Test-Retest Reliability, Effects of Age and Comparison of Horizontal 2 Semicircular Canals Gain Values between Head Impulse and Suppression Head Impulse Paradigms.

BACKGROUND: This study investigates the test-retest reliability, aging effects, and differences in horizontal semicircular canals gain values between the head impulse paradigm and suppression head impulse paradigm. METHODS: Sixty healthy adult subjects aged 22-76-year-old (mean ± standard deviation=47.27 ± 18.29) participated in the head impulse paradigm and suppression head impulse paradigm using the video head impulse test. The Head impulse paradigm was used to assess all 6 semicircular canals, while suppression head impulse paradigm measured only the horizontal canals. Twenty subjects aged 22-40-year-old (25.25 ± 4.9) underwent a second session for the test-retest reliability. RESULTS: There were good test-retest reliability for both measures (right horizontal head impulse paradigm, intraclass correlation coefficient=0.80; left horizontal head impulse paradigm, intraclass correlation coefficient=0.77; right anterior head impulse paradigm, intraclass correlation coefficient=0.86; left anterior head impulse paradigm, intraclass correlation coefficient=0.78; right posterior head impulse paradigm, intraclass correlation coefficient=0.78; left posterior head impulse paradigm, intraclass correlation coefficient=0.75; right horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.76; left horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.79). The test-retest reliability for suppression head impulse paradigmanti-compensatory saccade latency and amplitude were moderate (right latency, intraclass correlation coefficient=0.61; left latency, intraclass correlation coefficient=0.69; right amplitude, intraclass correlation coefficient=0.69; left amplitude, intraclass correlation coefficient=0.58). There were no significant effects of age on head impulse paradigm and suppression head impulse paradigm vestibulo-ocular reflex gain values and suppression head impulse paradigmsaccade latency. However, the saccade amplitude became smaller with increasing age, P < .001. The horizontal suppression head impulse paradigm vestibuloocular reflex gain values were significantly lower than the head impulse paradigm for both sides (right, P = .004; left, P = .004). CONCLUSION: There was good test-retest reliability for both measures, and the gain values stabilized with age. However, suppression head impulse paradigm anti-compensatory saccade latency and amplitude had lower test-retest reliability than the gain. The suppression head impulse paradigm vestibulo-ocular reflex gain was lower than the head impulse paradigm and its anti-compensatory saccade amplitude reduced with increasing age.

Oral hygiene practices and knowledge among stroke-care nurses: A multicentre cross-sectional study.

AIMS AND OBJECTIVES: To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia. BACKGROUND: Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia. DESIGN: A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided. METHODS: All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined. RESULTS: Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p < .001). CONCLUSIONS: The clinical practice of providing oral hygiene care is less than ideal, and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.

An unexpected delivery: pregnancy experience of a paraplegic lady.

INTRODUCTION: Spinal cord injury (SCI) has increased over the years, and so has the survival. Women with SCI remain fertile and have equal chance of pregnancy. CASE PRESENTATION: We described a case of a 29-year-old lady with traumatic spinal cord injury (SCI) resultant with paraplegia in 2008, who conceived naturally 2 years after the injury. She only had her antenatal check-up at a low-risk antenatal center throughout her pregnancy and was not referred to specialized obstetric care. She did not appreciate active labor, and unexpectedly had a precipituous labor and gave birth in the bathroom. DISCUSSION: Pregnancy is relatively safe in women with spinal cord injury (SCI). However, disability-related issues can be exaggerated during pregnancy, delivery and post-partum periods. Thus, understanding common issues related to pregnancy in this population is important. Specialized obstetric care with rehabilitation input throughout antenatal and postnatal care is crucial for a good overall outcome of a pregnant woman with SCI.

The next revolution in stroke care.

Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.

The evolution of stroke rehabilitation randomized controlled trials.

BACKGROUND: In the interest of prioritizing resources and providing future direction for researchers, a complete overview of the landscape of stroke rehabilitation literature was conducted. AIM: We aimed to examine the evolution of stroke rehabilitation randomized controlled trials, with respect to number, sample size, and methodological quality between 1970 and September 2012. METHODS: Using the Evidence-Based Review of Stroke Rehabilitation (http://www.ebrsr.com), all randomized controlled trials related to stroke rehabilitation interventions were eligible for inclusion and were divided into five groups based on the primary outcome (i.e., motor, cognitive, medical complications, psychosocial, and 'other'). RESULTS: One thousand sixty-three randomized controlled trials met inclusion criteria, with motor studies accounting for 58·8% of the total. The total number of randomized controlled trials grew between 1970 and 2012, with 35·2% of all the studies published in the last five-years. Motor randomized controlled trials had the smallest median sample size compared with cognitive (P < 0·018), medical complications (P < 0·001), psychosocial (P < 0·001), and 'other' (P < 0·001) randomized controlled trials. Between 1973 and 1977 and 2008 and 2012, there was no statistically significant increase in median sample sizes (P = 0·845). Psychosocial randomized controlled trials had higher median Physiotherapy Evidence Database scores when compared with motor (P = 0·002), cognitive (P = 0·035), and 'other' randomized controlled trials (P = 0·036), but not medical complication randomized controlled trials (P = 0·591). Over time, median Physiotherapy Evidence Database scores for all randomized controlled trials significantly increased from 5 (interquartile range 0·5) in 1973-1977 to 7 (interquartile range 3) in 2008-2012 (P = 0·008). CONCLUSIONS: Randomized controlled trials in stroke rehabilitation have increased over the past four decades, with an associated increase in methodological quality, but not sample size.

Stroke: More than a 'brain attack'.

Stroke is a life-altering event that potentially affects stroke survivors, their families, healthcare resources, and society in general. Stroke has often been described as 'brain attack', denoting emergency emphasis on the vascular pathology. Consequently, many national and provincial stroke strategies have emphasized vascular care through primary prevention strategies and thrombolysis. Despite being important initiatives, this has resulted in a stroke system that emphasizes the frontloading of stroke care, focusing on the vascular pathology. The advent of thrombolysis therapy has benefited a small proportion of patients while a vast majority are still affected by stroke-related impairments. Management of the vascular elements of stroke is important; however, the impact of rehabilitation on stroke recovery has been relatively undervalued. Stroke care is in need of a revolution toward a more comprehensive and balanced approach. It is anticipated that the major focus of stroke care will include promoting recovery, in line with the growing evidence on stroke rehabilitation interventions. A paradigm shift is necessary to ensure that comprehensive and balanced stroke care which incorporates rehabilitation is taken into account, leading to a stroke care system where patient needs are managed both as a 'brain attack' and an 'injured brain'.