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Biomedical subjects

R J Greenwood

Publications and source records attributed to R J Greenwood.

At least 19 recordsLinked to original sources
PubMed2006

Exploring Theta Burst Stimulation as an intervention to improve motor recovery in chronic stroke.

OBJECTIVE: To explore the effects of a single session of repetitive Transcranial Magnetic Stimulation, given as Theta Burst Stimulation, on behavioural and physiological measures of hand function in chronic stroke patients. METHODS: Six chronic stroke patients with incomplete recovery of the hand were tested under three conditions: excitatory TBS over the stroke hemisphere (iTBS(SH)), inhibitory TBS (cTBS(IH)) over the intact hemisphere and sham stimulation. Behavioural outcomes included simple and choice reaction time paradigms. Physiological effects were assessed using single pulse TMS on both sides. Changes were sought for up to 40min after TBS. RESULTS: Immediately after iTBS(SH) simple reaction times in the paretic hands were decreased and, compared to sham stimulation, remained significantly shorter throughout the testing period. The amplitude of the MEPs at rest and during background contraction and the area under the Input-Output curves were also increased on the stroke side after iTBS(SH). cTBS(IH) suppressed the MEPs evoked in the healthy hands but did not change motor behaviour or the electrophysiology of the paretic hands. No side effects were encountered. CONCLUSIONS: TBS seems safe in chronic stroke patients. iTBS over the stroke hemisphere transiently improved motor behaviour and corticospinal output in the paretic hands. SIGNIFICANCE: Excitatory TBS may represent a useful rTMS protocol to apply to the stroke hemisphere in future longer term therapy trials.

Adult↗
PubMed2006

Pharmacological management for agitation and aggression in people with acquired brain injury.

BACKGROUND: Of the many psychiatric symptoms that may result from brain injury, agitation and/or aggression are often the most troublesome. It is therefore important to evaluate the efficacy of psychotropic medication used in its management. OBJECTIVES: To evaluate the effects of drugs for agitation and/or aggression following acquired brain injury (ABI). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other electronic databases. We also searched the reference lists of included studies and recent reviews. In addition we handsearched the journals Brain Injury and the Journal of Head Trauma Rehabilitation. There were no language restrictions. The searches were last updated in June 2006. SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated the efficacy of drugs acting on the central nervous system for agitation and/or aggression, secondary to ABI, in participants over 10 years of age. DATA COLLECTION AND ANALYSIS: We independently extracted data and assessed trial quality. Studies of patients within six months after brain injury and/or in a confusional state, were distinguished from those of patients more than six months post-injury, or who were not confused. MAIN RESULTS: Six RCTs were identified and included in this review. Four of theses evaluated the beta-blockers, propranolol and pindolol, one evaluated the central nervous system stimulant, methylphenidate and one evaluated amantadine, a drug normally used in parkinsonism and related disorders. The best evidence of effectiveness in the management of agitation and/or aggression following ABI was for beta-blockers. Two RCTs found propranolol to be effective (one study early and one late after injury). However, these studies used relatively small numbers, have not been replicated, used large doses, and did not use a global outcome measure or long-term follow-up. Comparing early agitation to late aggression, there was no evidence for a differential drug response. Firm evidence that carbamazepine or valproate is effective in the management of agitation and/or aggression following ABI is lacking. AUTHORS' CONCLUSIONS: Numerous drugs have been tried in the management of aggression in ABI but without firm evidence of their efficacy. It is therefore important to choose drugs with few side effects and to monitor their effect. Beta-blockers have the best evidence for efficacy and deserve more attention. The lack of evidence highlights the need for better evaluations of drugs for this important problem.

Adrenergic beta-Antagonists↗
PubMed2006

Arm function after stroke: neurophysiological correlates and recovery mechanisms assessed by transcranial magnetic stimulation.

Transcranial Magnetic Stimulation has been used for over 20 years to investigate recovery of motor function in stroke patients. In particular, it has been used to quantify the extent of damage to the corticospinal output, reorganisation of the cortical representation of the affected body parts and excitability of intracortical and cortico-cortical circuitries in both hemispheres. In this review, we provide a detailed account of most of the published data with particular reference to methodological issues that affect their interpretation.

