Managing the upper-limb after stroke
|
|
- Bridget Rice
- 8 years ago
- Views:
Transcription
1 2 nd Queen Square Upper Limb Neurorehabilitation Course Managing the upper-limb after stroke NICK WARD, UCL INSTITUTE OF NEUROLOGY, QUEEN SQUARE Follow us #QSULrehab
2 Overview 1. How do we treat (upper limb dysfunction) after stroke? 2. How do we increase the dose? 3. Neuroimaging in neurorehabilitation what is it for? 4. Enhancing plasticity in neurorehabilitation
3 I. How do we treat people after stroke?
4 I. How do we treat people after stroke? 1. Preservation of tissue 2. Avoid complications 3. Task specific or augmented training 4. Enhancement of plasticity 5. Compensation Rehabilitation Recovery
5 I. How do we treat people after stroke? Upper limb recovery after stroke is unacceptably poor. ¾ of stroke survivors will have upper limb symptoms after acute stroke (Lawrence et al, 2001) Initial severity is most significant predictor of long term outcome (Coupar et al, 2013), but also anatomical damage 60% of patients with non-functional arms 1 week post-stroke didn t recover function at 6 months (Wade et al, 1983) Those showing some synergistic movement in UL within 4 weeks after stroke have 90% chance of improving (Kwakkel et al, 2003)
6 I. How do we treat people after stroke? The dose of UL treatment after stroke is unacceptably low... Patients engaged in activity for only 13% of the day (Bernhardt et al, 2004) Patients were alone for over 60% of the day (Bernhardt et al, 2004) Practice of task-specific, functional UL movements in only 51% of UL sessions (Lang et al, 2009)
7 I. How do we treat people after stroke? Is there evidence to support increased dose - time on task? 2-3 hours of arm training a day for 6 weeks improved both FM and ARAT when started 1-2 months after stroke (Han et al, 2013) Other studies equivocal but high variability in design extra = 2 hrs/week to 3 hrs/day some initiated early, some late
8 I. How do we treat people after stroke? Is there evidence to support increased dose repetitions? In animals, changes in primary motor cortex synaptic density occur after 400 (but not 60) reaches (Remple et al, 2001) Most rodent studies involve hundreds of repetitions in a training session In human stroke patients, typical number of repetitions in a session is 30 (Lang et al, 2009) Ability to perform repetitions related to function might be a threshold above which UL use improves and below which it decreases (Schweighofer et al, 2009)
9 I. How do we treat people after stroke? Is there evidence to support task-specific training? Is task-specific training enough? Cochrane review says no To be useful, task-specific training must be both retained and generalizable (Krakauer, 2006) Apply principles of motor learning 1. Distributed practice - frequent and longer rest periods 2. Variable practice - varying parameters of task 3. Contextual interference - random ordering of related tasks
10 II. Increasing the dose of what? ADAPTATION Motor system responds to altered environment in order to regain former levels of performance Driven by prediction error Can occur in single session Short lived after effect SKILL LEARNING Acquiring new patterns of muscle activation to achieve higher levels of performance Not just faster or more accurate both Driven by reward and reinforcement Occurs within session and with extended practice Number of repetitions determines acquisition Other factors promote retention and generalisability
11 II. How do we increase dose? Dose is important Motor 1000 s of repetitions Language 100 hours
12 II. How do we increase dose? multi-site single blind randomized controlled trial 4-week self-administered graded repetitive upper limb program in 103 stroke patients approx 3 weeks post stroke 3 grades (mild, moderate, severe) Provided with exercise book with instructions Repetitions, inexpensive equipment strength, range of motion, gross and fine motor skills GRASP group showed greater improvement in upper limb function GRASP group maintained this significant gain at 5 months post-stroke
13 II. How do we increase dose? Saebo ReJoyce Biometrics ImAble Robotic arm training
14 II. How do we increase dose?
15 II. How do we increase dose? Detailed upper limb assessment and report A thorough discussion of goals and prognosis Advice on symptom management When appropriate we will suggest further intensive in-patient treatment (involving at least 4 hours therapy per day) as part of a 3 week programme at Queen Square Where required, we will make referrals to other NHNN services (e.g. spasticity assessment clinic, upper limb Functional Electrical Stimulation clinic, specialist vocational rehabilitation clinic, orthotics clinic) We will liaise closely with local outpatient and community services where appropriate In all cases we will advise on how to achieve long term self-management where able Referrals to: Dr Nick Ward n.ward@ucl.ac.uk
16 III. Brain imaging in neurorehabilitation what for? 1. Predicting long term outcome e.g. EXPLICIT, PREP, PLORAS 2. Predicting response to treatment behavioural training plasticity enhancement
17 III. Predicting outcome after stroke
18 III. Predicting outcome after stroke Track from fmri-defined hand areas in 4 different cortical motor areas Shultz et al, Stroke 2012 Corrrelation with poststroke hand grip strength
19 III. Predicting outcome after stroke 1. SAFE = Shoulder Abduction + Finger Extension (MRC scale) 72 h after stroke (range 0 10) 2. TMS at 2 weeks Stinear, C. M. et al. Brain 2012 Aug;135: MRI/DTI at 2 weeks Copyright restrictions may apply.
