A scoping review protocol of the rehabilitation needs of people with brain tumours.

Background: Every year 480 people are diagnosed with a primary brain tumour in Ireland. Brain tumours can vary in type, location, treatment, and progression but neurological impairments are a consistent feature. Such neurological disability creates significant symptom burden that can seriously impact peoples' functional ability and quality of life. Rehabilitation can improve functional prognosis (motor and cognitive) and quality of life in people with brain tumours. However, research and experience consistently show that people with brain tumours can have difficulties accessing rehabilitation services. Our scoping review will investigate the research evidence concerning the rehabilitation needs of people with brain tumours. Methods: The scoping review will be conducted in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. Relevant databases (PubMed, Embase, CINAHL+, PsychINFO, PEDro) and grey literature sources will be searched. Publications relating to international rehabilitation practices will be included. A data extraction table will be created to facilitate narrative synthesis of the results. Conclusions: This scoping review will examine the scope of the literature on the rehabilitation needs of people with brain tumours. The findings will inform a research project entitled "Surgery, radiotherapy, chemotherapy, but now what? Exploring the rehabilitation needs of people with brain tumours in Ireland". An article reporting the results of the scoping review will be submitted to a scientific journal and presented at relevant national and international conferences.

Identifying priority interventions for stroke in Ireland through stakeholder engagement to inform population-based modelling: a mixed methods protocol.

Introduction  Improvements in stroke survival have resulted in increasing numbers of people living with stroke, and with a rapidly evolving evidence-base for stroke prevention and management, there is a need for robust data and evidence to inform future policy decision-making. Population-based modelling and economic evaluation of alternative policy options is a useful tool to support decision making. However, this process must be aligned to key stakeholder priorities. The aim of the proposed research is to engage with stakeholders in Ireland to identify their priorities for the development of stroke prevention and management strategies and policies. Methods  The design is iterative, based on mixed methods. Phase 1 involves a qualitative approach for initial priority gathering, based on an open-ended online survey (target sample: 100-120) and interviews (target sample: 34-40). Stakeholders will include: 1) stroke survivors and family member/main carers, 2) healthcare professionals (HCPs) providing stroke care and 3) people working in stroke research, policy and advocacy. These data will be analysed qualitatively, with the aim of identifying a long-list of specific interventions. Phase 2 involves an interim priority-setting exercise, based on a quantitative online survey. Participants will be asked to rank the interventions on the initial long-list. These rankings will be used to inform a final priority-setting workshop (Phase 3), where a small stakeholder group will decide on the final set of priorities. Discussion  The rich and detailed quantitative and qualitative data, based on the views of diverse stakeholders, will be directly relevant to policy makers and service planners involved in developing and improving stroke care in Ireland. The information provided will also be essential to inform the Scenario and Intervention Modelling in Ireland for Stroke (SIMI-Stroke) project, a population-based economic and epidemiological modelling study aimed at identifying cost-effective interventions for stroke across the prevention, acute and post-acute care continuum.

Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial.

BACKGROUND: Previous lower-limb mirror therapy research has focused on non-weight bearing interventions. OBJECTIVES: The primary aim of this study was to investigate the effect and feasibility of a combination of mirror therapy and treadmill training on post-stroke lower-limb recovery compared to a placebo intervention. METHODS: All patients (N = 30) walked on a treadmill for 30 min per day, 3 days per week, for 4 weeks. The mirror therapy and treadmill training group (n = 15) walked on the treadmill while viewing a reflection of their non-paretic limb in a mirror positioned in their mid-sagittal plane. The placebo group (n = 15) received no mirror visual feedback due to an altered mirror position. PRIMARY OUTCOME MEASURES: Ten Metre Walk Test (10MWT) and Six Minute Walk Test (6MWT). SECONDARY OUTCOME MEASURES: Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Feasibility was appraised by examining participant compliance and any adverse events. RESULTS: No significant between group differences were demonstrated for the 10MWT, 6MWT or FMA-LE at post-training or 3-month follow-up assessment. A significant between group difference on the MAS was demonstrated in the reduction of ankle dorsiflexion muscle tone (p = 0.006) and ankle plantarflexion muscle tone (p = 0.01) in the mirror therapy group compared to the placebo group at post-training assessment but not at 3-month follow-up. CONCLUSION: Our study reveals that in our group of patients with chronic stroke, mirror therapy combined with treadmill training facilitated significant reductions in ankle muscle tone (p < 0.05) compared to a placebo intervention.

Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis.

BACKGROUND: Mirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke. RESEARCH QUESTION: This systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions. METHODS: Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning. RESULTS: Nine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24-0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD -0.55; 95% CI -1.01 to -0.10), walking velocity (SMD 0.71; 95% CI 0.35-1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71-1.69) and step length (SMD 0.56; 95% CI -0.00 to 1.12). SIGNIFICANCE: The results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.

Thrombolysis for stroke in Ireland: increasing access and maintaining safety in a challenging environment.

BACKGROUND: In the setting of a national audit of acute stroke services, we examined the delivery of thrombolytic therapy for ischaemic stroke and whether current practice was achieving safe outcomes and consistent delivery for patients. METHOD: Data obtained from the recent national stroke audit was compared against previous Irish audit, the most recent SSNAP UK stroke audit and the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) study. RESULTS: Thrombolysis was provided in 27 acute hospitals throughout Ireland during the period assessed with 82% (22/27) providing 24/7 access, the remaining sites using redirect policies. Decision to thrombolyse was made by stroke trained consultants in 63% (17/27) of units, with general physicians and emergency medicine consultants covering the other units. Thrombolysis rate for non-haemorrhagic stroke was 11% (n = 80/742, CI 95% ±2.23) versus a 1% rate in the 2008 audit. Sites receiving patients through a redirect policy had the highest thrombolysis rate, an average of 24%. Nearly 30% of cases were thrombolysed on the weekend. Eighty-three percent of cases were managed in a stroke unit at some time during admission versus 54% of the national total cases. Thirty-seven percent of patients were ≥80 years old. The mortality rate was 11.3% versus the national mortality rate for non-thrombolysed ischaemic strokes of 10% (p > 0.5), and this is comparable to the SITS-MOST 2007 study 3-month mortality rate of 11.3% (p > 0.5). CONCLUSION: Stroke thrombolysis is being effectively and safely provided in acute stroke services in Ireland despite regular involvement of non-specialist staff. There is still potential to improve thrombolysis rate.

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in Polio survivors: a randomised controlled trial.

OBJECTIVE: To investigate the effect of an eight-week home-based arm ergometry aerobic exercise programme on physical fitness, fatigue, activity and quality of life in Polio Survivors. DESIGN: An assessor blinded randomised controlled trial. SETTING: Home-based exercise. SUBJECTS: Fifty-five Polio survivors randomised to exercise or control groups. INTERVENTION: Home-based arm ergometry at an intensity of 50%-70% maximum heart rate, compared with usual physiotherapy care. MAIN MEASURES: The Six-minute Arm Test, Fatigue Severity Scale, Physical Activity Scale for Individuals with Physical Disabilities and SF-36. Assessments were completed at baseline and at eight weeks. RESULTS: There was no significant difference in the primary outcome, exercising heart rate during the Six-minute Arm Test, between the groups at follow-up [97.6 (SD10.1) compared to 102.4 (SD13.7) beats per minute ( P=0.20)]. Blood pressure was significantly lower in the intervention group at follow-up [systolic blood pressure 132(18.6)mmHg compared to 144.1(14.6)mmHg ( P=0.002)]. There were no between group differences in the Fatigue Severity Scale ( P=0.25) or Physical Activity Scale for Individuals with Physical Disabilities ( P=0.49), with a small difference in SF-36 physical component score ( P=0.04). CONCLUSIONS: This home-based arm ergometry programme successfully facilitated aerobic exercise in Polio Survivors, but did not result in a significant change in physical fitness, measured by the Six-minute Arm Test.

Clinical guideline adherence by physiotherapists working in acute stroke care.

The publication of the Irish Clinical Guidelines for Stroke in 2009 provided healthcare professionals with an essential tool for improving stroke services. The aim of this study was to identify the degree to which Senior Physiotherapists in acute stroke care adhered to the Irish Clinical Guidelines for Stroke. This was a cross-sectional study, a postal or online survey was distributed to 31 Senior Physiotherapists working in acute stroke care, 23 responded, achieving a 74% response rate. There was excellent compliance with guidelines for the completion and documentation of full assessment within 5 working days of admission 19 respondents (82.6%), and the involvement of the patient in goal setting 19 (82.6%). Poor compliance was reported in relation to the provision of early assessment 10 (43.5%) and adequate rehabilitation intensity 9 (39%). The main barriers to compliance in these areas were organisational in nature.