Arm↗
PubMed2004

A study of acute rehabilitation after head injury.

In 1999 a report from the Royal College of Surgeons of England drew attention to the fact that, in the UK, there is little structured acute inpatient rehabilitation for patients admitted after traumatic brain injury (TBI). This paper reports the results of a retrospective study of acute inpatient rehabilitation (AR) after TBI, comparing aspects of resource use in 92 patients who received structured unit-based multidisciplinary AR with 97 patients who received usual practice. About 10% of patients admitted via casualty after TBI required AR after neurosurgical consultation or care. These patients remained in AR for a mean of 20.5 days; length of stay in an acute bed was not prolonged compared with patients in usual practice. Sixty per cent of patients discharged home from unit-based care were referred to community-based rehabilitation on discharge compared with no patients discharged home from neurosurgical care. There is an urgent need to discuss and plan at national level the structured secondary provision of acute rehabilitation after acquired brain injury.

Adult↗
PubMed2003

Process and outcome during early inpatient rehabilitation after brain injury.

PURPOSE: To describe aspects of process and outcome during early inpatient rehabilitation of younger adults after single incident brain injury. METHOD: Analysis of a database of 290 patients discharged from an inner-city hospital based inpatient unit for younger adults after single incident neurological events, over a 5-year period. RESULTS: Analysis showed a stable case-mix of patients over the 5 years surveyed with a preponderance of young male patients after traumatic brain injury. Improvements in patients' disability and dependency, measured by the Barthel Index and Functional Independence Measure, were recorded in the majority of patients. The ethnic diversity of the patients, reflecting the multi-cultural nature of the catchment population, did not appear to affect rehabilitation outcome. Failure to record improvement in 15% of patients was related to the floor and ceiling effects of the instruments. A useful regression equation was produced relating length of stay to Barthel score on admission. CONCLUSIONS: These data demonstrate the changes that occur during early inpatient rehabilitation after single incident brain injury. They explore clinical indicators of dependency and outcome, and aspects of resource utilization that characterize our service. Publication of data of this sort, from this and other units, should encourage the development and improvement of current rehabilitation service delivery after brain injury.

Adult↗
PubMed2003

Pharmacological management for agitation and aggression in people with acquired brain injury.

BACKGROUND: Of the many psychiatric symptoms that may result from brain injury, agitation and/or aggression are often the most troublesome. It is therefore important to evaluate the efficacy of psychotropic medication used in its management. OBJECTIVES: To evaluate the effects of drugs for agitation and/or aggression following acquired brain injury (ABI). SEARCH STRATEGY: We searched MEDLINE (1966-2002), EMBASE (1980-2002) and the Cochrane Controlled Trials Register (1996-2002), Web of Science Citation Index, reference lists of papers meeting the inclusion criteria and recent reviews. We handsearched Brain Injury and the Journal of Head Trauma Rehabilitation. There were no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated the efficacy of drugs acting on the central nervous system for agitation and/or aggression, secondary to ABI, in participants over 10 years of age. Studies using lower levels of evidence (i.e. case series studies, single case studies and controlled group comparison studies), were collated in an appendix. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. Authors were contacted where necessary for additional information. Studies of patients within six months after brain injury and/or in a confusional state, were distinguished from those of patients more than six months post-injury, or who were not confused. MAIN RESULTS: Six randomised controlled trials were identified. Four RCTs evaluated the beta-blockers, propranolol and pindolol, one RCT evaluated the central nervous system stimulant, methylphenidate and one RCT evaluated amantadine, a drug normally used in parkinsonism and related disorders. The best evidence of effectiveness in the management of agitation and/or aggression following ABI was for beta-blockers. Two RCTs found propranolol to be effective (one study early and one late after injury). However, these studies used relatively small numbers, have not been replicated, used large doses, and did not use a global outcome measure or long-term follow-up. Comparing early agitation to late aggression, there was no evidence for a differential drug response. Firm evidence that carbamazepine or valproate is effective in the management of agitation and/or aggression following ABI is lacking. REVIEWER'S CONCLUSIONS: Numerous drugs have been tried in the management of aggression in ABI but without firm evidence of their efficacy. It is therefore important to choose drugs with few side effects and to monitor their effect. Beta-blockers have the best evidence for efficacy and deserve more attention. The lack of evidence highlights the need for better evaluations of drugs for this important problem.