20 III. Predicting outcome after stroke 1. Database of (i) hi-res structural MRI, (ii) language scores and (iii) time since stroke 2. MRI converted to 3D image with index of degree of damage at each 2mm 3 voxel 3. A machine learning approach is used to compare lesion images to others in database and similar patients identified 4. Different recovery curves can then be estimated for different behavioural measures
21 III. Predicting treatment effect after stroke Damage to M1 pathway limits response to robot assisted therapy
22 III. Predicting treatment effect after stroke Cramer et al., Stroke 2007; 38: Less activity in M1 limits response to robot assisted therapy
23 III. Predicting treatment effect after stroke 17 chronic stroke patients (FM 4-25) 30 days of UL training 30 mins +/- APBT Change in FM relatively small 0 6 points Overall FA (DTI) symmetry predicted ΔFM (r 2 = 0.38) But better model by considering those with and without MEPs Copyright restrictions may apply. Stinear, C. M. et al. Brain :
24 III. Predicting treatment effect after stroke Needs to inform what kind of treatment? not who should we treat?
25 IV. Experience dependent plasticity after stroke Brain slice Cortex Pyramidal cell Plasticity takes place in the cortex changing strength of existing connections new connections getting rid of unused connections
26 IV. Experience dependent plasticity after stroke Dendrite Axon dendrites axon
27 A IV. Experience dependent plasticity after stroke affected side infarct 10 days post stroke 17 days post stroke 24 days post stroke 31 days post stroke 3 months post stroke B affected side OUTCOMES Barthel ARAT GRIP NHPT Patient A 20/20 57/ % 78.9% Patient B 20/20 57/ % 14.9%
28 IV. Experience dependent plasticity after stroke Drugs NIBS BAT
29 IV. Experience dependent plasticity after stroke less disability more disability amphetamine Several agents considered: Acetylcholinesterase inhibitors Amphetamine SSRIs (e.g. FLAME, FOCUS in UK) DA agonists (e.g. DARS in UK) Reduced GABAergic inhibition? Increased glutamatergic/bdnf mediated LTP?
30 IV. Experience dependent plasticity after stroke
31 IV. Experience dependent plasticity after stroke Why not perform large RCTs? Inhibitory TBS? Excitatory TBS? Hamada M et al. Cereb. Cortex 2013;23: TBS (and TDCS) is very variable!
32 IV. Experience dependent plasticity after stroke Getting plasticity enhancement into clinical practice
33 IV. Experience dependent plasticity after stroke ctdcs to contralesional M1 reduced SICI (less inhibition) in ipsilesional M1 tdcs-induced enhancement of skill acquisition Reduced intracortical inhibition re-opens periods of plasticity in chronic stroke?
34 IV. Experience dependent plasticity after stroke Intracortical networks Task related networks Large scale networks MESOSCOPIC MACROSCOPIC
35 Summary Upper limb recovery after stroke is unacceptably poor. The dose of UL treatment after stroke is unacceptably low... We need to increase the dose of therapy Technology and new clinical services can help achieve this Neuroscience will help to understand the mechanisms of recovery allowing us to target appropriate interventions to appropriate patients
36 Acknowledgements FIL: Richard Frackowiak Rosalyn Moran Karl Friston Will Penny Jennie Newton Peter Aston Eric Featherstone ABIU/NRU: Fran Brander Kate Kelly Diane Playford Alan Thompson All QS nurses, physios, OTs, SLTs SOBELL DEPARTMENT : Holly Rossiter Ella Clark Marie-Helen Boudrias Chang-hyun Park Karine Gazarian John Rothwell Penny Talelli Some more slides at Follow us on Ward Lab at UCL FUNDING:
37 References Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke 2001 Jun;32(6): Kwakkel G, Kollen BJ, van der Grond J, Prevo AJH. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003 Sep;34(9): Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil Apr;75(4): Sunderland A, Fletcher D, Bradley L, Tinson D, Hewer RL, Wade DT. Enhanced physical therapy for arm function after stroke: a one year follow up study. J Neurol Neurosurg Psychiatry Jul;57(7): Wade DT, Langton-Hewer R, Wood VA, Skilbeck CE, Ismail HM. The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry Jun;46(6): Coupar F, Pollock A, Rowe P, Weir C, Langhorne P. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil Apr;26(4): Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right: what can be learned from animal models? Neurorehabil Neural Repair Oct;26(8): Bernhardt J, Dewey H, Thrift A, Donnan G. Inactive and alone: physical activity within the first 14 days of acute stroke unit care. Stroke 2004 Apr;35(4): Lang CE, Macdonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil Oct;90(10): Han C, Wang Q, Meng P, Qi M. Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial. Clin Rehabil Jan;27(1): Remple MS, Bruneau RM, VandenBerg PM, Goertzen C, Kleim JA. Sensitivity of cortical movement representations to motor experience: evidence that skill learning but not strength training induces cortical reorganization. Behav Brain Res Sep 14;123(2): Schweighofer N, Han CE, Wolf SL, Arbib MA, Winstein CJ. A functional threshold for long-term use of hand and arm function can be determined: predictions from a computational model and supporting data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial. Phys Ther Dec;89(12): Harris JE, Eng JJ, Miller WC, Dawson AS. A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial. Stroke Jun;40(6): Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol Feb;19(1):84 90.
