PubMed Health⌕ Search

Biomedical subjects

R L Hewer

Publications and source records attributed to R L Hewer.

At least 55 records · Page 3Linked to original sources
PubMed1983

Why admit stroke patients to hospital?

Stroke patients consume nearly one-twentieth of all National Health Service resources, and much of this is attributable to the admission of patients with acute strokes to hospital. However, patients rarely need to be admitted for diagnostic or therapeutic reasons, and rehabilitation given in hospital is sometimes inappropriate. The major reason for admission relates to nursing during the acute illness, yet this could be done at home in more cases than at present. It is suggested that rehabilitation services should be more readily available to patients at home, so that fewer need to be admitted and so that those admitted can return home sooner. This might lead to a more appropriate rehabilitation, less anxiety and depression in the patient and his family, and a more efficient use of limited resources.

Acute Disease↗
PubMed1983

Recovery after stroke.

One hundred and sixty-two patients were referred to a rehabilitation unit after an acute stroke. The patterns of recovery of overall functional ability, arm function, walking and speech in 92 of 101 survivors have been analysed. In all modalities the majority of recovery occurs within 3 months; although improvement is seen thereafter it does not reach statistical significance. Possible reasons for the apparent lack of late recovery are discussed.

Activities of Daily Living↗
PubMed1983

The Bristol Stroke Unit.

The Bristol Stroke Unit was set up in 1975 in order to provide a service for stroke patients and to undertake both service and biomedical research. During the first 5 years, 472 stroke patients were seen and 388 were treated. Detailed information was kept on most patients and this has been used for studies on prediction and outcome. General principles of management evolved and these are itemized. Important developments include the expansion of the Unit remit to include the management of other disabling disorders such as multiple sclerosis, a greater emphasis on service research, and the development of a voluntary service.

Adult↗
PubMed1983

The heart disease of Friedreich's ataxia: a clinical and electrocardiographic study of 115 patients, with an analysis of serial electrocardiographic changes in 30 cases.

One hundred and fifteen patients with carefully defined Friedreich's ataxia were assessed clinically and electrocardiographically for evidence of heart disease. Cardiac symptoms, of which dyspnoea and palpitations were the most frequent, occurred in less than 30 per cent. Abnormalities on clinical examination were present in a similar proportion; harsh systolic murmurs, ventricular hypertrophy and added heart sounds were the commonest of these. Cardiac failure and persistent arrhythmias were rare and occurred late in the evolution of the neurological disease. Two patients presented with heart disease before developing neurological symptoms. Cardiac signs and symptoms were uncommon in patients without electrocardiographic abnormalities. About two-thirds of the cases had definitely abnormal ECG recordings. The characteristic finding was of widespread T-wave inversion with ventricular hypertrophy. Serial ECGs, recorded over periods of up to 32 years, were available in 30 cases and showed that abnormalities may develop in patients with Friedreich's ataxia at any time up until 20 years after the onset of neurological symptoms. In four patients initial ECG abnormalities had either improved or disappeared subsequently.

Adolescent↗
PubMed1983

Predicting Barthel ADL score at 6 months after an acute stroke.

In 83 patients with stroke, multiple regression analysis was used to identify 5 variables, measured at the 1st assessment shortly after stroke, that related to the Barthel ADL score at 6 months. The variables were age, the presence of hemianopia or visual inattention, the presence of urinary incontinence, the motor deficit in the affected arm, and the patient's sitting balance. A 2nd equation, based upon the initial Barthel score with age and hemianopia added, was also developed. The success of the 1st equation in predicting the final Barthel score was about 55%, a rate better than that yielded by the 2nd equation, and also better than that produced by adding the average improvement score to the patient's initial score.

Activities of Daily Living↗
PubMed1980

Assessment of recovery of arm control in hemiplegic stroke patients. 1. Arm function tests.

