Rehabilitation of hemiplegia: indices of assessment and prognosis.

Hurwitz, L.J.; Adams, Gerry

doi:10.1136/bmj.1.5792.94

Cited by 52 publications

(16 citation statements)

References 63 publications

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“…This scale has already proved satisfactory in assessing disability after stroke from the medical records at this institution.' 3 The scale has additional advantages in that it has been widely used in other studies 17 and is compatible with the dependency classifications used in controlled trials of stroke rehabilitation.…”

Section: Methodsmentioning

confidence: 99%

Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975-1979.

Dombovy

Basford

Whisnant

et al. 1987

Stroke

136

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Medical records of all residents of Rochester, Minnesota, who had a first stroke in 1975-1979 were reviewed to determine level of disability, disposition, and use of rehabilitation services. Of the 292 persons with a first stroke, 251 (86%) (mean age 70 years) survived > 1 week. The mean Rankin disability score (Grade 1, no disability, through Grade 5, severe disability) changed from 1.7 before stroke to 2.8 in survivors at hospital discharge; 29% of those discharged required further institutional care. The level of disability in survivors remained relatively constant from 6 months after stroke through 5 years of observation. Of the 112 patients with an admission score of 5,40 (36%) were alive at 1 year and only 5 of those (13%) improved to relative independence (Rankin scores of 1 or 2). The most common comorbidity contributing to disability was cardiovascular disease (31%). After the first 18 months, the mortality in patients with stroke was similar to that in a normal population having the same age and sex distribution. Of the 2511-week survivors, 132 (53%) had rehabilitation (

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Section: Methodsmentioning

confidence: 99%

Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975-1979.

Dombovy

Basford

Whisnant

et al. 1987

Stroke

136

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“…This viewpoint is .supported by the observation that unawareness of physical and cognitive impairment is much more frequent in right-than in left-brain-damaged patients (Anderson & Tranel, 1989). The suggestion that the quality of the disability may influence quality and severity of the post-stroke depression is also supported by the' observation that aphasic patients feel particularly stigmatised and report lowered selfesteem and feelings of shame as a consequence of their communication disorders (Hyman, 1972;Hurwitz & Adams, 1972). This does not mean, however, that neurological factors (such as the laterality of lesion) and psychological factors (such as' the reaction to communication difficulties) leave no room for psychosocial factors in the determining of poststroke depression.…”

Section: Gainommentioning

confidence: 96%

Emotional and psychosocial problems after brain injury

Gainotti

1993

Neuropsychological Rehabilitation

117

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Emotional and psychosocial disorders of brain-damaged patients have a strong impact upon the outcome of the rehabilitation. However, owing to methodological difficulties, and to the intrinsic complexity of such disorders, these issues have received only a limited amount of interest. The aim of this paper is to try to disentangle some of the major factors underlying these disturbances, making a schematic distinction between three main categories:(1) neurological factors; (2) psychological (or psychodynamic) factors;(3) psychosocial factors. Emotional disorders stem directly from neurological factors when they result from the disruption of specific neural mechanisms subserving the modulation and control of emotional and social. behaviour. Patients with severe traumatic head injury are, in general, the more prototypical instances of this category, as in them the lesion usually involves some of the most important cortical components of the limbic system. According to some authors, poststroke depression should also be included in this category. Psychological or psychodynamic factors, on the other hand, consist of those personal attitudes towards the disability that result from an implicit or explicit awareness of the defect and of its implications as to the future quality of life of the patient. These factors are linked to the personality of the patient, to their life-style and to their whole system of values. Finally, psychosocial factors can be considered as the interconnected set of consequences that the handicap, resulting from the functional impairment, will produce on the patient's social activities and on their network of social relationships. An important component of this category consists of the burden that the cognitive and personality change produced by the lesion represents for the close relatives of the patient, of their reaction to this burden, and of the influence that these reactions can have on the process of recovery.

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“…With regard to rehabilitation, subsequent research has suggested that (civilian) patients with right hemisphere lesions have a poorer prognosis than those with comparable lesions in the left hemisphere (Hurwitz & Adams, 1972;Marquardsen, 1969;Mazaux, Barat, Borde, & Arne, 1979), although the underlying causes for this finding have not been definitively specified.…”

Section: Outcome Statisticsmentioning

confidence: 99%

Very Late Outcome After Focal Wartime Brain Wounds

Newcombe

1996

Journal of Clinical and Experimental Neuropsychology

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This paper reviews outcome studies of wartime head-injury in Europe and North America. These include Goldstein's major but neglected contribution. intensive clinical and experimental studies of World War I veterans, in which he emphasizes the need for rehabilitation and community care. The present paper reports a follow-up, in Oxford U.K., of a cohort of World War II veterans drawn from over a thousand head-injured servicemen admitted to St Hugh's Military Hospital in Oxford, usually within one to two days of wounding. This cohort was initially examined in 1963 and thereafter until the present day. Behavioural outcome is remarkably good. Cognitive data show a striking preservation of ability in the group as a whole, despite previously reported selective impairments related to specific loci of lesion. Psychiatric illness is rare; and there is little difference in self-report on rating scales between the veterans and a carefully recruited, age-matched control panel. This positive outcome is attributed to a number of factors, including the psychosocial context of World War II for British servicemen, the expert and systematic medical care that commenced within hours of wounding, and the positive attitude of the civilian population. It reinforces the crucial importance of after-care.

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Rehabilitation of hemiplegia: indices of assessment and prognosis.

Cited by 52 publications

References 63 publications

Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975-1979.

Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975-1979.

Emotional and psychosocial problems after brain injury

Very Late Outcome After Focal Wartime Brain Wounds

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