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Biomedical subjects

Robert Teasell

Publications and source records attributed to Robert Teasell.

At least 19 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↗
PubMed2006

Evidence-based practice and setting basic standards for stroke rehabilitation in Canada.

It is a concern that the consistency of care in stroke rehabilitation appears to vary significantly among practice settings within Canada. Based upon an evidence-based review of stroke rehabilitation, a group of physiatrists from across Canada agreed to some basic standards for stroke rehabilitation. The following standards were deemed to be critical to providing effective stroke rehabilitation care: early assessment and quick access to specialized interdisciplinary rehabilitation, appropriate intensity of therapies, availability of outpatient therapy, appropriate community supports, and careful attention to secondary prevention of stroke. Providing stroke rehabilitation care consistently within these standards remains a challenge, particularly given the potential initial costs, despite significant improvements in patient outcomes and quality of life. Nevertheless, these standards should be the expectation of stroke patients, essentially forming a stroke rehabilitation "bill of rights."

Canada↗
PubMed2005

Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.

OBJECTIVE: To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. METHODS: Databases were searched (1966 through May 2005) using terms "cerebrovascular disorders," "deglutition disorders," and limited to "humans" for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics. Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. RESULTS: Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). CONCLUSIONS: The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.

Adult↗
PubMed2005

Heterocyclics and selective serotonin reuptake inhibitors in the treatment and prevention of poststroke depression.

OBJECTIVES: To review the best current evidence on heterocyclic and serotonin-reuptake inhibitor (SSRI) treatments of poststroke depression (PSD). DESIGN: A literature review using multiple databases was conducted to identify randomized, controlled trials of the treatment or prevention of PSD. Odds ratios were used to test for significant treatment response between the treatment arms for dichotomous outcomes. Continuous outcome measures were evaluated using weighted mean difference and 95% confidence intervals. SETTING: Literature review. PARTICIPANTS: Patients with stroke enrolled in the study of PSD of each selected article. MEASUREMENTS: Frequency of patients with and without depression; frequency of patients who responded to treatment. RESULTS: Nine articles were reviewed. Six investigated use of antidepressant therapy on treatment of PSD, and three examined the prevention of PSD. There was evidence to suggest that patients responded to treatment with antidepressants and significantly improved on depression scales, but treatment, especially with heterocyclic antidepressants, led to a significant number of dropouts due to side effects. There were insufficient data to pool the results of the prevention-based studies. CONCLUSION: Treatment with heterocyclic antidepressants and SSRIs appears to be a viable option for PSD, but their absolute or relative efficacy has yet to be fully established. The effectiveness of early initiation of antidepressants in the prevention of PSD is not clear.

Antidepressive Agents↗
PubMed2005

Treatment of whiplash-associated disorders--part I: Non-invasive interventions.

BACKGROUND: A whiplash-associated disorder (WAD) is an injury due to an acceleration-deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations. OBJECTIVE: The objective of the present article--the first installment of a two-part series on interventions for WAD--is to provide a systematic review of the literature published between January 1993 and July 2003 on noninvasive interventions for WAD using meta-analytical techniques. METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all studies on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measure. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta-analyses of the data. The results of all the studies were compiled and systematically reviewed. RESULTS: Studies were categorized as exercise alone, multimodal intervention with exercise, mobilization, strength training, pulsed magnetic field treatment and chiropractic manipulation. A total of eight RCTs and 10 non-RCTs were evaluated. The mean score of methodological quality of the RCTs was five out of 10. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables. CONCLUSIONS: There exists consistent evidence (published in two RCTs) in support of mobilization as an effective noninvasive intervention for acute WAD. Two RCTs also reported consistent evidence that exercise alone does not improve range of motion in patients with acute WAD. One RCT reported improvements in pain and range of motion in patients with WAD of undefined duration who underwent pulsed electromagnetic field treatment. Conflicting evidence in two RCTs exists regarding the effectiveness of multimodal intervention with exercise. Limited evidence, in the form of three non-RCTs, exists in support of chiropractic manipulation. Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD, and supporting or refuting the benefit of pulsed electromagnetic field treatment. Mobilization is recommended for the treatment of pain and compromised cervical range of motion in the acute WAD patient.