Adrenergic beta-Antagonists↗
PubMed2003

Clinically significant benign pneumoperitoneum as a complication of percutaneous endoscopic gastrostomy.

Benign pneumoperitoneum is a complication of percutaneous endoscopic gastrostomy (PEG) feeding tube placement. The rate of occurrence is reported as up to 25%. It is usually an incidental finding that arises immediately following the procedure. We report a case of pneumoperitoneum that developed a significant time after the initial procedure. The patient developed intractable vomiting and had to be fed parenterally. The pneumoperitoneum resolved and the gastrostomy tube feed was re-started.

Adult↗
PubMed2001

Evidence-based measurement: which disability scale for neurologic rehabilitation?

OBJECTIVE: To compare the 10-item Barthel Index (BI), 18-item Functional Independence Measure (FIM), and 30-item Functional Independence Measure + Functional Assessment Measure (FIM+FAM) as measures of disability outcomes for neurologic rehabilitation. METHODS: A total of 149 inpatients from two rehabilitation units in South England specializing in neurologic disorders were studied. Traditional psychometric methods were used to evaluate and compare acceptability (score distributions), reliability (internal consistency, intrarater reproducibility), validity (concurrent, convergent and discriminant construct), and responsiveness (standardized response mean). RESULTS: All three rating scales satisfied recommended criteria for reliable and valid measurement of disability, and are acceptable and responsive in this study sample. The FIM and FIM+FAM total scales are psychometrically similar measures of global disability. The BI, FIM, and FIM+FAM motor scales are psychometrically similar measures of physical disability. The FIM and FIM+FAM cognitive scales are psychometrically similar measures of physical disability. CONCLUSIONS: In the sample studied, the BI, FIM, FIM+FAM have similar measurement properties, when examined using traditional psychometric analyses. Although instruments with more items and item response categories generate more qualitative information about an outcome, they may not improve its measurement. Results highlight the importance of using recognized techniques of scale construction to develop health outcome measures.

Adolescent↗
PubMed2001

The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation.

OBJECTIVE: To examine the impact of fitness training with recently brain-injured inpatients on exercise capacity and functional and psychologic outcome measures. DESIGN: A randomized controlled trial of exercise versus relaxation training for 3 months. Blind assessments were conducted before and after the end of a 12-week training program, as well as at follow-up assessment 12 weeks posttraining. SETTING: Four regional neurologic inpatient rehabilitation units. PATIENTS: Of 157 patients recruited 24 +/- 14 weeks after single-incident brain injury, 142 patients were assessed at week 12, and 128 patients at follow-up. INTERVENTIONS: Patients were randomized between cycle ergometer aerobic training and a relaxation training control condition, which was theoretically inert with respect to cardiovascular fitness. MAIN OUTCOME MEASURES: Validation of exercise training (peak work rate, peak heart rate, body mass index); mobility and physical function (modified Ashworth scale, Berg balance scale, Rivermead Mobility Index, 10-m walk velocity); disability and dependency (Barthel index, FIMtrade mark instrument, Nottingham Extended Activities of Daily Living); and psychologic function (fatigue questionnaire, Hospital Anxiety and Depression Scale). RESULTS: Significant improvements in exercise capacity (p <.05) in the exercise training group (n = 70) relative to the control group (n = 72) were not matched by greater improvements in functional independence, mobility, or psychologic function, at either 12 weeks or follow-up. CONCLUSIONS: The benefits of improved cardiovascular fitness did not appear to extend to measurable change in function or psychologic state.

Activities of Daily Living↗
PubMed1999

Maternal predictors of early breast milk output.