A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital.

Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample to profile elderly fallers referred for physiotherapy in ED. Forty-subjects were assessed over 14 weeks. Mean age was 84.88 years (s.d. 7.3) and 31 (77.5%) were female. All demonstrated slow walking speed and 26 (65%) demonstrated poor grip strength. A quarter of subjects reported fear of falling and 30 (75%) were classified as frail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosis had been diagnosed in 9 (22.5%) subjects--a low prevalence compared with international research, but 25 (62.5%) subjects had never had a DEXA scan. The prevalence of frailty in the sample of elderly fallers in this study was very high (75%).

Stroke rehabilitation: recent advances and future therapies.

Despite advances in the acute management of stroke, a large proportion of stroke patients are left with significant impairments. Over the coming decades the prevalence of stroke-related disability is expected to increase worldwide and this will impact greatly on families, healthcare systems and economies. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. In this review, we discuss the effects of stroke, principles of stroke rehabilitative care and predictors of recovery. We also discuss novel therapies in stroke rehabilitation, including non-invasive brain stimulation, robotics and pharmacological augmentation. Many trials are currently underway, which, in time, may impact on future rehabilitative practice.

A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder.

In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.

Life histories and fitness of two tuber moth species feeding on native Andean potatoes.

In the inter-Andean valleys of central Perú, two species of tuber moth, Phthorimaea operculella (Zeller) and Symmetrischema tangolias (Gyen), often occur simultaneously in stored potatoes. Traditional farming communities in the region produce a variety of native potatoes for local consumption. These include Solanum tuberosum subsp. andigena, the presumed predecessor of commercial potatoes, S. tuberosum subsp. tuberosum. In this study, we examined resistance against P. operculella in ten native Peruvian potato varieties (Casa blanca, Chispiadita, Madre de vaca, Mamaco negro, Misha, Chorisa, Mamaco rosado, Occa papa, Vacapa jayllo, and Yana tornasol). We also compared resistance in the first five of these varieties against S. tangolias. Varieties with pigmented periderms showed moderate resistance (30-40% against P. operculella in Mamaco negro, Mamaco rosado, and Yana tornasol and 55% against S. tangolias in Mamaco negro). All the other varieties were susceptible to both moth species. Small tubers tended to be the most resistant to the attack by both moths; however, this was not related to the availability of food for developing larvae, since pupal weight and development time were unaffected by the size of tubers. Similar responses by the two moths to native potatoes indicate that tuber resistance could be used to control the complex of tuber moths that damage potatoes in the Andes. We suggest that native potatoes, which are often easily introgressed with commercial potatoes, are a potential source of resistance against tuber moths.

Clinical assessment of rehabilitation potential of the older patient: a pilot study.

Clinical assessment of 'rehabilitation potential' is an everyday occurrence in hospitals, where scarcity of dedicated rehabilitation facilities require clinicians to decide who is most likely to benefit from extended rehabilitation. We examined the reliability of this judgement by different interdisciplinary team members in 27 consecutive admissions to a geriatric rehabilitation ward. The reliability of a clinical judgement was in general quite poor (kappa = 0.21). A more reliable means of determining patient 'rehabilitation potential' is needed.

The development of a comprehensive stroke programme in the acute hospital.

Stroke is the third leading cause of death and an important cause of hospital admissions and long term disability. The incidence of stroke is estimated at 200 per 100,000 of the population, Dublin has approximately 2,400 new strokes per annum. In 1989 a comprehensive stroke programme was introduced in St Vincent's Hospital. The aim was to provide patients with a coordinated approach to rehabilitation. A study of the programme was conducted in 1993 by detailed chart review. 129 patients with a clinical diagnosis of stroke were referred to the programme during a 12 month period. 27.13% were under age 65 and 72.87% were over 65 years, 18% died and 44.2% were discharged home, independently mobile. The study findings suggest that the comprehensive stroke programme in St Vincent's Hospital represents a feasible model of care in the acute general hospital setting.