Chiropractic↗
PubMed2005

Treatment of whiplash-associated disorders--part II: Medical and surgical interventions.

BACKGROUND: Whiplash-associated disorder (WAD) is a term used to describe injury due to an acceleration-deceleration mechanism at the neck. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations. OBJECTIVE: The objective of the present article--the second installment of a two part review on WAD--is to provide a systematic review of the literature published between January 1993 and July 2003 on medical and surgical interventions for WAD using meta-analytical techniques. METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all clinical trials on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measures. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta-analyses of the data. The results of all the studies were compiled and systematically reviewed. RESULTS: The studies were categorized as medical or surgical interventions. A total of five RCTs and six non-RCTs were evaluated. The mean methodological quality of the RCTs was 7.3 among studies on medical interventions and 7.5 for studies on surgical intervention. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables. CONCLUSIONS: While several quality RCTs and epidemiological studies have been published since 1993 on medical and surgical interventions, the cumulative evidence is lacking. Moderate evidence exists in support of radiofrequency neurotomy. Evidence for steroid injections, botulinum treatments, carpal tunnel decompression and cervical discectomy is conflicting or unclear. Future research is required to clarify the utility of radiofrequency neurotomy and pulsed electromagnetic field treatment for WAD.

Humans↗
PubMed2005

Intrinsic factors influencing post stroke brain reorganization.

Reorganization of the brain, specifically the motor cortex surrounding the stroke, accounts for much of the observed neurological recovery following stroke. Not surprisingly, size of the stroke lesion has the greatest impact on neurological recovery in both animal and clinical research studies. Spontaneous recovery of lost function is possible after a cortical lesion, particularly if the lesion is small. Age correlates negatively with recovery; older individuals generally demonstrate slower and less complete recovery. However, age by itself is a poor predictor of functional recovery.

Age Factors↗
PubMed2005

Plasticity and reorganization of the brain post stroke.

Reorganization of the cortex post stroke is dependent not only on the lesion site but also on remote brain areas that have structural connections with the area damaged by the stroke. Motor recovery is largely dependent on the intact cortex adjacent to the infarct, which points out the importance of preserving the penumbral areas. There appears to be a priority setting with contralateral and ipsilateral motor pathways, with ipsilateral (unaffected hemisphere) pathways only becoming prominent after more severe strokes where functional contralateral (affected hemisphere) pathways are unable to recover. Ipsilateral or unaffected hemisphere motor pathway activation is therefore associated with a worse prognosis.

Animals↗
PubMed2005

Plasticity and reorganization of the uninjured brain.

Brain capacity is dependent not so much on the number of neurons but on the number of synaptic connections with functional connections that develop over a lifetime of genetic programming and life experiences. In the uninjured human brain, cortical reorganization that occurs in response to learning and experience is referred to as brain plasticity. Motor learning and complex environments result in a greater number of synapses and an increase in dendritic branching, whereas repetitive movements alone, in the absence of motor learning, do not. Learning and experience lead to an expansion of cortical representation, while failure to maintain training results in a contraction of cortical representation. In animals, loss of sensory peripheral afferent input results in an expansion of the forelimb representation of the intact adjacent cortex. Prolonged periods of peripheral nerve stimulation in both animals and humans can lead to reorganization of related sensorimotor cortical maps.

Animals↗
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

Training and stimulation in post stroke recovery brain reorganization.

In both animal and clinical studies, training or rehabilitation increases cortical representation with subsequent functional recovery, whereas a lack of rehabilitation or training decreases cortical representation and delays recovery. Animals exposed to enriched environments post stroke have improved functional outcomes compared with animals exposed to nonenriched environments. In humans, stroke units may be the closest approximation there is to an enriched environment. However, studies indicate that patients spend the majority of time being inactive and alone while on a stroke unit. Given the animal evidence (which emphasizes increased stimulation and increased activity), there is clearly an opportunity for improving the stroke rehabilitation experience to maximize post stroke recovery.

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↗