Motor recovery after stroke
NICK WARD, UCL INSTITUTE OF NEUROLOGY, QUEEN SQUARE n.ward@ucl.ac.uk Follow us on twitter @Wardlab UCL Institute of Neurology MSc Lectures, Queen Square, March 2014 Recovery After Stroke: Neurorehabilitation
More informationPhysiotherapy for the severely paretic arm and hand in patients with acquired brain injury - Virtual reality combined with task specific practice
Physiotherapy for the severely paretic arm and hand in patients with acquired brain injury - Virtual reality combined with task specific practice Christian Gunge Riberholt, PT MR Nakayama et al, 1994 (Copenhagen
More informationRecovery and Rehabilitation after Stroke
Recovery and Rehabilitation after Stroke NICK WARD UCL INSTITUTE OF NEUROLOGY QUEEN SQUARE n.ward@ucl.ac.uk Follow us on Twitter @WardLab For more information go to http://www.ucl.ac.uk/ion/departments/sobell/research/nward
More informationTHE FUTURE OF STROKE REHABILITATION
Disclosure of Financial Relationships Gary M. Abrams M.D. THE FUTURE OF STROKE REHABILITATION Gary M. Abrams M.D. Professor of Clinical Neurology Director of Neurorehabilitation UCSF Has disclosed the
More informationSUMMARY This PhD thesis addresses the long term recovery of hemiplegic gait in severely affected stroke patients. It first reviews current rehabilitation research developments in functional recovery after
More informationSTROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014
STROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014 Rehabilitation Innovations in Post- Stroke Recovery Madhav Bhat, MD Fort Wayne Neurological Center DISCLOSURE Paid speaker for TEVA Neuroscience Program.
More informationFaculty/Presenter Disclosure
The Long-Term Rehabilitation Management of Stroke Patients Robert Teasell MD FRCPC Professor, Dept PM&R Schulich School of Medicine University of Western Ontario CFPC CoI Templates: Slide 1 Faculty/Presenter
More informationPotential for new technologies in clinical practice
Potential for new technologies in clinical practice International Neurorehabilitation Symposium University of Zurich Feb 12-13th 2009 Prof Jane Burridge Jane Burridge Feb 2009 Introduction Societal drivers
More informationGRASP. Graded Repetitive Arm Supplementary Program: A home-work based program to improve arm and hand function in people living with stroke
GRASP Graded Repetitive Arm Supplementary Program: A home-work based program to improve arm and hand function in people living with stroke GUIDELINES & MANUAL October 2012 The GRASP Program was developed
More informationClinical Neuropsychology. Recovery & Rehabilitation. Alan Sunderland School of Psychology
Clinical Neuropsychology. Recovery & Rehabilitation Alan Sunderland School of Psychology 1 The Changing Role of Clinical Neuropsychology HISTORY The Origins of Clinical Neuropsychology Emergence as a profession
More informationThe Future of Rehabilitation. Matt Wilks, PT Richmond Stroke Symposium 2011
The Future of Rehabilitation Matt Wilks, PT Richmond Stroke Symposium 2011 Disclosure Information Matt Wilks, PT, Director of Therapy Innovative Practices in Stroke Rehabilitation Financial Disclosure:
More informationFunctional recovery differs between ischemic and hemorrhagic stroke patients
6 Functional recovery differs between ischemic and hemorrhagic stroke patients Vera Schepers, Marjolijn Ketelaar, Anne Visser-Meily, Vincent de Groot, Jos Twisk, Eline Lindeman Submitted Chapter 6 Abstract
More informationNew Technologies and Their Role in Enhancing Neurological Recovery
REHABILITATION CARE 2014: under the ACA Patient Centered Medical Home for Persons with Disability: Acute Neurology, Medicine, Surgery services seamlessly blending into Acute inpatient Rehabilitation Ambulatory
More informationBrad Steinle, M.D. Medical Director, Rehabilitation Services Saint Luke s Hospital of Kansas City Medical Director, Adult Rehabilitation Services,
Brad Steinle, M.D. Medical Director, Rehabilitation Services Saint Luke s Hospital of Kansas City Medical Director, Adult Rehabilitation Services, Rehabilitation Institute of Kansas City Presenter Disclosure
More informationHow many RCTs in Stroke Rehab?