Previous attempts to show a quantitative relationship between maternal hormone levels and early milk output have used small sample sizes and simple correlations. Women of mixed parity and similar socio-economic status and education were recruited to a study using multivariate analysis to look for these associations. Hormone levels (oestradiol, progesterone, prolactin and thyrotropin (TSH)) were determined for 91 mothers at four time points (ante- and postnatally) from finger-prick blood spots by fluoro-immunoassay. Milk output at 1 and 4 weeks was determined from 24-h test weighings. Parity was found to be the most significant factor affecting breast milk volume at 1 wk postpartum (multiparous women delivered 142 ml more milk in 24 h than primiparous women). Total time spent feeding had a strong association with breast milk volume, with increasing time having a negative effect. Multiple regression analysis, controlling for parity and time spent feeding, showed a positive association of milk output at 1 wk with antenatal progesterone and antenatal prolactin levels. At 4 wk, higher postpartum oestradiol levels had a negative association and antenatal progesterone levels a positive association with milk output. This study demonstrates that there are quantitative associations between antenatal maternal hormone levels and breast milk output in the early postnatal period.

Adult↗
PubMed1998

Measuring progress and outcome in community rehabilitation after brain injury with a new assessment instrument--the BICRO-39 scales. Brain Injury Community Rehabilitation Outcome.

OBJECTIVE: Construction and validation of a new instrument, the Brain Injury Community Rehabilitation Outcome scales, to assess problems experienced by brain-injured patients living in the community. DESIGN: Seventy-six items describing aspects of personal and social functioning were generated. Two hundred thirty-five patients and/or their carers (separately) rated the items on 6-point scales, and patients retrospectively rated their functioning before injury. Seven scales were derived from factor analysis; one was included a priori. Thirty-nine items with high factor loadings were retained. Test-retest reliability, interrater reliability, and construct validity were examined in subsamples. SETTING: Patients were recruited from four centers: two community-based teams, a day-patient clinic, and an outpatient clinic. PATIENTS: Of the patients, 127 had traumatic brain injury, 72 had cerebrovascular accidents, 15 had multiple sclerosis, and 21 had acquired brain injury of other origins. Mean time since brain injury was 2.6 years; mean age was 43 years; 164 were men and 71 were women. RESULTS: All scales showed good test-retest reliability, and agreement between patient and carer ratings was moderate to high. They showed predicted moderate correlations with other relevant scales. Postinjury scores differed significantly from preinjury scores, and 6 of the 8 scales showed change over a period of recovery/rehabilitation. CONCLUSIONS: The scales appear reliable and easy to complete. They may have utility as quantitative measures of outcome for clinical and treatment evaluations.

Activities of Daily Living↗
PubMed1998

Motivational deficits after brain injury: a neuropsychological approach using new assessment techniques.

Deficits of motivation are recognized as a significant clinical problem following brain injury, and a neuropsychological model is postulated linking such deficits with cognitive deficits of a frontal type. However, few, if any, quantitative assessment measures exist; most descriptions in the literature are qualitative, and this has limited the scope and robustness of research into the problem. The authors in the present research have developed new tools for assessing patients' level of motivation in therapy (percent participation index) and their behavioral responsiveness to experimental incentive (the card-arranging reward responsivity objective test). Relationships among poor motivation, reward responsiveness, frontal lobe function, and mood were explored in a sample of 54 patients with nonfocal vascular or traumatic brain injury; the results were consistent with the neuropsychological model. Preliminary reliability and validation data on the new measures are reported.

Adolescent↗
PubMed1998

Unilateral neglect: a common but heterogeneous syndrome.

The neglect syndrome is a cluster of neurologic symptoms commonly found after right hemisphere damage. This study investigates the degree of association between the main components in a representative sample of 69 patients at 2 to 3 days poststroke. Despite evidence of statistically significant associations between components, many dissociations were found, indicating that neglect is a highly heterogeneous condition.

Aged↗
PubMed1997

The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report.

