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Biomedical subjects

Katherine Salter

Publications and source records attributed to Katherine Salter.

8 recordsLinked to original sources
PubMed2006

Specialized stroke services: a meta-analysis comparing three models of care.

BACKGROUND: Using previously published data, the purpose of this study was to identify and discriminate between three different forms of inpatient stroke care based on timing and duration of treatment and to compare the results of clinically important outcomes. METHODS: Randomized controlled trials, including a recent review of inpatient stroke unit/rehabilitation care, were identified and grouped into three models of care as follows: (a) acute stroke unit care (patients admitted within 36 h of stroke onset and remaining for up to 2 weeks; n = 5), (b) units combining acute and rehabilitative care (combined; n = 4), and (c) rehabilitation units where patients were transferred onto the service approximately 2 weeks following stroke (post-acute; n = 5). Pooled analyses for the outcomes of mortality, combined death and dependency and length of hospital stay were calculated for each model of care, compared to conventional care. RESULTS: All three models of care were associated with significant reductions in the odds of combined death and dependency; however, acute stroke units were not associated with significant reductions in mortality when this outcome was analyzed separately (OR 0.80; 95% CI: 0.61-1.03). Post-acute stroke units were associated with the greatest reduction in the odds of mortality (OR 0.60; 95% CI: 0.44-0.81). Significant reductions in length of hospital stay were associated with combined stroke units only (weighted mean difference -14 days; 95% CI: -27 to -2). CONCLUSIONS: Overall, specialized stroke services were associated with significant reductions in mortality, death and dependency and length of hospital stay although not every model of care was associated with equal benefit.

Hospital Units↗
PubMed2006

Progress in clinical neurosciences: stroke recovery and rehabilitation.

BACKGROUND: Recent literature has provided new insights into the role of rehabilitation in neurological recovery post-stroke. The present review combines results of animal and clinical research to provide a summary of published information regarding the mechanisms of neural recovery and impact of rehabilitation. METHODS: Plasticity of the uninjured and post-stroke brain is examined to provide a background for the examination of brain reorganization and recovery following stroke. SUMMARY AND CONCLUSIONS: Recent research has confirmed many of the basic underpinnings of rehabilitation and provided new insight into the role of rehabilitation in neurological recovery. Recovery post stroke is dependent upon cortical reorganization, and therefore, upon the presence of intact cortex, especially in areas adjacent to the infarct. Exposure to stimulating and complex environments and involvement in tasks or activities that are meaningful to the individual with stroke serves to increase cortical reorganization and enhance functional recovery. Additional factors associated with neurological recovery include size of stroke lesion, and the timing and intensity of therapy.

Animals↗
PubMed2006

Identification of aphasia post stroke: a review of screening assessment tools.

INTRODUCTION: Aphasia is one of the most common consequences of stroke. Early identification, diagnosis and treatment of language deficits are important steps in maximizing rehabilitation gains. A routine screening test is an invaluable tool in the identification and appropriate referral of patients with potential communication problems. The present study presents an evaluation of the measurement properties of screening tools for aphasia found within the stroke research literature. METHODS: Screening tools were identified following searches of the published research literature in stroke. Instruments were reviewed on the basis of reliability, validity, classification sensitivity and practical utility. RESULTS: Six aphasia screening tools were identified. For most tools, information pertaining to measurement properties and clinical utility was limited. CONCLUSIONS: The Frenchay Aphasia Screening Test (FAST) appears to be the most widely used and thoroughly evaluated tool found within the stroke research literature. Further evaluation of the measurement properties and clinical utility of screening tools is recommended.

Aphasia↗
PubMed2006

Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke.

OBJECTIVE: Delayed admission to rehabilitation may result in poorer outcomes by reducing exposure to therapeutic interventions at a time when the brain is primed for neurological recovery. The present study examined the effects of early vs delayed admission on functional outcome and length of stay in patients admitted to a rehabilitation unit for first-ever unilateral stroke. DESIGN: Retrospective chart review. METHODS: Differences in length of rehabilitation stay and functional outcome variables among 435 patients, grouped by interval from stroke event to rehabilitation admission (=30 days vs 31-150 days and 5 additional subgroups) were examined using a multivariate technique. RESULTS: Admission and discharge FIM scores, FIM change and FIM efficiency were significantly higher among early admission patients (p<0.01), while length of stay was significantly longer among delayed admission patients (p<0.01). A significant association was identified between age and admission (p<0.01) and discharge FIM (p<0.01) scores as well as FIM change scores (p=0.017). Subgroup analyses revealed significant differences in FIM scores, FIM change and length of stay between groups of patients admitted 0-15 and 16-30 days (p<0.01) and between patients admitted 16-30 days and 31-60 days post-stroke (p<0.01). No significant differences were noted between patients admitted from 31-60 and 61-90 or 61-90 and 91-150 days. CONCLUSION: Patients admitted to stroke rehabilitation within 30 days of first-ever, unilateral stroke experienced greater functional gains and shorter lengths of stay than those whose admission to rehabilitation was delayed beyond 30 days.

Aged↗
PubMed2005

A comparison of the Barthel Index and the Functional Independence Measure as outcome measures in stroke rehabilitation: patterns of disability scale usage in clinical trials.

In order to compare the frequency and patterns of use of the Barthel Index (BI) and Functional Independence Measure (FIM) in stroke rehabilitation trials, all randomized controlled trials (RCTs) of stroke rehabilitation published between 1968 and 2002 were identified and reviewed to determine the frequency with which the BI and FIM measures were used relative to other measures of disability. The date and location of each study citing either the FIM or the BI were also recorded. Studies were assigned ratings of methodological quality based on the physiotherapy evidence database (PEDro) scoring system. Comparisons of the age, frequency and continents of origin and methodological quality of the studies were explored. Results indicate that the BI and FIM were the most common measures of disability used in RCTs examining stroke rehabilitation. However, the BI was used more often than the FIM (n=86, P<0.001) and was cited in trials of superior quality (P=0.005). Studies from North America were more likely to use the FIM compared with European studies (n=24, P<0.001). Publications citing the BI were significantly more recent when originating in Europe as opposed to North America (P=0.023). These results provide insight into current patterns of scale use in stroke rehabilitation research.

Activities of Daily Living↗
PubMed2005

The role of task-specific training in rehabilitation therapies.

Task-oriented therapy is important. It makes intuitive sense that the best way to relearn a given task is to train specifically for that task. In animals, functional reorganization is greater for tasks that are meaningful to the animal. Repetition alone, without usefulness or meaning in terms of function, is not enough to produce increased motor cortical representations. In humans, less intense but task-specific training regimens with the more affected limb can produce cortical reorganization and associated, meaningful functional improvements.

Animals↗
PubMed2005

The role of timing and intensity of rehabilitation therapies.

In both animal and clinical studies, motor rehabilitation and training increase cortical representation and improve recovery, whereas lack of training decreases cortical representation for particular motor functions. In animals, delays in providing rehabilitation reduce the impact of therapy with a worsening in motor outcomes and a corresponding reduction in cortical reorganization. In clinical studies, there is an association between earlier admission to rehabilitation and better outcomes that correlates with animal work both in terms of functional gains from chronic stroke deficits and cortical reorganization. There is a likely relationship between therapy intensity and improvements in functional outcomes. Clinically, greater intensity of stroke rehabilitation has been associated with improved outcomes.

Animals↗