Evidence Based Stroke Rehabilitation: Maximizing Recovery and Improving Outcomes Robert Teasell MD FRCPC Professor and Chair Chief Physical Medicine & Rehabilitation St. Joseph s Health Care London University
More informationNeuro-rehabilitation in Stroke. Amit Kumar Neuro-Occupational Therapist
Neuro-rehabilitation in Stroke Amit Kumar Neuro-Occupational Therapist Neuro-rehabilitation A process whereby patients who suffer from impairment following neurologic diseases regain their former abilities
More informationThe Key Elements of Stroke Rehabilitation: Mark Bayley MD FRCPC
The Key Elements of Stroke Rehabilitation: Mark Bayley MD FRCPC 1 Presenter Disclosure Information Presenter: Mark Bayley Associate Professor, University of Toronto and Medical Director, Neuro Rehabilitation,
More informationPRELIMINARY STUDY OF THE EFFECT OF LOW-INTENSITY HOME-BASED PHYSICAL THERAPY
PRELIMINARY STUDY OF THE EFFECT OF LOW-INTENSITY HOME-BASED PHYSICAL THERAPY IN CHRONIC STROKE PATIENTS Jau-Hong Lin, Ching-Lin Hsieh, 1 Sing Kai Lo, 2 Huei-Ming Chai, 3 and Long-Ren Liao 4 Faculty of
More informationStroke Rehabilitation - Evidence Based Practice
Stroke Rehabilitation - Evidence Based Practice Section 1 1) What percent of stroke patients are left with moderate functional impairment? a) 25% b) 40% c) 55% d) 70% 2) Which is not a component of the
More informationInternational Neurorehabilitation Symposium 2009 Rehabilitation of the Upper Limbs: First Experiences with Armor and Amadeo
International Neurorehabilitation Symposium 2009 Rehabilitation of the Upper Limbs: First Experiences with Armor and Amadeo Leopold Saltuari Hospital Hochzirl, Austria Zurich, 12 14 February 2009 Different
More informationNeuropharmacologic Agents for Treatment of Cognitive Impairment After Brain Injury
Neuropharmacologic Agents for Treatment of Cognitive Impairment After Brain Injury Disclosures Most, it not all, of the medications discussed have not been tested in pediatric populations. Most, if not
More informationMotor learning: its relevance to stroke recovery and neurorehabilitation John W. Krakauer
Motor learning: its relevance to stroke recovery and neurorehabilitation John W. Krakauer Purpose of review Much of neurorehabilitation rests on the assumption that patients can improve with practice.
More informationREHABILITATION MEDICINE by PROFESSOR ANTHONY WARD
REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD What is Rehabilitation Medicine? Rehabilitation Medicine (RM) is the medical specialty with rehabilitation as its primary strategy. It provides services
More informationNICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
Rehabilitation for movement difficulties after stroke bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online.
More informationBrief, Evidence Based Review of Inpatient/Residential rehabilitation for adults with moderate to severe TBI
Brief, Evidence Based Review of Inpatient/Residential rehabilitation for adults with moderate to severe TBI Reviewer Peter Larking Date Report Completed 7 October 2011 Important Note: This brief report
More informationihome: ipad application for stoke rehab at home
University of Toronto From the SelectedWorks of Gustavo Saposnik July, 2014 ihome: ipad application for stoke rehab at home Gustavo Saposnik Available at: http://works.bepress.com/gustavo_saposnik/57/
More informationLITTLE THERAPY, LITTLE PHYSICAL ACTIVITY: REHABILITATION WITHIN THE FIRST 14 DAYS OF ORGANIZED STROKE UNIT CARE
J Rehabil Med 2007; 39: 43 48 ORIGINAL REPORT LITTLE THERAPY, LITTLE PHYSICAL ACTIVITY: REHABILITATION WITHIN THE FIRST 14 DAYS OF ORGANIZED STROKE UNIT CARE Julie Bernhardt, PhD 1,2,3, James Chan, BSc,
More informationINTERNATIONAL CONFERENCE OF OCCUPATIONAL THERAPY 2012
INTERNATIONAL CONFERENCE OF OCCUPATIONAL THERAPY 2012 To study the effectiveness of repetitive task oriented training as Occupational Therapy intervention in upper limb weakness in adult stroke: Systematic
More informationRehabilitation Robotics What Lies Ahead?
