Category Archives: Mobility

Behavioural Domains

April 2017: Ramsey et al (2017) Behavioural clusters and predictors of performance during recovery from stroke. Nature Human Behaviour, Early Online, DOI: 10.1038/s41562-016-0038

Although this may be a difficult “read”, its this month’s journal article because it challenges the way we think about stroke recovery and particular impairments or areas of dysfunction. To date, our understanding of the impact of stroke is usually in terms of differentiating between impairments. Different therapists see patients with different impairments based on their professional expertise . For example, speech pathologists manage patients with language impairments. However, what Ramsey et al found challenges this approach. In relation to recovery in the first 12 months after first-ever stroke, they have found a clustering of impairments and two behavioural domains: 1) motor and attention; and 2) language and memory. This means we may need to re-think our differentiation and management of impairments after stroke.

This article is freely available and is well worth reading. To find the abstract and “humble opinion”, go to Journal Club 2017 and select: Behavioural Domains.

Impairments after Stroke

December 2016: Lawrence et al (2001) Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke, 32, 1279-1284 http://dx.doi.org/10.1161/01.STR.32.6.1279

OK, so this is a bit weird! I’m reviewing an article that was published 6 years ago!! What are you doing Isobel? Isn’t one of your aims to make sure you only ever review recently-published evidence?

True, but this time I’m going to make an exception. I’m currently in the process of writing a book!! It’s titled “Stroke and the Upper Limb: A practical guide for therapists”. I’m aiming to launch it mid-way through next year. Whilst researching the evidence about predicting upper limb recovery, I wanted to find out how prevalent upper limb dysfunction was and where it ranked on the prevalence “hierarchy”. I probably shouldn’t have been surprised, but Lawrence et al (2001) report that upper limb motor dysfunction has the highest prevalence in patients 3 months post-stroke. At 77% of all patients, it comes in just in front of lower limb motor dysfunction. No wonder we see so many patients with motor dysfunction!

This article is a really interesting “read” if you’d like to know more about the prevalence hierarchy of impairments early after stroke. I also thought this was a good place to conclude this year’s Journal Club. Our aim is to reduce the impact of stroke and this article is a useful summary of the oh-so-many impairments that patients experience after stroke. The article is publicly available at: http://stroke.ahajournals.org/content/32/6/1279.short

To find the full reference, abstract and “humble opinion”, go to Journal Club 2016 and Impairments After Stroke.

Physical Fitness Training

November 2016: Saunders et al. (2016) Physical fitness training for stroke patients. Cochrane Database Systematic Review March 24;3: CD003316. doi: 10.1002/14651858.CD003316.pub6

It’s been quite some time since I’ve reviewed a Cochrane Database Systematic Review. This research was led by Professor Gillian Mead. If you’ve not heard of her before, I would recommend her to you. She is a stroke champion, who, as her website states: “aims to find out how to improve recovery and quality of life in people who survive a stroke”.

Stroke is a cardiovascular disease, so perhaps it’s somewhat surprising that for so many years we’ve ignored the importance of physical fitness and cardiovascular health in survivors of stroke. In the past, stroke rehabilitation has focused on the restoration of independence in everyday activities, but increasingly, the focus is shifting towards physical fitness, which is a positive move in my humble opinion, as both go hand-in-hand.

These authors found that: “Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking… Cognitive function is under-investigated despite being a key outcome of interest for patients.”

As a Cochrane Review, it is publicly available at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003316.pub6/full

To find the full reference, abstract and “humble opinion”, go to Journal Club 2016 and Physical Fitness Training.