In a preliminary study a group of hemiplegic patients have been assessed for return of arm function for periods up to 64 weeks after stroke. The assessment procedure employs a few simple and easily performed tests which take into account principles of the central nervous control of movement. The tests are highly repeatable and can be carried out by staff untrained in medicine or any form of physical therapy. Patients have been divided into two groups on the basis of the scores obtained in the tests at 16 weeks after stroke. The group scoring 80% or more are very likely subsequently to recover useful function of the arm and hand. The group of patients scoring less than 80% at 16 weeks after stroke are likely subsequently to recover limited arm movements and little hand movement. The preliminary results would suggest that the tasks provide a guide to prognosis and an indiction of the most suitable type of general physical therapy.

Aged↗
PubMed1980

Assessment of recovery of arm control in hemiplegic stroke patients. 2. Comparison of arm function tests and pursuit tracking in relation to clinical recovery.

In a preliminary study, return of arm function in hemiplegic patients has been assessed for periods up to 64 weeks after stroke using two methods of testing. The first method concerns the performance of simple motor tasks involving the arm and hand. The second method is a pursuit tracking task using elbow movements. Patients were divided into two groups depending on whether they scored above 80% (Group I) or below 80% (Group II) on the first method at 16 weeks after stroke. When the two arm assessment methods were compared with clinical assessments for all the patients, general agreement was shown. Among Group I patients there was also significant agreement between the assessments; among Group II patients the agreement was poor. The two arm assessment methods, however, showed mutual agreement. In conclusion, both arm assessments provide a general prediction of the recovery of movement control of patients following stroke.

Aged↗
PubMed1980

Multiple sclerosis--management and rehabilitation.

After reviewing the size of the problem of multiple sclerosis, and the likely case-load for doctors in different settings, this paper than proceeds to consider the major challenges in management and rehabilitation for this disease. The latter resolve themselves into what to discuss with the patient; relapses and their prevention, including general advice on such matters as stress, pregnancy, and infection; major problems including bladder and bowel dysfunction, sexual difficulties, spasticity, ataxia and incoordination, vision, and intellectual and psychological manifestations, and other problems, such as menstruation, obesity, and pressure sores. The paper concludes with a discussion of the role of specialist physicians.

Constipation↗
PubMed1975

Intention tremor--a method of measurement.

A method of measuring and analysing intention tremor using a linear accelerometer is described. Reasons are given for measuring this particular parameter of the tremor, for using this specific energy conversion device, and for employing the particular form of analysis. A comparison of the numerical values obtained for the amount of tremor activity, compared with a corresponding clinical grading, is made for 30 patients with intention tremor due to a variety of pathological causes. It is shown that the method gives clear correlation with the clinical assessments, although certain discrepancies are noted, and their importance discussed.

Acceleration↗
PubMed1975

Application of an objective method of assessing intention tremor - a further study on the use of weights to reduce intention tremor.

Thirty-one patients with intention tremor due to a variety of causes were subjected to measurements of their intention tremor. The effect of varying amounts of lead weights on the amount of limb tremor recorded was noted. It is concluded that simple methods of treatment may be of benefit, and that an objective method of measuring intention tremor overcomes many of the difficulties of a clinical trial of this type. The method described yields quantifiable data which can be subjected to statistical analysis to help overcome the problem of variability. Bias in the results due to practice or fatigue effects has proved negligible. An optimum amount of lead, which was usually between 600 and 840 g, has been noted.

Adolescent↗
PubMed1973

Effect of the beta adrenergic blocking agent propranolol on essential tremor.

A double blind trial of a single 40 mg dose of the beta adrenergic blocking agent propranolol in the treatment of essential tremor produced significant reduction of tremor in four of five patients, but this effect was transient and had considerably diminished within four hours. A month's double blind clinical trial of propranolol, in a dose of 30 mg three times a day, showed that the active drug gave statistically better results than placebo for the attenuation of tremor. The mode of action of propranolol in the reduction of essential tremor is probably a dual one, due both to blockage of peripheral beta receptors and to a central depressant effect.

Adult↗
PubMed1972

Stroke units.

Explore the source record for details and available documents.

Cerebrovascular Disorders↗