Rehabilitation Robotics What Lies Ahead? W Zev Rymer Rehabilitation Institute of Chicago 3/3/09 International Neurorehabilitation Symposium 2009 1 Outline focus on stroke recovery Robot-assisted therapy
More informationJava Therapy: Web-Based Robotic Rehabilitation
Java Therapy: Web-Based Robotic Rehabilitation David J. Reinkensmeyer, Clifton T. Pang, Jeff A. Nessler, Chris C. Painter Department of Mechanical and Aerospace Engineering Center For Biomedical Engineering
More informationNEUROLOGICAL REHABILITATION A Briefing Paper for Commissioners of Clinical Neurosciences
NEUROLOGICAL REHABILITATION A Briefing Paper for Commissioners of Clinical Neurosciences British Society of Rehabilitation Medicine C/o Royal College of Physicians, 11 St Andrews Place, London NW1 4LE
More informationProgress in Motor Control X., Budapest, Hungary, July 22-25. Symposium 1: Neurophysiological Mechanisms of Motor Control
Progress in Motor Control X., Budapest, Hungary, July 22-25 Preliminary Program Wednesday, July 22 Welcome reception, 7 pm Thursday, July 23 morning Symposium 1: Neurophysiological Mechanisms of Motor
More informationAT&T Global Network Client for Windows Product Support Matrix January 29, 2015
AT&T Global Network Client for Windows Product Support Matrix January 29, 2015 Product Support Matrix Following is the Product Support Matrix for the AT&T Global Network Client. See the AT&T Global Network
More informationClinical Guidelines for Stroke Management
Stop stroke. Save lives. End suffering. Clinical Guidelines for Stroke Management quick guide for physiotherapy This summary is an implementation tool designed to raise the awareness of the recommendations
More informationRobot-Assisted Stroke Rehabilitation
American Heart Association International Stroke Conference, 2012, New Orleans Robot-Assisted Stroke Rehabilitation Albert Lo, M.D., PhD Departments of Neurology and Epidemiology Associate Director, Center
More informationOriginal Article. Annals of Rehabilitation Medicine INTRODUCTION
Original Article Ann Rehabil Med 2012; 36: 16-21 pissn: 2234-0645 eissn: 2234-0653 http://dx.doi.org/10.5535/arm.2012.36.1.16 Annals of Rehabilitation Medicine The Effect of Prolonged Inpatient Rehabilitation
More informationMEDICAL POLICY SUBJECT: COGNITIVE REHABILITATION. POLICY NUMBER: 8.01.19 CATEGORY: Therapy/Rehabilitation
MEDICAL POLICY SUBJECT: COGNITIVE REHABILITATION PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationRehabilitation and the role of carers
Rehabilitation and the role of carers Dr Jacinta Morgan Consultant in Rehabilitation Medicine National Clinical Lead, Rehabilitation Medicine Programme (HSE CSPD) EMSP Spring Conference Gibson Hotel Dublin,
More information2014 Neurologic Physical Therapy Professional Education Consortium Webinar Course Descriptions and Objectives
Descriptions and Neuroplasticity Health care providers are facing greater time restrictions to render services to the individual with neurological dysfunction. However, the scientific community has recognized
More informationExercise and FES cycle fact sheet
Exercise and FES cycle fact sheet FES = Functional Electrical Stimulation. An electrical current is passed through paralysed muscle causing it to contract. The electrical current uses the peripheral nerves
More informationKimberly Anderson-Erisman, PhD Director of Education University of Miami & Miami Project to Cure Paralysis
Webinar title: What is the Vibe? Vibration Therapy as a Rehabilitation Tool Presenter/presenters: Kimberly Anderson-Erisman, PhD Director of Education University of Miami & Miami Project to Cure Paralysis
More informationTORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Recommendations Guide (updated January 23, 2014)
TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Guide (updated January 23, 2014) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals:
More informationMental Practice as a Gateway to Modified Constraint-Induced Movement Therapy: A Promising Combination to Improve Function
Mental Practice as a Gateway to Modified Constraint-Induced Movement Therapy: A Promising Combination to Improve Function Stephen J. Page, Peter Levine, Valerie Hill KEY WORDS function mental priming modified
More informationCOMPARISON OF FIXED & VARIABLE RATES (25 YEARS) CHARTERED BANK ADMINISTERED INTEREST RATES - PRIME BUSINESS*
COMPARISON OF FIXED & VARIABLE RATES (25 YEARS) 2 Fixed Rates Variable Rates FIXED RATES OF THE PAST 25 YEARS AVERAGE RESIDENTIAL MORTGAGE LENDING RATE - 5 YEAR* (Per cent) Year Jan Feb Mar Apr May Jun
More informationCOMPARISON OF FIXED & VARIABLE RATES (25 YEARS) CHARTERED BANK ADMINISTERED INTEREST RATES - PRIME BUSINESS*
COMPARISON OF FIXED & VARIABLE RATES (25 YEARS) 2 Fixed Rates Variable Rates FIXED RATES OF THE PAST 25 YEARS AVERAGE RESIDENTIAL MORTGAGE LENDING RATE - 5 YEAR* (Per cent) Year Jan Feb Mar Apr May Jun
More informationIntegrated Neuropsychological Assessment
Integrated Neuropsychological Assessment Dr. Diana Velikonja C.Psych Neuropsychology, Hamilton Health Sciences, ABI Program Assistant Professor, Psychiatry and Behavioural Neurosciences Faculty of Health
More informationUniversity Rehabilitation Institute Republic of Slovenia. Helena Burger, Metka Teržan University Rehabilitation Institute, Ljubljana, Slovenia
