The impact of rehabilitative services in the lives of adults and children with disabilities

What is the impact of rehabilitative services in the lives of adults and children with disabilities and is their a relationship between amount of treatment and functional gains. This question was asked by Dr. Patel from St. Bartholomew’s Hospital , London , UK in Disability & Rehabilitation, 05/06/2013. Occupational therapy and physical therapy were the primary rehabilitation services received by patients across impairment groups. The authors failed to find enough evidence in the literature to answer these questions and concluded that better systematic reporting of type and quantity of rehabilitation therapies along with functional assessments is needed.

Home therapy to improve arm and hand function after brain injury in New Zealand

Over 30,000 New Zealanders have a traumatic brain injury (TBI) each year. Added to this only 11 per cent of people with stroke receive any rehabilitation therapy after they leave hospital.

Because of this the Health Research council of New Zealand have awarded two grants to physical therapists from  The University of Auckland who will use technologies to treat and support brain injury patietns including stroke after discharge from in patient therapy. Firstly, Dr Kersten and her team will train people in the community who have had a TBI in the past to act as mentors or peer mentors for people with a recent moderate to severe TBI. Participation is considered a fundamental outcome of rehabilitation for people with TBI,” Dr Kersten says.
A second project lead by Dr Stinear will evaluate a new home-coach model of therapy for stroke survivors. In New Zealand, only 11 per cent of people with stroke receive any rehabilitation therapy after they leave hospital. This is despite research that shows rehabilitation therapy is capable of improving hand and arm function months or years after stroke. Dr James Stinear from The University of Auckland says “There are tens of thousands of people living with stroke in our community who have an untapped capacity to recover,” explains Dr Stinear and the objective of this study is to test and design a ‘home-therapy’ protocol.”
After a physiotherapist has assessed the therapy needs of a person with stroke a family member, carer, friend or other volunteer will act as a ‘home-coach’ to deliver daily therapy in the home.

New Evidence for Therapies in Stroke Rehabilitation

A report in Current Atherosclerosis Reports, 05/03/2013 looks at the evidence based in medicine for physical therapy interventions to promote Neurologic rehabilitation post stroke.
The report by Dobkin BH et al. from Department of Neurology, Geffen School of Medicine, University of California Los Angeles, CA, USA shows that persons with serious stroke do return to participation in usual self-care and daily activities as independently as is feasible. The physical and occupational therapy detailed includes progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations. The group also discuss how intensive practice can induce adaptations at multiple levels of the nervous system which lead to neuroplasticity and functional improvement.  The group discuss recent clinical trials to manage walking, reach and grasp, aphasia, visual field loss, and hemi-inattention.

Upper limb arm and hand home-based exercise training for people after stroke in the UK

New research in the UK will be conducted on administering Physiotherapy at home after stroke. Neuro physical therapists from Bristol, Birmingham and Newcastle will recruit patients with upper-limb motor impairment including shoulder  and hand movement deficits after discharge from hospital post-stroke. The stroke patients will be up to 12 months post stroke. The primary outcome measures for assessment of arm function will be the Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT). The secondary measures will be the Motor Activity Log, Stroke Impact Scale, Carer Strain Index, and health and social care resource use.

White Matter Changes Correlate with Cognitive Functioning in Parkinsons Disease

Diffusion tensor imaging (DTI) can be used to see cortical white-matter integrity in Parkinson’s disease (PD).

Writing in Frontiers in Neurology, 05/02/2013 Theilmann RJ et al from Neurology Service VA San Diego Healthcare System and the Department of Neuroscience, University of California San Diego, USA  show that abnormal tissue diffusivity may be sensitive to cognitive changes and cognitive decline in PD. These changes may be of prognostic use in the future.   Motor symptom severity did not correlate to abnormal tissue diffusivity.

Resting-State fMRI pinpoints changes in brain organization after TBI

Evidence from functional MRI findings show the traumatic effect on brain network function of traumatic brain injury (tbi). Writing in Neurology, 04/26/2013 Zhou Y et al. from New York University Langone Medical Center, New York.USA report that RS-fMRI shows a variety of changes in subjects after mild TBI that may be responsible for both physical deficits and behavioral symptoms following traumatic brain injury.

Chronic pain syndromes after ischemic stroke

Chronic pain syndromes after ischemic stroke and are associated with increased functional dependence and cognitive decline.

Writing in Stroke, 05/01/2013 O’Donnell MJ et al from McMaster University Ontario,Canada looks at a large cohort with ischemic stroke. Of these stroke patients ~ 11% reported new chronic post stroke pain, with 3% central post stroke pain and 1.5% with peripheral neuropathic pain and 1.3% with pain from spasticity. The group concluded that Chronic pain syndromes after ischemic stroke and are associated with increased functional dependence and cognitive decline.