OBJECTIVE: To investigate the benefits of the focal use of botulinum toxin in spasticity in the forearm seen after incomplete spinal cord injury. DESIGN: A single case study with standardized assessment before and at three-week intervals after injection. INTERVENTION: EMG-guided selective injection of botulinum toxin. SUBJECT: A 23-year-old man, 18 months post injury. MEASURES: Rivermead Motor Assessment; grip strength; Jebsen hand tests; visual analogue scale; Ashworth spasticity scale. RESULTS: Weakness was seen as expected with some functional losses, but the patient made gains in the areas of concern: shaking hands, typing, using the hand to drink. These gains were sustained at 12 weeks. CONCLUSION: Selective use of botulinum toxin to weaken muscles can lead to functional benefit.

Adult↗
PubMed1997

Population and movement characteristics of radio-collared striped skunks in North Dakota during an epizootic of rabies.

We observed a total of 102 striped skunks (Mephitis mephitis) from March to July of both 1991 and 1992 in Stutsman County, North Dakota (USA) during an experiment with food supplementation. Twenty-three apparently healthy skunks in 1991 and 56 in 1992 were equipped with radio-collars. In 1991, one of the 23 was tested and found to be rabid. In 1992, 50 of 56 were tested; 35 (70%) were rabid. Of skunks with ages estimated, 19 (66%) of 29 were first year animals in 1991 compared with nine (22%) of 41 first year animals in 1992. All 18 females captured in 1991 were pregnant or parous compared with 21 (60%) of 35 in 1992. The estimated survival rate of skunks was 0.85 during April to June 1991, but only 0.17 during April to July 1992. In 1992, the survival rate of first year skunks was 0.08, compared with 0.35 for older animals. Eleven (31%) of 36 skunks found dead of rabies or in late clinical stage were located below ground. We detected no differences in 1992 between healthy and rabid skunks in estimated mean (+/- SE) rate of travel (232 +/- 14 m/hr), distance traveled (2,047 +/- 141 m/night), or home range size (1.6 +/- 0.4 km2) during half-month periods from April through June. Among rabid skunks, mean rate of travel tended to decrease from 298 +/- 48 m/hr during the 14 days preceding the clinical period of rabies (pre-clinical) to 174 +/- 48 m/hr during the clinical period of rabies (14 days immediately before death). Similar decrease occurred in distance traveled in a night (2,318 +/- 281 m, pre-clinical; 1,497 +/- 281 m, clinical). Mean home range size of males (2.8 +/- 0.4) was greater than of females (1.2 +/- 0.4) during the pre-clinical period, but during the clinical period home range sizes of males (1.8 +/- 0.4) and females (1.8 +/- 0.4) were similar. Mean home range size of females did not differ between pre-clinical (1.2 +/- 0.4) and clinical (1.8 +/- 0.4) periods (P = 0.22). Deaths of skunks from rabies in 1992 tended to be more spatially clumped than expected had they been random, mostly due to deaths detected before 8 May. We detected no correlation between locations of animals found dead of rabies and dates of death.

Age Distribution↗
PubMed1996

Motivational deficits after brain injury: effects of bromocriptine in 11 patients.

OBJECTIVE: To test the hypothesis that treatment with bromocriptine would ameliorate deficits in clinical motivation, responsiveness to reward, and frontal cognitive function after brain injury. METHOD: An open trial in six men and five women who had had either traumatic brain injury or subarachnoid haemorrhage between two months and five years previously. After repeated baseline assessments, bromocriptine was given in gradually increasing doses. Assessments were repeated at increasing doses, during maintenance, and after withdrawal. Novel structured instruments for quantifying motivation were developed; measures of anxiety and depression, and cognitive tests sensitive to motivation or frontal lobe involvement were also given. RESULTS: Bromocriptine treatment was followed by improved scores on all measures other than mood. Improvement was maintained after bromocriptine withdrawal in eight of the patients. CONCLUSION: Poor motivation in patients with brain injury may result from dysfunction in the mesolimbic/mesocortical dopaminergic circuitry, giving rise to associated deficiencies in reward responsiveness and frontal cognitive function.

Adult↗