University Rehabilitation Institute Republic of Slovenia Helena Burger, Metka Teržan University Rehabilitation Institute, Ljubljana, Slovenia 2 3 Introduction * Primary level PT only * Secondary level:
More informationmytherappy.co.uk Using Apps to support rehabilitation and recovery Ruth Siewruk Neuro Occupational Therapist Louise Holmes Neuro Physiotherapist
mytherappy.co.uk Using Apps to support rehabilitation Ruth Siewruk Neuro Occupational Therapist Louise Holmes Neuro Physiotherapist Nicola Mathers Speech & language therapist and recovery Today s session
More information20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow
20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow Julie Bernhardt Assoc Prof, Director AVERT Very Early Rehabilitation Program, National Stroke Research Institute and School of Physiotherapy,
More informationWebinar title: Know Your Options for Treating Severe Spasticity
Webinar title: Know Your Options for Treating Severe Spasticity Presented by: Dr. Gerald Bilsky, Physiatrist Medical Director of Outpatient Services and Associate Medical Director of Acquired Brain Injury
More informationPostgraduate Opportunities for 2013 Queensland Cerebral Palsy Research and Rehabilitation Centre School of Medicine, The University of Queensland
Postgraduate Opportunities for 2013 Queensland Cerebral Palsy Research and Rehabilitation Centre School of Medicine, The University of Queensland Website: www.som.uq.edu.au/cerebralpalsy Our Research Team
More informationPost-Acute Rehab: Community Re-Entry After Stroke? Sheldon Herring, Ph.D. Roger C. Peace Rehab Hospital Greenville Hospital System
Post-Acute Rehab: Community Re-Entry After Stroke? Sheldon Herring, Ph.D. Roger C. Peace Rehab Hospital Greenville Hospital System 2014 Neurocognitive Deficits After Stroke: The Hidden Disability Sheldon
More informationApplication of a device for arm support in stroke rehabilitation: preparation of implementation in 7 Dutch rehabilitation centers
Application of a device for arm support in stroke rehabilitation: preparation of implementation in 7 Dutch rehabilitation centers GB Prange, PhD; AIR Kottink, PhD; A Snoek, MSc; AHA Stienen, PhD; JH Buurke,
More informationMotor rehabilitation and brain plasticity after hemiparetic stroke
Progress in Neurobiology 73 (2004) 61 72 Motor rehabilitation and brain plasticity after hemiparetic stroke Judith D. Schaechter MGH/MIT/HMS, Athinoula A. Martinos Center for Biomedical Imaging, 13th Street,
More informationNeurological Principles and Rehabilitation of Action Disorders: Rehabilitation Interventions
Neurological Principles and Rehabilitation of Action Disorders: Rehabilitation Interventions Neurorehabilitation and Neural Repair Supplement to 25(5) 33$--435 TheAuthor(s) 2011 Reprints and permission:
More informationPROFESSIONAL EXPERIENCE
CURRICULUM VITAE Catherine F. H. Siengsukon Office Phone: 913-588-6913 Mail Stop 2002 Lab Phone: 913-588-0601 3901 Rainbow Blvd Fax: 913-588-4568 Kansas City, KS 66160 Email: csiengsukon@kumc.edu Physical
More informationHands-on therapy interventions for upper limb motor dysfunction following stroke (Review)
Hands-on therapy interventions for upper limb motor dysfunction following stroke (Review) Winter J, Hunter S, Sim J, Crome P This is a reprint of a Cochrane review, prepared and maintained by The Cochrane
More informationMild head injury: How mild is it?
Mild head injury: How mild is it? Carly Dutton; Gemma Foster & Stephen Spoors Sunderland and Gateshead Community Acquired Brain Injury Service (CABIS), Northumberland, Tyne and Wear NHS Foundation Trust
More informationTORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013)
Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team
More informationStroke Rehabilitation Triage Severe Strokes
The London Stroke Rehab Data Base Project Robert Teasell MD FRCPC Professor and Chair-Chief Department of Phys Med Rehab London Ontario Retrospective Data Bases In stroke rehab limited funding for clinical
More informationDepression in patients with coronary heart disease (CHD): screening, referral and treatment. 2014 Na)onal Heart Founda)on of Australia
Depression in patients with coronary heart disease (CHD): screening, referral and treatment Screening, referral and treatment for depression in patients with CHD A consensus statement from the National
More informationNeurological Rehabilitation in Practice
Neurological Rehabilitation in Practice Christopher Ward Professor & Consultant in Rehabilitation Medicine University of Nottingham School of Community Health Sciences Derby Hospitals Foundation Trust
More informationNational Hospital for Neurology and Neurosurgery. Managing Spasticity. Spasticity Service
National Hospital for Neurology and Neurosurgery Managing Spasticity Spasticity Service If you would like this document in another language or format, or require the services of an interpreter please contact
More informationGrasping, holding, and manipulating objects are
Research Articles Functional Electrical Stimulation Enhancement of Upper Extremity Functional Recovery During Stroke Rehabilitation: A Pilot Study Gad Alon, PhD, PT, Alan F. Levitt, MD, and Patricia A.
