal planning meetings.

Objective: To study how satisfied members of interdisciplinary rehabilitation teams are with goal planning meetings.

Design: Survey.

Setting: A regional rehabilitation center for people with acute nonprogressive brain injuries in the United Kingdom.

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.

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.

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.

Life goals: the concept and its relevance to rehabilitation.

Objective: Life goals are desired states that people seek to obtain maintain or avoid. These goals may influence motivation to participate in the rehabilitation process. The aim of this paper is to review the literature on life goals and the influence of life goals on the rehabilitation process.

Changing patterns of cognitive-motor interference (CMI) over time during recovery from stroke.

Objective: To explore the extent and nature of change in cognitive-motor interference (CMI) among rehabilitating stroke patients who showed dual-task gait decrement at initial assessment.

Design: Experimental, within-subjects, repeated measures design.

Setting: Rehabilitation centre for adults with acquired, nonprogressive brain injury.

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.

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.

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.

A study of emotionalism in patients undergoing rehabilitation following severe acquired brain injury.

The present study describes the phenomenon of emotionalism in a sample of brain injured patients of mixed aetiology, with a view to identifying issues relevant to clinical management, and possible causal factors. 82 subjects with severe acquired brain injury undergoing rehabilitation participated in a structured interview in which they were asked to report the presence/absence of emotionalism and degree of distress associated with it. Their overt crying behaviour was also observed and recorded.

An initial investigation of the reliability of the Rivermead Extended ADL index in patients presenting with neurological impairment.

The objective of this study was to establish the reliability and sensitivity of both postal and interviewer-administrated versions of the Rivermead Extended Activities of Daily Living (READL) index, which assesses six domestic activities and six community activities. Sixty patients with stable neurological impairment were recruited. In one group (n = 40), every patient was assessed face-to-face using the READL, the Barthel index (BI) and the short orientation memory and concentration test (SOMC).

Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment.

Objective: To establish the reliability and validity of 4 mobility measures in neurologically impaired adults undergoing rehabilitation.

Design: Repeated assessment of same patients.

Setting: Two specialized neurologic centers in England.

The effect of magnesium oral therapy on spasticity in a patient with multiple sclerosis.

The effects of magnesium glycerophosphate oral therapy on spasticity was studied in a 35-year-old woman with severe spastic paraplegia resulting from multiple sclerosis (MS). We found a significant improvement in the spasticity after only 1 week from the onset of the treatment on the modified Ashworth scale, an improvement in the range of motion and in the measures of angles at resting position in lower limbs. No side-effects were reported and there was no weakness in the arms during the treatment.

High-intensity cycling exercise after a stroke: a single case study.

Aerobic exercise training has demonstrated positive effects after brain injury. However, therapists express concern regarding the use of effortful exercise in individuals presenting with spasticity or involuntary muscle activity. This study aimed to address this concern and to evaluate whether an intervention of maximal intensity cycling exercise impaired an individual's ability to actively extend his hemiparetic elbow.

Relationship and family breakdown following acquired brain injury: the role of the rehabilitation team.

Although the literature documents the considerable problems acquired brain injury causes for the survivor's family and close relationships, and the corresponding significantly inflated rate of separation and divorce, few papers offer practical solutions. The objective of this paper is to respond to this gap in the literature by presenting some of the problems raised for the rehabilitation team when a family separates, and some suggestions for ways in which these problems could be overcome. The literature is reviewed briefly, followed by reflections and suggestions which are based on this review and on clinical experience.

Neurological rehabilitation nursing: a review of the research.

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours.

The Short Orientation-Memory-Concentration Test: a study of its reliability and validity.

Objective: To establish the limits of intra-observer test-retest reliability of the Short Orientation-Memory-Concentration Test (SOMC), and to investigate the relationship of performance on the SOMC with a test of verbal memory.

Design: Each patient was assessed twice by the same assessor over an interval of 3-7 days.

Setting: Two specialist rehabilitation units concerned with patients with severe and/or complex disability arising from neurological disease.

Current practice and clinical relevance of somatosensory assessment after stroke.

Objective: To examine the perceived clinical relevance, current practice and knowledge of somatosensory testing in three professional groups involved in the management and rehabilitation of stroke.

Design: Structured postal questionnaire sent to therapists and doctors.

Subjects: One hundred and eighty occupational therapists from the National Association of Neurological Occupational Therapists (NANOT), 180 physiotherapists from the Association of Chartered Physiotherapists with an Interest in Neurology (ACPIN) and 360 doctors from the Association of British Neurologists (ABN) and the British Geriatrics Society (BSG).