More informationMaximising Ability, Reducing Disability. Dr. Áine Carroll Clinical Lead Valerie Twomey Programme Manager
Rehabilitation Medicine Programme Maximising Ability, Reducing Disability Dr. Áine Carroll Clinical Lead Valerie Twomey Programme Manager 1 Quality, Access and Cost Quality: Reduce morbidity: Reduced pressure
More informationby Argyrios Stampas, MD, Carolin Dohle, MD, and Elizabeth Dominick, PT, DPT, NCS
by Argyrios Stampas, MD, Carolin Dohle, MD, and Elizabeth Dominick, PT, DPT, NCS Therapist Jennifer Metz (right) helps a patient use a body-weight support treadmill system. Up and Moving Blending dedication
More informationPre-budget Submission 2016. Joint Committee on Finance, Public Expenditure and Reform
Pre-budget Submission 2016 Joint Committee on Finance, Public Expenditure and Reform July 2015 SUMMARY POINTS Acquired Brain Injury Ireland (ABI Ireland) is asking the Government to support people living
More informationVirtual Environments
Re-Learning Motor Control Using Virtual Environments Maureen K. Holden, PhD, PT Northeastern University, Boston, MA, USA International Neurorehabilitation Symposium 2009 University of Zurich, Switzerland
More informationSplinting in Neurology. Jo Tuckey MSc MCSP
Splinting in Neurology Jo Tuckey MSc MCSP Splinting in Neurology When should splinting be considered? How to choose the most appropriate splint or position for splinting. Practicalities of providing a
More informationRehabilitation Services within Essex Cancer Network for people with Brain & CNS tumours
Rehabilitation Services within Essex Cancer Network for people with Brain & CNS tumours The NICE IOG for people with Brain & other CNS tumours (2006) states that patients with such tumours should have
More informationOrganization of Rehabilitation and Post-Acute Care
Organization of Rehabilitation and Post-Acute Care Inaugural Meeting of NECC Boston, MA - September 13, 2006 Janet Prvu Bettger, ScD University of Pennsylvania Department of Physical Medicine and Rehabilitation
More informationAn Evidence Based Occupational Therapy Toolkit for Assessment and Treatment of the Upper Extremity Post Stroke
An Evidence Based Occupational Therapy Toolkit for Assessment and Treatment of the Upper Extremity Post Stroke Brenda Semenko, Leyda Thalman, Emily Ewert, Renee Delorme, Suzanne Hui, Heather Flett, Nicole
More informationDivision of Biomedical Engineering, Chonbuk National University, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do 561-756, Republic of Korea 3
Upper Extremity Rehabilitation Program Using Inertial Sensors and Virtual Reality for Patients with Upper Extremity Hemiplegia due to Disorders after Stroke Je-Nam Kim 1, Mun-Ho Ryu 2,3, Yoon-Seok Yang
More informationPage 1 of 5 Schaefer, Sydney Y.
Sydney Y. Schaefer, PhD Dept. of Health, Physical Education and Recreation Utah State Phone: 435-797-8441 7000 Old Main Hill Fax: 435-797-3759 Logan, UT 84322-7000 Email: sydney.schaefer@usu.edu PROFESSIONAL
More informationImplementing Evidence Based Community Stroke Services
Implementing Evidence Based Community Stroke Services Dr Rebecca Fisher & Professor Marion Walker University of Nottingham () Damian Jenkinson & Ian Golton (NHS Stroke Improvement Programme) A partnership
More informationSurvivors need to be reminded to use affected limbs and impaired functions.
Progress in Recovery Stroke is overwhelming. At one moment, we are fully functional, and in the next, abilities are taken away and we feel shock, loss, fear, grief, and helpless to forces beyond our control.
More informationTreatment of Dysarthria in Patients with Multiple Sclerosis. Barbara Bryant Jane Vyce
Treatment of Dysarthria in Patients with Multiple Sclerosis Barbara Bryant Jane Vyce What is MS? An autoimmune disease Destruction of myelin Destruction of axons What is MS? Etiology/Pathophysiology Cause
More informationA STAR is born. Collaborative Strategy that works!
A STAR is born Collaborative Strategy that works! Objective Demonstrate the importance of developing and nurturing partnerships in achieving quality outcomes, providing the right care at the right place
More informationMEDICAL POLICY SUBJECT: OCCUPATIONAL THERAPY (OT) POLICY NUMBER: 8.01.17 CATEGORY: Therapy/Rehabilitation
MEDICAL POLICY SUBJECT: OCCUPATIONAL THERAPY (OT) PAGE: 1 OF: 7 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationCognitive rehabilitation in MS
14th MS Nurse International Workshop Lyon, France, October 9th 2012 Cognitive and psychological issues in MS Cognitive rehabilitation in MS Psychological Unit Neurological Department San Raffaele Hospital
More informationHandicap after acute whiplash injury A 1-year prospective study of risk factors
1 Handicap after acute whiplash injury A 1-year prospective study of risk factors Neurology 2001;56:1637-1643 (June 26, 2001) Helge Kasch, MD, PhD; Flemming W Bach, MD, PhD; Troels S Jensen, MD, PhD From
More information12 Steps to Changing Neuropathways. Julie Denton
12 Steps to Changing Neuropathways Julie Denton Review the neurobiology of the brain Understand the basics of neurological damage to the brain from addiction Understand how medications and psychotherapy
More informationRehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center
Rehabilitation Where You Recover Inpatient Rehabilitation Services at Albany Medical Center You're Here and So Are We As the region s only academic medical center, Albany Medical Center offers a number
More informationName of Policy: Medical Criteria for Physical/Occupational Therapy and Osteopathic/Chiropractic Manipulative Treatment
Name of Policy: Medical Criteria for Physical/Occupational Therapy and Osteopathic/Chiropractic Manipulative Treatment Policy #: 132 Latest Review Date: January 2015 Category: Administrative Policy Grade:
More informationNeurorehabilitation Strategy Briefing Document and Position Paper
Neurorehabilitation Strategy Briefing Document and Position Paper Background What is neurorehabilitation? The World Health Organisation defines neurorehabilitation as: A problem-solving process in which
More informationCase 2:08-cv-02463-ABC-E Document 1-4 Filed 04/15/2008 Page 1 of 138. Exhibit 8
Case 2:08-cv-02463-ABC-E Document 1-4 Filed 04/15/2008 Page 1 of 138 Exhibit 8 Case 2:08-cv-02463-ABC-E Document 1-4 Filed 04/15/2008 Page 2 of 138 Domain Name: CELLULARVERISON.COM Updated Date: 12-dec-2007
More informationNeurobiology of Depression in Relation to ECT. PJ Cowen Department of Psychiatry, University of Oxford
Neurobiology of Depression in Relation to ECT PJ Cowen Department of Psychiatry, University of Oxford Causes of Depression Genetic Childhood experience Life Events (particularly losses) Life Difficulties
More informationExercise therapy in the management of upper limb dysfunction in people with Rheumatoid Arthritis. Speaker declaration: no conflicts of interest
Exercise therapy in the management of upper limb dysfunction in people with Rheumatoid Arthritis Speaker declaration: no conflicts of interest Exercise a planned, structured and repetitive bodily movement
More informationNeuro-developmental Treatment of Adults with Hemiplegia. Kathryn R. Shaab, PT, DPT Sheltering Arms Hospital May 2008
Neuro-developmental Treatment of Adults with Hemiplegia Kathryn R. Shaab, PT, DPT Sheltering Arms Hospital May 2008 History of NDT Developed by Berta Bobath Physiotherapist Gymnast Assisted by her husband,
More informationSujata D. Pradhan, P.T., Ph.D.
CURRICULUM VITAE Sujata D. Pradhan, P.T., Ph.D. Revised Feb 2015 PERSONAL DATA Office Address: University of Washington School of Medicine Department of Rehabilitation Medicine 1959 NE Pacific Street,
More informationM ultiple sclerosis (MS) is the most common cause of
1225 PAPER A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment J Craig, C A Young, M Ennis, G Baker, M
More informationObjectives. Workshop Organization. Reality Check: Trends in Ontario. Ontario Stroke Rehab 2005/2006
Objectives Rehabilitation of Severe Strokes: Making the Tough Decisions Robert Teasell MD FRCPC Professor and Chair Chief Depart of Phys Med Rehab Parkwood Hospital Understand the impact of stroke severity
More informationEffect of intensity on rehabilitation outcomes: What s the evidence? (Version with most patient pictures removed)
Effect of intensity on rehabilitation outcomes: What s the evidence? (Version with most patient pictures removed) Janice Eng, PhD, BSc(PT/OT) Dept of Physical Therapy University of BC GF Strong Rehab Centre
More informationRELAPSE MANAGEMENT. Pauline Shaw MS Nurse Specialist 25 th June 2010
RELAPSE MANAGEMENT Pauline Shaw MS Nurse Specialist 25 th June 2010 AIMS OF SESSION Relapsing/Remitting MS Definition of relapse/relapse rate Relapse Management NICE Guidelines Regional Clinical Guidelines
More informationENHANCEMENT OF ACUTE SERVICE IN KCC ON CLINICAL PATHWAY FOR GERIATRIC HIP FRACTURE. Elaine Wong WY Queen Elizabeth Hospital 7 May 2012
ENHANCEMENT OF ACUTE SERVICE IN KCC ON CLINICAL PATHWAY FOR GERIATRIC HIP FRACTURE Elaine Wong WY Queen Elizabeth Hospital 7 May 2012 BACKGROUND In KCC, there are around 800 cases admitted for geriatric
More informationTraumatic Brain Injury for VR Counselors Margaret A. Struchen, Ph.D. and Laura M. Ritter, Ph.D., M.P.H.
Training Session 1c: Understanding Recovery Courses and Outcomes after TBI What is the typical recovery course after a mild or moderate/severe TBI? What are the effects of personal and environmental factors,
More informationJill Campbell Stewart, PT, PhD
, PT, PhD Program in Physical Therapy, Department of Exercise Science University of South Carolina, 921 Assembly Street, Room 301D, Columbia, SC, 29208 Phone: 803-777-6583 Fax: 803-777-0558 Email: jcstewar@mailbox.sc.edu
More informationMultiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON
Multiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON First-line DMTs Reduce Relapse Frequency by ~30% vs. Placebo Frequency of relapse with various DMTs, based
More information